Medicare 101
Medicare is a federally funded health insurance program designed to provide healthcare coverage for people 65 years and older, as well as for certain younger individuals with disabilities or specific health conditions. Understanding the various parts and options available can be overwhelming, but this guide will break down the basics to help you make informed decisions.
Part A: Hospital Insurance
What it covers: Part A helps cover inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services.
Cost: Most people don’t pay a premium for Part A if they or their spouse paid Medicare taxes for at least 10 years while working.
Part B: Medical Insurance
What it covers: Part B helps cover outpatient care, such as doctor visits, preventive services, and some home health services.
Cost: Most people pay a monthly premium for Part B, which can vary depending on income. For 2025 the standard premium is $185.
Part C: Medicare Advantage Plans
What it covers: Part C (Medicare Advantage) includes all benefits covered under Part A and Part B and often includes additional services like vision, dental, and prescription drug coverage. These plans are offered by private insurance companies approved by Medicare.
Cost: The cost varies depending on the plan, but you generally pay the Part B premium plus an additional premium for the Medicare Advantage plan if it has one.
Part D: Prescription Drug Coverage
What it covers: Part D helps cover the cost of prescription medications.
Cost: Part D plans are offered by private insurance companies. The premium varies by plan and the medications you need. The Part D benefit may be included with the Part C.
Medicare Supplements
What it covers: Medicare Supplements, also known as Medigap policies, are private insurance plans designed to work alongside Original Medicare (Parts A and B). They help cover some of the healthcare costs that Medicare doesn’t fully pay, like copayments, coinsurance, and deductibles.
Costs: A premium that is on top of the cost of Medicare and a Part D plan if you are needing prescription coverage.
Navigating Medicare with Expert Advice
Additional Information
You are eligible for Medicare if you meet one of the following criteria:
- Age 65 or older: You can enroll in Medicare three months before your 65th birthday, the month of your birthday, or three months after.
- Under 65 with a qualifying disability: If you’ve 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, like End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), may make you eligible for Medicare at any age.
When to Enroll in Medicare
There are specific times when you can sign up for Medicare:
- Initial Enrollment Period (IEP): This period lasts 7 months — it starts 3 months before you turn 65, includes your birthday month, and ends 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 amounts paid for Part B, Part C, or Part 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 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, our team is here to help!
