Medicare

Medicare is a federal health insurance program in the United States that provides coverage for eligible individuals, primarily those aged 65 and older. It also covers certain younger individuals with disabilities and specific medical conditions. 

Medicare is divided into several parts:

• Part A: Hospital Insurance
• Part B: Medical Insurance
• Part C: Medicare Advantage Plans
• Part D: Prescription Drug Coverage

You can enroll in Medicare during your Initial Enrollment Period (IEP), which usually begins three months before your 65th birthday and extends for seven months. If you’re still working and have healthcare coverage through your employer, you might have other options.

This depends upon the size of your employer.  If your employer has less than 20 employees you must enroll into Medicare when you become eligible, because by law Medicare becomes the primary payor.  If your employer has over 20 employees, and if the plan is creditable, you can safely delay enrollment into Medicare.  However, it is always best to weigh your options because you may be able to get coverage at a lower cost providing more benefits through Medicare. If you or your spouse qualifies for Medicare due to disability and your employer has less than 100 employees, Medicare would be considered as primary coverage.

Medicare Part A covers hospital stays, skilled nursing facility care, hospice care, and some home health care services. Most people don’t pay a premium for Part A if they or their spouse have paid Medicare taxes while working. 

Medicare Part B covers outpatient services, doctor visits, preventive care, and some home health care services. It requires a monthly premium.

Medicare Advantage Plans (Part C) are offered by private insurance companies approved by Medicare. They combine Part A and Part B coverage and often include additional benefits with lower monthly premiums.

Supplement plans, often referred to as ‘Medigap’ plans are offered by private health insurance companies and pick up where Part A and Part B leave off. They help with paying some of the health care costs not covered under original Medicare Part A and Part B, like coinsurance, copays and deductibles.  Typically, the more comprehensive the coverage, the higher the monthly premium.

Yes, if you want prescription drug coverage, you can enroll in a Medicare Part D plan. These plans are also offered by private insurance companies.

The Medicare Open Enrollment Period, also known as the Annual Enrollment Period (AEP), occurs from October 15 to December 7 each year. During this time, you can make changes to your Medicare Advantage or Part D plans. Supplement plans are not subject to AEP.  

Yes, many individuals are eligible for both Medicare and Medicaid. This is often referred to as “dual eligibility.” Medicaid can help cover costs that Medicare doesn’t, such as copayments and deductibles.

Yes, there are certain periods during the year when you can make changes to your Medicare coverage. These include the Annual Enrollment Period and Special Enrollment Periods triggered by certain life events.