Medicare 101

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• Medicare 101
• Enrollment Periods
• Medicare Advantage (Part C)
• Medicare Part D
• Medicare & Medicaid Dual Eligibility
• Medicare Supplement Plans
• FAQs

Medicare is a federal health insurance program for individuals aged 65 and older, under 65 with certain disabilities, or those diagnosed with End-Stage Renal Disease (ESRD). It consists of different parts that cover specific services: Medicare Part A provides hospital insurance and is premium-free for participants who have earned enough work credits (paid taxes on work) or have a spouse who has done so and is at least 62 years old. Part B requires a monthly premium and covers outpatient and medical care, with enrollment necessary for retirees or those who no longer have current employment status but are eligible for Medicare. Part D offers prescription drug coverage, with a monthly premium unless the participant qualifies for extra help assistance.

It's important to understand when to enroll in Medicare or join a Medicare plan. Be mindful of these periods to maximize your Medicare benefits and avoid late enrollment penalties:

Initial Medicare Enrollment Period: Initial Medicare Enrollment Period: Most individuals enroll in Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) during this period. It begins 3 months before your 65th birthday and extends for 3 months afterward. If you're not receiving Social Security benefits before your Initial Enrollment Period begins, you must sign up for Medicare online or contact Social Security. To maximize your Medicare benefits and avoid the Part B late enrollment penalty, complete your Medicare enrollment application during this period. This penalty is lifelong and increases the longer you delay enrollment, adding to your monthly Part B premium. Determine if Part B is appropriate for your situation.

General Medicare Enrollment Period: If you miss your Initial Enrollment Period, you can enroll during Medicare's General Enrollment Period, which runs from January 1 to March 31. Coverage will begin on July 1st.

Special Enrollment Period: Once your Initial Enrollment Period ends, you may have the opportunity to enroll in 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.

Private insurance companies offering Medicare Advantage plans have more flexibility in designing their coverage, resulting in significant differences between plans. It's crucial to carefully compare plan options to avoid overlooking important details. Medicare Advantage plans offer coverage beyond Original Medicare, including routine vision and dental care, hearing services, and health wellness programs. Typically, these services would be paid out of pocket under Original Medicare unless you have other insurance.

Another advantage of Medicare Part C is that many plans also include Medicare Part D prescription drug coverage. Known as Medicare Advantage Prescription Drug plans, these combine all Medicare benefits into a single plan for added convenience.

Enrolling in a Medicare Advantage Prescription Drug plan eliminates the need for an additional Medicare Prescription Drug Plan! 

Medicare Part D, the prescription drug benefit, covers most outpatient prescription drugs under Medicare. Part D is provided by private companies either as a standalone plan for those enrolled in Original Medicare or as part of the benefits included with your Medicare Advantage Plan.

If you're enrolled in both Medicare and full Medicaid coverage, most of your healthcare expenses are likely covered. You have the option to receive your Medicare benefits either through Original Medicare or a Medicare Advantage Plan (Part C). With Medicare and full Medicaid, your Part D prescription drug coverage is provided through Medicare, and you automatically qualify for Extra Help to assist with these costs. Additionally, Medicaid may cover certain medications and other healthcare services that Medicare does not include. Medicare takes primary responsibility for payments, with Medicaid stepping in as the secondary payer after Medicare, employer group health plans, and/or Medicare Supplement (Medigap) Insurance have contributed.

Medicare Supplement insurance plans complement Original Medicare, covering certain costs that Part A and Part B do not. These plans do not provide independent coverage; you must remain enrolled in Part A and Part B for hospital and medical coverage. Medicare primarily pays for your healthcare expenses, while a Medigap plan helps with out-of-pocket costs such as copayments or deductibles required by Medicare. Additionally, Medigap plans may cover other expenses not included in Original Medicare, such as Medicare Part B excess charges or emergency medical costs when traveling abroad. 

If you do not currently have credible prescription drug coverage (coverage that is as good as Medicare Part D), it is advisable to consider purchasing a separate stand-alone Medicare Part D Prescription Drug Plan to cover your prescription medication costs. Moreover, Medicare Supplement insurance plans generally do not offer additional benefits such as routine dental, vision, or hearing coverage beyond what is already provided by Medicare.