FOR INDIVIDUALS

Medicare

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INTRODUCTION

Medicare is a federal health insurance program primarily for individuals aged 65 and older, but also for some younger people with disabilities. Understanding the different parts of Medicare and the enrollment process is crucial to ensuring you receive the coverage you need. We can assist you in understanding the options and recommending solutions to fill in the gaps not covered.

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Different Parts of Medicare

Medicare Part A: Hospital Insurance

Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Most people do not pay a premium for Part A if they have paid Medicare taxes for a certain amount of time.


Medicare Part B: Medical Insurance

Medicare Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. Part B comes with a monthly premium that varies based on income.


Medicare Part C: Medicare Advantage

Medicare Advantage Plans, also known as Part C, are offered by private companies approved by Medicare. These plans include all benefits and services covered under Part A and Part B, and often include Part D (prescription drug coverage) as well as additional benefits like vision, hearing, and dental.


Medicare Part D: Prescription Drug Coverage

Medicare Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. Part D is offered through private insurance companies approved by Medicare.

Enrollment Timing

IEP

Initial Enrollment Period

The Initial Enrollment Period is a 7-month period that begins three months before you turn 65, includes the month you turn 65, and ends three months after you turn 65. This is the best time to enroll in Medicare to avoid late enrollment penalties.

GEP

General Enrollment Period

If you miss your IEP, you can enroll during the General Enrollment Period from January 1 to March 31 each year. Coverage will begin on July 1 of the same year. Late enrollment penalties may apply.

SEP

Special Enrollment Period

You may qualify for a Special Enrollment Period if you or your spouse are still working and have health coverage through an employer or union. SEPs allow you to enroll in Medicare outside of the usual periods without penalty.

AEP

Annual Enrollment Period (AEP)

From October 15 to December 7 each year, you can make changes to your Medicare Advantage or Medicare Part D plan. Any changes made during this period will take effect on January 1 of the following year.

Common Questions

  • What is the difference between Original Medicare and Medicare Advantage?

    Original Medicare includes Part A and Part B and is managed by the federal government. Medicare Advantage (Part C) is offered by private insurance companies and includes all benefits under Part A and Part B, often with additional benefits and Part D coverage.

  • How do I know if I'm eligible for Medicare?

    You are eligible for Medicare if you are 65 or older, or under 65 with certain disabilities or end-stage renal disease (ESRD). Most people become eligible for premium-free Part A through their work history or their spouse’s work history.

  • Can I have both Medicare and employer coverage?

    Yes, if you are still working and have health coverage through your employer, you can have both Medicare and employer coverage. Coordination of benefits rules determine which pays first.

  • What happens if I miss my Initial Enrollment Period?

    If you miss your Initial Enrollment Period, you can enroll during the General Enrollment Period, but you may have to pay a late enrollment penalty. You may also qualify for a Special Enrollment Period depending on your situation.

  • What are the costs associated with Medicare?

    Costs vary depending on the parts of Medicare you enroll in. Part A is typically premium-free for most people, while Part B has a standard monthly premium. Medicare Advantage and Part D plans have their own premiums, deductibles, and co-pays, which vary by plan.

  • Can I change my Medicare plan later?

    Yes, you can change your Medicare Advantage or Part D plan during the Annual Enrollment Period from October 15 to December 7 each year. Special Enrollment Periods may also be available for certain life events.