Medicare
What is Medicare?
Medicare is a federal program that offers health insurance to American citizens and other eligible individuals based on age, disability or a qualifying medical condition. Medicare is individual insurance and doesn’t cover spouses or dependents.
Who can get Medicare?
U.S citizens and legal residents
Legal residents must live in the U.S for at least 5 years in a row, including the 5 years just before applying for Medicare.
You must also meet one of the following requirements:
- Age 65 or older
- Younger than 65 with a qualifying disability
- Any age with a diagnosis of end-stage renal disease or ALS
Eligible with a disability?
Your Medicare eligibility begins after 24 months of receiving Social Security disability benefits.
How do I enroll?
If you are receiving Social Security or Railroad Retirement Board benefits when you become eligible you will be automatically enrolled in Medicare Parts A and B. You’ll receive your Medicare card in the mail. If you’re not receiving benefits, you need to sign up for Medicare when you become eligible.
Go to ssa.gov to enroll online, or call or visit your local Social Security office. If you’re having trouble with enrolling give us a call and we’d be happy to assist.
Medicare Coverage Options
Original Medicare (Parts A & B) is provided by the federal government. It helps pay for hospital stays and doctor visits, but doesn’t cover everything. You may add coverage by enrolling in one or more private Medicare or Medicare-related plans.
STEP ONE
First, you need to enroll in Original Medicare
Provided by the federal government
Part A
Helps pay for hospital stays and inpatient care
Part B
Helps pay for doctor visits and outpatient care
STEP TWO
Now, you can look at additional coverage options
Offered by private insurance companies
Option 1
Medicare Part D Plan
Helps pay for prescription drugs
And, you can also add:
Medicare Supplement insurance (Medigap)
Helps pay some out-of-pocket costs not paid by Original Medicare
Option 2
Medicare Advantage Plan (Part C)
Combines Original Medicare Part A & B coverage in one plan
Usually includes prescription drug coverage (Part D)
May offer additional benefits like dental vision and hearing coverage
When Can I Enroll?
IEP | Your Initial Enrollment Period (IEP) is 7 months long
When you turn 65, you become eligible for Medicare. You have a 7-month window to sign up, which includes your birthday month, the three months before, and the three months after. If your birthday is on the first of the month, the period starts and ends one month earlier.
During this time, you can enroll in Medicare Part A, Part B, or both. You can also choose to join a Medicare Advantage plan (Part C), a Medicare Supplement Insurance plan (Medigap), or a Part D prescription drug plan.
If you want a Medigap plan, you have 6 months to get guaranteed coverage, starting the first month you are 65 or older and enrolled in both Medicare Part A and Part B. You can apply for Medigap at other times, but you might be denied coverage or have to pay more based on your health history. Some states offer additional open enrollment rights under state law.
GEP | General Enrollment Period (GEP) for those who missed IEP
You can sign up for Medicare Part A, Part B, or both. The General Enrollment Period (GEP) is every year from January 1 to March 31, and your coverage starts the month after you enroll. If you want to join a Medicare Advantage plan (Part C) or a Part D prescription drug plan, you can sign up from April 1 to June 30 of the same year.
SEP | Medicare provides Special Enrollment Period (SEP) for enrolling after retiring or losing your employee coverage
You might qualify for a Special Enrollment Period (SEP) to sign up for Part A, Part B, or both without a penalty. This period lasts up to 8 months after the month your (or your spouse’s) job or employer health coverage ends, whichever happens first. You can also join a Medicare Advantage plan or a prescription drug plan up to 2 full months after this event, if you are eligible.
When Can I Change Coverage?
AEP | The Medicare Annual Enrollment Period (AEP), AKA the Medicare Open Enrollment Period (OEP)
During this time, you can join, switch, or drop a Medicare Advantage plan (Part C) or a Part D prescription drug plan. If you drop a Medicare Advantage plan, your coverage goes back to Original Medicare.
SEP | A Special Enrollment Period due to a qualifying life event
Usually, you have 2 full months after a qualifying event to change your Medicare plan. During this time, you can join, switch, or drop a Medicare Advantage plan or a Part D prescription drug plan without a penalty, even if it’s outside the Medicare Annual Enrollment Period. Common qualifying events include moving or losing retiree, union, or COBRA coverage.
MA OEP | The Medicare Open Enrollment Period (MA OEP)
If you have a Medicare Advantage plan on January 1, you can make one coverage change between January 1 and March 31. You can switch to a different Medicare Advantage plan or go back to Original Medicare. If you return to Original Medicare, you can also sign up for a Part D prescription drug plan during this time.
What Does Medicare Cost?
Medicare isn’t free. The amount you’ll pay will depend on the coverage you choose and the health care services you receive.
The four kinds of payments you might have:
Premium (Flat monthly fee)
Medicare Part B has a monthly premium. Some people also have to pay a premium for Medicare Part A if they didn’t work for 40 or more quarters. Medicare Advantage (Part C), Medicare Supplement and Part D plans may also have premiums, and amounts will vary by provider and plan.
Example: You pay $100 a month to have your plan.
Deductible (Contribute up to a limit)
A set amount you pay for covered services before your plan pays.
Example: You pay up to a limit of $500, and the plan pays the rest.
Copay (Fixed rate fee)
A fixed amount you pay at the time you receive a covered service.
Example: You pay a fixed amount of $20 when you get a particular service rendered, and the plan pays the rest.
Coinsurance (Percentage fee)
A percentage of the cost you pay for a covered service.
Example: You pay 20% of a bill when services are rendered.
How Do I Choose?
Answering the following questions can help you decide which coverage options best fits your health and lifestyle needs:
Your Health
How often do you go to the doctor? Do you have any health conditions? What medications do you take regularly?
Your Budget
What are you able to pay each month in premiums? How comfortable are you meeting your deductibles and covering copays or coinsurance for services? How willings are you to accept the risk of high out-of-pocket costs?
Your Preferences
Which doctors, hospitals and pharmacies do you like to go to? How important is it for you to have access to health care while traveling? What other coverage do you have, such as an employer or retiree plan?