What is Medicare?
Medicare is a federal health insurance program primarily for individuals aged 65 and older, as well as certain younger individuals with disabilities. It’s essential to understand the different parts of Medicare, as each covers distinct services. Below, we explain the various components of Medicare to help you navigate your options.
What Are the Parts of Medicare?
Medicare consists of different “parts” that provide specific coverage. Most people are familiar with Medicare Part A and Medicare Part B, which are part of Original Medicare. Additionally, there are Medicare Part C and Medicare Part D, which offer alternative or additional coverage.
Medicare Part A is known as hospital insurance and helps cover the following:
- Inpatient Hospital Care: Coverage for semi-private rooms, meals, nursing services, and other hospital services during an inpatient stay.
- Skilled Nursing Facility Care: Covers skilled nursing and rehabilitation services after a hospital stay.
- Hospice Care: Includes medical and support services for individuals with terminal illnesses, along with emotional and spiritual support for their families.
- Home Health Care: Covers limited home health services for those who are homebound and require skilled nursing care or therapy.
Enrollment and Costs:
- Most people are automatically enrolled in Medicare Part A when they turn 65 if they are receiving Social Security benefits.
- Many do not pay a premium for Part A, but deductibles, coinsurance, and copayments may apply for specific services.
Medicare Part B covers outpatient medical services that help diagnose and treat medical conditions, including:
- Provider Services: Medically necessary doctor visits and procedures.
- Durable Medical Equipment: Medical equipment used at home, such as diabetic supplies.
- Home Health Services: Skilled nursing or therapy care for homebound individuals.
- Ambulance Services: Emergency transportation and limited non-emergency transport when no safe alternative exists.
- Preventive Services: Physical, speech, and occupational therapy.
- X-rays, Lab Tests, and Chiropractic Care: Diagnostic tests and chiropractic care for spine subluxation.
- Certain Prescription Drugs: Immunosuppressants, select anti-cancer medications, and other physician-administered drugs.
Medicare Advantage (Part C) offers an alternative to Original Medicare (Parts A and B). These plans are provided by private insurance companies approved by Medicare and include:
- All-in-One Coverage: Combines the benefits of Part A and Part B, with many plans also offering Part D (prescription drug coverage) and additional benefits like dental, vision, and hearing.
- Managed Care Models: Operates as an HMO, PPO, or other types of managed care plans. These plans often require the use of network providers.
- Cost Sharing: Includes premiums, deductibles, and copayments, which vary by plan. Some plans have $0 premiums.
- Extra Benefits: May offer fitness memberships, transportation services, and more.
Medicare Part D offers prescription drug coverage through private insurance plans. To learn more about Medicare Part D by clicking here
What is the Medicare Enrollment Period?
Your eligibility starts 3 months before your 65th birthday, the month of your birthday and 3 months after your birthday. If you miss this enrollment period and do not have any other “credible” coverage, you may have to pay a penalty and have a gap in your coverage.
Example
My birthday is June 15th.
My medicare coverage would be effective June 1st. March is the earliest I can contact social security to enroll in Medicare for June 1st. I can apply in March, or April or May for June 1st.
If I waited until June or July, I could still apply and depending on when they get the application, would be the effective date. I would have until September to apply and still be considered within my enrollment period, avoiding any penalties.
Client Testimonials
Frequently Asked Questions
Learn More About The Products
& Services We Provide:
Medicare Advantage Plans
Medicare Supplement Insurance
