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Medicare Basics

What is Medicare?

Medicare is a federal health insurance program for those who are age 65 or older. Certain younger people with disabilities or End-Stage Renal Disease are also covered. Medicare provides hospital and medical coverage.


Eligibility

When are you eligible for Medicare?

To receive Medicare, you must meet specific criteria and enroll. For specific information and how to enroll, see the Official U.S. Government Site for Medicare. In general, you are eligible for Medicare if:

  • You are 65 years of age or older*
  • You or your spouse have worked for at least 10 years in Medicare-covered employment (employment that pays into the Medicare system)
  • You are a citizen or permanent resident of the United States
  • Certain younger people with disabilities or End-Stage Renal Disease may also be eligible.

Medicare Benefits

What does Medicare cover?

There are several different parts to Medicare coverage, with different benefits and costs. You need to decide what you need.

  • What is Medicare Part A?

    Medicare Part A covers hospitalization. Basically, it pays for inpatient care, and some home healthcare, skilled nursing home care and nursing home care. It also pays for hospice care. Most people do not have to pay premiums for Part A.
  • What is Medicare Part B?

    Part B covers medical services such as doctor’s visits and outpatient treatments, as well as medical services and supplies not covered under Part A. Most people pay premiums for Part B.
  • What is Medicare Part C?

    Part C is more commonly called Medicare Advantage. It is provided by private insurance companies and combines Parts A and B. Part D may be included. Because Medicare Advantage is offered by private companies, the costs and benefits may vary from plan to plan. At a minimum, you must continue to pay your Part B premiums. There may be other costs. There also may be other benefits.
  • What is Medicare Part D?

    Part D covers prescription drug costs and is available to individuals who have Part A, B or C. Just like in a traditional insurance plan, the amount of coverage for each drug is determined by the type of drug and how it is classified on a Formulary. Most people pay premiums for Part D. If you don’t enroll in a Part D plan when you become eligible for Medicare Part A and B or if you drop your Part D coverage for more than 63 days, you may have to pay a late enrollment penalty if you decide to enroll in Part D at a later time.

Need help paying for Medicare?

Medicare is administered by the Centers for Medicare and Medicaid Services. Assistance may be available to low-income individuals to help with the costs of Medicare through Extra Help, also called Low-Income Subsidy (LIS).If you are eligible, this lowers your plan premium and drug copays, as well as eliminates the coverage gap (the donut hole). You must be on a plan that includes prescription drug coverage to qualify. Note: Levels are reviewed annually by the Social Security Administration and may change each year.

Sign Up for Medicare

When can I enroll in Medicare?

Medicare Initial Enrollment Period

You are first able to enroll for Medicare Part A and/or Part B during the Initial Enrollment Period. The Initial Enrollment Period is the seven month period that begins three months before your 65th birthday, the month of your 65th birthday, and the three months after your 65th birthday. You should sign up for Medicare even if you don’t plan to retire. If you already collect Social Security benefits, you will be automatically enrolled for Medicare Part A. If you’re not already collecting Social Security benefits before your Initial Enrollment Period starts, you’ll need to sign up for Medicare online or contact Social Security.

To avoid gaps in coverage or a late enrollment penalty, enrollment in Part A and Part B should take place BEFORE your 65th birthday. In most cases, if you don’t sign up for Part B when you’re first eligible, you may have a delay in getting Medicare coverage in the future (in some cases over a year), and you may have to pay a late enrollment penalty for as long as you have Part B.

Medicare Special Enrollment Period

Once your Initial Enrollment Period ends, you may have the chance to sign up for Medicare during a Special Enrollment Period (SEP). You can sign up for Part A and or Part B during an SEP if you have special circumstances.

Medicare General Enrollment Period

If you miss your Initial Enrollment Period, you can sign up during Medicare’s General Enrollment Period (January 1–March 31), and your coverage will start July 1.

When is Medicare Annual Enrollment Period (AEP)?

Medicare's Annual Enrollment Period, which is often confused with Medicare Advantage Open Enrollment (MA OEP), occurs every year October 15 through December 7. Changes made during this time are effective January 1.

The options for Medicare Annual Enrollment allow you to make one of the following changes:

  • If you’re in Original Medicare (Part A and/or Part B), you can switch to a Medicare Advantage plan (Part C).
  • You can switch from a Medicare Advantage (Part C) plan with drug coverage (Part D) to one without drug coverage.
  • You can join or drop a Medicare prescription drug plan (Part D).
  • You can choose a new plan from your current insurer or choose a new insurer.

When is Medicare Advantage Open Enrollment Period (MA OEP)?

The Medicare Advantage Open Enrollment Period is from January 1 through March 31 each year. It allows individuals enrolled in a Medicare Advantage plan to make a one-time election to go to either another Medicare Advantage plan or Original Medicare. Coverage under your new plan will start on the first day of the month following the month you make a change

 

 

Last Updated: 10/01/2020