What Is Medicare?
Medicare is the federal health insurance program for people age 65 or older. Some people who are between the ages of 18 and 65 with certain disabilities that prevent them from working can also get Medicare. People who work past age 65 and are covered by their employer’s medical plan usually hold off on enrolling in Medicare until after their employment ends.
How Benefit Writers Can Help...
Whether you’re new to Medicare, getting ready to turn 65, or preparing to retire, you’ll need to make several important decisions about your health coverage. If you wait to enroll, you may have to pay a penalty, and you may have a gap in coverage. Use these steps to gather information so you can make informed decisions about your Medicare:
Step 1: Learn about the different parts
The different parts of Medicare help cover specific services. Medicare Part A (Hospital Insurance) covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Medicare Part B (Medical Insurance) covers certain doctors' services, outpatient care, medical supplies, and preventive services.
Step 2: What Are The Ages I Can Qualify
There are only certain times when people can enroll in Medicare. Depending on the situation, some people may get Medicare automatically, and others need to apply for Medicare. The first time you can enroll is called your Initial Enrollment Period. Your 7-month Initial Enrollment Period usually:
- Begins 3 months before the month you turn 65
- Includes the month you turn 65
- Ends 3 months after the month you turn 65
Get an estimate of when you can enroll.
If you don’t enroll when you’re first eligible, you may have to pay a Part B late enrollment penalty, and you may have a gap in coverage if you decide you want Part B later.
Step 3: Decide if you want Part A & Part B
Most people should enroll in Part A when they turn 65, even if they have health insurance from an employer. This is because most people paid Medicare taxes while they worked so they don't pay a monthly premium for Part A. Certain people may choose to delay Part B. In most cases, it depends on the type of health coverage you may have. Everyone pays a monthly premium for Part B. The premium varies depending on your income and when you enroll in Part B. Most people will pay the standard premium amount of $134 in 2018.
Learn more about whether you should take Part A and Part B.
Step 4: Choose your coverage
If you decide you want Part A and Part B, there are 2 main ways to get your Medicare coverage — Original Medicare or a Medicare Advantage Plan (like an HMO or PPO). Some people get additional coverage, like Medicare prescription drug coverage or Medicare Supplement Insurance (Medigap). Most people who are still working and have employer coverage don’t need additional coverage. Learn about these coverage choices.
Step 5: Sign up (unless you’ll get it automatically)
Some people automatically get Part A and Part B. Find out if you’ll get Part A and B automatically. If you're automatically enrolled, you'll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday or your 25th month of disability. If you don't get Medicare automatically, you’ll need to apply for Medicare online.
Step 6: Learn about 5 tasks for your first year.
Medicare is the federal health insurance program for:
- People who are 65 or older
- Certain younger people with disabilities
- People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)
The different parts of Medicare help cover specific services:
Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Medicare Part B (Medical Insurance)
Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.
Medicare Part C (Medicare Advantage Plans)
A type of Medicare health plan offered by a private company that contracts with Medicare. Medicare Advantage Plans provide all of your Part A and Part B benefits. Medicare Advantage Plans include:
- Health Maintenance Organizations
- Preferred Provider Organizations
- Private Fee-for-Service Plans
- Special Needs Plans
- Medicare Medical Savings Account Plans
If you’re enrolled in a Medicare Advantage Plan:
- Most services are covered through the plan
- Medicare services aren’t paid for by Original Medicare
Most Medicare Advantage Plans offer prescription drug coverage.
Medicare Part D (prescription drug coverage)
Part D adds prescription drug coverage to:
- Original Medicare
- Some Medicare Cost Plans
- Some Medicare Private-Fee-for-Service Plans
- Medicare Medical Savings Account Plans
These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.
Not sure what kind of coverage you have?
- Check your red, white, and blue Medicare card.
- Check all other insurance cards that you use. Call the phone number on the cards to get more information about the coverage.
- Check your Medicare health or drug plan enrollment.
Choose from 2 ways to get prescription drug coverage. You can choose a Medicare Part D plan. Or, you can choose a Medicare Advantage Plan (like an HMO or PPO) that offers drug coverage.
Learn what Medicare drug plans cover, including information about a drug formulary and tiers.
Learn about the types of costs you’ll pay in a Medicare drug plan.
Find out when you can sign up for or change your coverage. This includes your Medicare Advantage Plan (Part C) or Medicare Prescription Drug Coverage (Part D).
How Part D works with other insurance
Learn about how Medicare Part D (prescription drug coverage) works with other coverage, like employer or union health coverage.
Find and compare drug plans, health plans, and Medicare Supplement Insurance (Medigap) policies.
Medigap & Medicare drug coverage (Part D)
Still Have Questions about Medicare? Let Diane Eller Help You Feel More Comfortable. Call Now... 214-771-3011
Note: For 2024, CMS has proposed to reinstate the 48-hour Scope of
Appointment (SOA) time frame, prohibiting personal marketing
appointments from taking place until 48 hours after a potential
enrollee completes an SOA. Under the new rule, SOAs will need to
be obtained at least 48 hours in advance and will remain valid for six
months from the beneficiary's signature date.
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