Medicare Basics
What is Medicare?
Medicare is a federal health insurance program that gives you access to specific coverage and benefits. Medicare is different from health insurance you may have had before. It offers you a variety of coverage options — and it has key enrollment dates and guidelines you need to follow. We’re here to help you make sense of it all.
How is Medicare Different From Other Health Insurance?
You may be surprised at the differences between Medicare and other types of health insurance. If you’ve had health coverage through your employer, your plan likely included medical and prescription drug coverage, along with other benefits. It also may have covered both you and your spouse.
Medicare only covers one person at a time. This means you and your spouse must enroll separately. In addition, Medicare gives you options that can make it possible to receive your benefits in a variety of different ways.
You can:
Choose hospital and medical coverage delivered through the federal government.
Add prescription drug coverage delivered through a private company.
Purchase a supplemental insurance policy from a private insurer that can help cover some of the costs.
Choose coverage from a private insurer that combines hospital, medical and often prescription drug coverage into one plan.
In short, with Medicare you can choose coverage that fits your needs, budget and lifestyle. We can help you take full advantage of that freedom.
Who is Eligible for Medicare?
Age 65 +
Under age 65 with certain disabilities
Have End-Stage Renal Disease (ESRD)
When and How Do I Enroll?
If you’re like most people, you’ll enroll in Medicare around the time you turn 65. Your Initial Enrollment Period begins three months before your 65th birthday, includes the month you turn 65 and ends three months after that birthday.
Keep in mind that if you don’t get Medicare during this Initial Enrollment Period, you may have to pay Medicare Part B or Part D late enrollment penalties. Plus, you could be missing out on coverage and benefits that can help protect your health and finances. That’s why it’s generally a good idea to enroll as soon you can. How you enroll generally depends on if you’re getting benefits from Social Security, the Railroad Retirement Board or the Office of Personnel Management.
If you're receiving benefits from any of these sources at least four months before you turn
- You'll automatically get Medicare Part A and Part
B starting the first day of the month you turn 65.
- If your birthday is on the first day of the month, Part A and Part B will start the first day of the prior month.
If you're not receiving benefits from any of these sources at least four months before you turn
You'll need to sign up with Social Security to get
Medicare Part A and Part B.
You can apply online at socialsecurity.gov, at your local Social Security office or by calling Social Security at 1-800-772-1213 (TTY: 1-800-325-0778).
If you worked for a railroad, call the RRB at 1-877-
772-5772.
If you're under 65 and have a qualifying disability, you'll automatically get Part A and Part B:
After you get disability benefits from Social Security for 24 months.
After you get certain disability benefits from the
RRB for 24 months.
The month your disability benefits begin it you have ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig's Disease).
If you have ESRD (End-Stage Renal Disease), you can choose to enroll in Part A and Part B:
You'll need both Part A and Part B to qualify for the full benefits that cover certain dialysis and kidney transplant services.
You can apply online at socialsecurity.gov, at your local Social Security office or by calling Social Security at 1-800-772-1213 (TTY: 1-800-325-
0778).
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What If I Continue to Work Past the Age of 65?
Turning 65 doesn’t always mean you have to sign up for Medicare right away — especially if you’re still working. If you or your spouse are actively employed by a company with 20 or more employees and you’re receiving health insurance through that employer, you can:
Stay with the employer health plan as your primary coverage and delay Medicare enrollment.
Enroll in Medicare Part A and use it as secondary coverage to help pay for things the employer health plan doesn’t cover. One thing to note - you can no longer contribute to a commercial HSA once enrolled in Medicare Part A.
Choose to delay enrolling in Medicare Part B until the employment ends or the coverage stops, without paying late enrollment penalties if you enroll later.
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Connect with a licensed insurance agent
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Parts of Medicare
What Are the Parts of Medicare?
Medicare has four different parts that provide coverage for specific services. Learning what each part covers can help you better understand your options and feel more confident about your decisions.
Medicare Part A (Hospital Coverage)
Together, Medicare Part A and Medicare Part B are known as Original Medicare. Medicare Part A is hospital insurance that provides coverage for:
Inpatient care
Skilled nursing facility care
Hospice care
Some home health care
Most people don’t pay a monthly premium for Medicare Part A. It’s coverage that’s earned from Medicare taxes that you or a spouse have paid while working. If you don’t qualify for premium-free Part A, you can also buy Part A coverage. Our licensed insurance agents can help guide you through that process.
