Medicare 101

Individuals who are 65 or older are eligible for Medicare, as well as some younger individuals with disabilities or End-Stage Renal Disease.

Medicare is a federally-administered health insurance program. There are two parts to Original Medicare – Part A and Part B. Part A covers inpatient hospital care, skilled nursing facility, hospice and home health care. Part B covers doctor appointments, outpatient care, preventive services, occupational/physical therapies and home health care.

Medicare Part D is offered by private insurance carriers and provides coverage for prescription drug costs. It is available for purchase as a separate Stand Alone Plan for those with Original Medicare or can also be included as part of a Medicare Advantage Prescription Drug plan.

Medicare Advantage Plans, also known as “Part C”, are offered by private insurance companies approved by Medicare. These plans combine the coverage of Original Medicare and include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). They often also include prescription drug coverage (Part D) and extra benefits and services that are not covered by Original Medicare.

While Original Medicare pays for much of the cost for covered health care services and supplies, it does not cover everything. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, such as copayments, coinsurance, and deductibles. Medicare Supplement plans are offered by private insurance carriers.

There are several enrollment periods for Medicare plans.

1. Initial Enrollment Period – begins 3 months before your 65th birthday and ends 3 months after the month that you turn 65.
2. Annual Enrollment Period – begins October 15 and ends December 7 each year.
3. Open Enrollment Period – allows you to make changes to your Medicare Advantage plan from January 1 through March 31.
4. Special Enrollment Periods – are available under certain circumstances throughout the year, such as moving out of your existing plan’s service area or retiring from a job that previously provided your benefits.

In addition to medical and/or prescription coverage, the benefits/coverage offered by different plans varies. A knowledgable Licensed Insurance Consultant can help you determine which benefits are available where you live.