Medicare 101
Medicare is a federally funded health insurance program aimed at providing healthcare coverage for individuals aged 65 and older, as well as certain younger individuals who meet Medicare eligibility criteria due to disabilities or specific health conditions. Navigating the different Medicare parts and understanding the various Medicare coverage options can feel overwhelming, but this guide will simplify the basics to assist you in making informed decisions.
Part A: Hospital Insurance
What it covers: Part A of Medicare includes coverage options for inpatient hospital stays, skilled nursing facility care, hospice care, and certain home health services. Most people don’t pay a premium for Part A if they or their spouse meet the Medicare eligibility requirement of having paid Medicare taxes for at least 10 years while working.
Part B: Medical Insurance
What it covers: Part B is one of the key Medicare parts that helps cover outpatient care, including doctor visits, preventive services, and certain home health services.
Cost: Most individuals eligible for Medicare must pay a monthly premium for Part B, which can vary based on income. For 2025, the standard premium is $185.
Part C: Medicare Advantage Plans
What it covers: Part C (Medicare Advantage) includes all benefits encompassed within the Medicare coverage options of Part A and Part B, often incorporating additional services such as vision, dental, and prescription drug coverage. These plans are provided by private insurance companies that are approved by Medicare.
Cost: The cost varies based on the plan, but generally, you are responsible for the Part B premium along with an additional premium for the Medicare Advantage plan, if applicable, which is important to consider when assessing Medicare eligibility.
Part D: Prescription Drug Coverage
What it covers: Medicare Part D helps cover the cost of prescription medications, which is one of the important Medicare coverage options available. Cost: Part D plans are offered by private insurance companies, with the premium varying by plan and the medications you need. Additionally, Medicare eligibility for Part D may also include benefits that are part of Medicare parts, such as Part C.
Medicare Supplements
What it covers: Medicare Supplements, also known as Medigap policies, are private insurance plans designed to complement Original Medicare (Parts A and B) and enhance your Medicare coverage options. These plans help cover some healthcare costs that Medicare doesn’t fully pay, such as copayments, coinsurance, and deductibles.
Costs: You will need to pay a premium in addition to your Medicare costs and a Part D plan if you require prescription coverage, which is important for understanding your Medicare eligibility.
Medicare Guide: Understanding Medicare 101
Additional Information
You qualify for Medicare if you meet one of the following criteria for Medicare eligibility:
Age 65 or older: You can enroll in Medicare three months before your 65th birthday, during your birthday month, or three months after.
Under 65 with a qualifying disability: If you have been receiving Social Security Disability Insurance (SSDI) for at least 24 months, you may be eligible for Medicare regardless of age.
Other specific conditions: Certain health conditions, such as End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), can make you eligible for Medicare at any age.
When to Enroll in Medicare
There are specific times when you can sign up for Medicare coverage options:
Initial Enrollment Period (IEP): This period lasts 7 months — starting 3 months before you turn 65, including your birthday month, and ending 3 months after.
General Enrollment Period (GEP): If you miss your IEP, you can enroll between January 1 and March 31 each year, but your coverage will begin on July 1.
Special Enrollment Period (SEP): If you or your spouse are still working and have health insurance through your job, you can delay enrolling in Medicare without penalty. You may enroll during an SEP when your work coverage ends.
Medicare costs can vary depending on the parts you choose, your income, and the coverage you need. Common costs include:
Premiums: Monthly payments for Medicare parts B, C, or D.
Deductibles: Amount you pay for healthcare services before your plan starts to pay.
Copayments and Coinsurance: Your share of the cost for services after you meet the deductible.
Many individuals may also qualify for programs to help cover these costs, such as Medicare Savings Programs or Medicaid.
Medicare vs. Medicaid: What’s the Difference?
Medicare is federal insurance primarily for seniors and some younger individuals with disabilities. Medicaid, on the other hand, is a joint federal and state program that provides healthcare for low-income individuals, including some people who qualify for Medicare. You may be eligible for both Medicare and Medicaid, in which case you can get help with costs through Dual Eligibility.
Frequently Asked Questions (FAQ)
1. Can I have both Medicare and employer insurance? Yes, you can have both Medicare and employer insurance. However, if you have both, Medicare may become the secondary payer.
2. What happens if I miss my enrollment period? If you miss your Initial Enrollment Period, you may face late enrollment penalties, which can result in higher premiums.
3. Does Medicare cover long-term care? No, Medicare generally does not cover long-term care, such as custodial care in a nursing home.
Need Help Navigating Medicare?
Choosing the right Medicare plan can be overwhelming. If you need assistance understanding your options, reviewing available plans, or enrolling in Medicare parts, our team is here to help!