Medicare Part B (Medical Coverage)
Together, Medicare Part A and Medicare Part B are known as Original Medicare. Medicare Part B is medical insurance for medically necessary services and preventive services. It provides coverage for:
Doctor's services
Outpatient care
Ambulance services
Clinical research
Durable medical equipment
Limited prescription drugs
Mental health
Early stage preventive services
Most people will pay a monthly premium for Medicare Part B. The standard amount is set each year and may increase based on your gross income as reported to the IRS.
If you receive benefits from Social Security, the Railroad Retirement Board or the Office of Personnel Management, your Part B premium is automatically deducted from Security benefit payment. Or you can choose to have your Part B premium deducted from your social security check. Otherwise, you will receive a bill.
You’re not required to enroll in Medicare Part B during your Initial Enrollment Period. However, in many cases delaying enrollment means you’ll have to pay a late enrollment penalty for as long as you have Part B coverage. We can help you decide if enrolling in Part B is right for you.
Medicare Part C (Medicare Advantage)
Medicare Part C, commonly known as Medicare Advantage, is coverage offered by private insurance companies that have a contract with the federal government. Medicare Advantage combines your Part A hospital, Part B medical and often Part D prescription drug coverage into one plan.
With Medicare Advantage, you must continue to pay your Medicare Part B premium. You may also have to pay a monthly premium to the insurance company that provides your coverage.
Medicare Part D (Prescription Drugs)
Offered by private insurance companies, Medicare Part D coverage helps you pay for your prescription drugs. There are two basic ways to get Part D prescription drug coverage:
Purchase a standalone Medicare Part D plan. You must have Parts A and/or B (Original Medicare) to join a Part D plan.
You'll need both Part A and Part B to qualify for the full benefits that cover certain dialysis and kidney transplant services.
Join a Medicare Advantage (Medicare Part C) plan that includes Part D prescription drug coverage
If you choose to join a Medicare Advantage plan that has prescription drug coverage, you won't pay an extra premium for Part D - those benefits are included in your plan.
All Part D plans — including Medicare Advantage plans with Part D benefits — cover a wide range of prescription drugs. However, coverage and cost vary from plan to plan:
Each plan has a formulary — a list of the specific prescription drugs the plan covers.
Many plan formularies also have tiers that place covered prescription drugs into different cost levels.
Prescription drugs in a lower tier will generally cost you less than those in a higher tier.
Medicare Supplement (Medigap)
Original Medicare (Parts A and B) doesn’t cover everything. It only covers a portion of your costs for covered services — and it doesn’t limit what you pay out-of-pocket for health care expenses each year.
To help fill these coverage gaps, many private insurance companies offer Medicare Supplement, or “Medigap”, insurance policies that help pay for your health care costs. When you have a Medigap policy, Medicare continues to pay its share of the approved amount for covered services. Your Medigap policy then pays its share.
Here are some important things to know about Medigap policies:
You must have Original Medicare (Parts A and B) to buy one.
They have a monthly premium that you pay to the insurance company.
You must also continue to pay your Medicare Part B premium.
They don’t include prescription drug coverage — you must purchase a Part D plan separately.
They generally don’t cover things like long-term care, vision, dental, hearing or private-duty nursing.
They only cover one person — if you and your spouse want Medigap coverage, you’ll each need separate policies.
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Ready to find coverage in your area?
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Get personalized guidance
Connect with a licensed insurance agent
609-928-7903
Enrollment
Medicare Annual Enrollment Dates
Beginning October 15th and ending December 7th, the Medicare Annual Enrollment Period (AEP) is generally the time when you can join or switch Medicare Advantage or Part D prescription drug plans.
Medicare Advantage Open Enrollment
There's also a Medicare Advantage Open Enrollment Period that begins January 1st and ends March 31st. During this time, if you're in a Medicare Advantage plan and want to change your coverage, you can switch to a different Medicare Advantage plan with or without prescription drug coverage. You can also go back to Original Medicare and, if needed, join a Part D prescription drug plan.
Special Enrollment Periods
Throughout the year, you may be able to sign up for Medicare during a Special Enrollment Period. These are typically reserved for times when certain events happen in your life — and each Special Enrollment Period can have different rules, depending on the circumstances.
