Medicare 101
What is Medicare?
Medicare is a federal health insurance program primarily for individuals aged 65 and older, as well as for certain younger people with disabilities or specific health conditions. It comprises several parts, each covering different healthcare services:
Part A (Hospital Insurance):
Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services.
Part B (Medical Insurance):
Includes outpatient care, doctor visits, preventive services, and medical supplies.
Part C (Medicare Advantage):
An alternative to Original Medicare (Parts A and B), offered by private insurance companies approved by Medicare. These plans often bundle Part A, Part B, and sometimes Part D (prescription drug coverage), and may offer additional benefits like dental, vision, and hearing services.
Part D (Prescription Drug Coverage):
Provides coverage for prescription medications, available through private insurers.
Eligibility
Age 65 and Older
U.S. citizens or permanent residents who have lived in the U.S. for at least five consecutive years are eligible.
Under 65
Individuals with certain disabilities, end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS) may qualify.
Enrollment Periods
Initial Enrollment Period (IEP)
A seven-month window starting three months before your 65th birthday month, including the birthday month, and ending three months after. During this time, you can enroll in Parts A and B.
Special Enrollment Periods (SEPs)
Available in specific situations, such as losing employer coverage or moving out of your plan’s service area.
Cost
Part A
Typically premium-free if you or your spouse paid Medicare taxes for at least 10 years. Otherwise, a premium is required.
Part B
Requires a monthly premium, which may vary based on income.
Part C & D
Premiums vary by plan and provider.
Additional Coverage
Medigap (Medicare Supplement Insurance)
Private policies that help cover out-of-pocket costs not paid by Original Medicare, such as copayments, coinsurance, and deductibles.
Medicare Myths
Myth: Medicare is Free
Fact: Medicare has costs, such as premiums, deductibles, and coinsurance. Part A is usually free if you’ve paid Medicare taxes for a sufficient period, but Part B, Part C, and Part D typically have premiums.
Myth: Medicare Covers All Medical Expenses
Fact: Medicare doesn’t cover everything. For example, it doesn’t cover most dental care, vision exams, hearing aids, or long-term care. Many people add Medigap or Medicare Advantage to help cover these gaps.
Myth: Medicare Advantage Plans Are the Same as Medigap
Fact: Medicare Advantage (Part C) is an alternative way to get Medicare benefits through a private insurer. Medigap is different—it’s supplemental insurance that helps cover costs not paid by Original Medicare (Parts A and B).
Myth: You Can Enroll Anytime After 65 Without Penalty
Fact: If you don’t sign up during your Initial Enrollment Period and aren’t covered by certain other health insurance, you could face a late enrollment penalty for Parts B and D.
Myth: Medicare Automatically Covers Prescription Drugs
Fact: Medicare Part D, which covers prescription drugs, is optional and must be added separately. It’s not included automatically with Original Medicare.
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