Reasons for a Special Enrollment Period may include changing where you live, losing your current coverage or if your plan changes its contract with Medicare.
Coverage Changes
Your health care needs can change from year to year. So do health plans. Fortunately, Medicare gives you the ability to join a plan or change your coverage during certain times of the year.
Each plan has a formulary — a list of the specific prescription drugs the plan covers.
Many plan formularies also have tiers that place covered prescription drugs into different cost levels.
Prescription drugs in a lower tier will generally cost you less than those in a higher tier.
Ready to Take the Next Step?
Ready to find coverage in your area?
View Medicare coverage options in your area
Get personalized guidance
Connect with a licensed insurance agent
609-928-7903
Coverage
Choosing Your Coverage
Choosing the right Medicare coverage begins by asking a simple question: What matters most to you? The providers you want to see, your prescription drugs, your budget and your lifestyle are all important factors to consider. We can help you understand your options and guide you to a plan that fits your needs.
Your Basic Coverage Options
Some of the most common ways for you to receive your Medicare benefits include:
Original Medicare
Original Medicare + Part D Prescription Drug Coverage
Original Medicare + Medigap Coverage
Original Medicare + Part D Prescription Drug Coverage + Medigap
Medicare Advantage Plan
Coverage Combinations Explained
Original Medicare
Includes Part A Hospital and Part B Medical coverage.
This option might be good for you if:
You only want basic Medicare coverage.
You want to be able to see any provider that accepts Medicare.
Keep in mind
Original Medicare has coverage gaps — it only pays a portion of the costs for covered services.
Prescription drug coverage is not included.
There’s no limit on what you pay out-of-pocket for medical expenses each year.
There are no extra benefits like dental, vision, hearing.
Original Medicare + Part D Prescription Drug Coverage
Adds a Part D prescription drug coverage plan from a private insurer to the Original Medicare plan.
This option might be good for you if:
You want prescription drug coverage to go with basic Medicare coverage.
You want to be able to see any provider that accepts Medicare.
Keep in mind
Original Medicare has coverage gaps — it only pays a portion of the costs for covered services.
There’s no limit on what you pay out-of-pocket for medical expenses each year.
There are no extra benefits like dental, vision, hearing and wellness.
You will pay a separate premium to a private insurance company for your Part D coverage.
Original Medicare + Medigap Coverage
Adds supplemental coverage from a private insurer to Original Medicare.
This option might be good for you if:
You want coverage to help fill the gaps in Original Medicare.
You want coverage to help fill the gaps in Original Medicare.
Keep in mind
Prescription drug coverage is not included.
Depending on the Medigap plan, there may or may not be a limit on what you pay out-of-pocket for medical expenses each year.
There are no extra benefits like dental, vision, hearing and wellness.
You will pay a separate premium to a private insurance company for your Medigap coverage.
Original Medicare + Medigap + Part D Prescription Drug Coverage
Adds supplemental coverage and a Part D prescription drug plan from private insurers to Original Medicare.
This option might be good for you if:
You want supplemental coverage that helps fill the gaps in Original Medicare.
You want coverage for your prescription drugs.
You want to be able to see any provider that accepts Medicare.
Keep in mind
Depending on the Medigap plan, there may or may not be a limit on what you pay out-of-pocket for medical expenses each year.
There are no extra benefits like dental, vision, hearing and wellness.
You will pay separate private insurance plan premiums for both your Medigap and Part D coverage.
Medicare Advantage
An all-in-one option for receiving your Medicare benefits through a private insurer.
This option might be good for you if:
You want to receive Part A hospital, Part B medical and often Part D prescription drug coverage together in one plan.
You want predictable costs and a firm limit on what you pay out-of-pocket for medical expenses each year.
You value coverage that typically includes extra benefits.
Keep in mind
Medicare Advantage plans typically come with a network contracted providers.
Some plans may give you the ability to use out-of-network providers at low or no extra cost.
You must continue to pay your Medicare Part B premium.
Depending on the plan, you may pay a separate premium to a private insurance company.
Can I change my coverage?
Your health care needs can change from year to year. So do health plans. Fortunately, Medicare gives you the ability to join a plan or change your coverage during certain times of the year.
Ready to Take the Next Step?
Ready to find coverage in your area?
View Medicare coverage options in your area
Get personalized guidance
Connect with a licensed insurance agent
609-928-7903
