The first step in making a wise Medicare decision is to make sure you understand the basics before you are eligible to enroll.
You’ll be eligible to enroll three months before your 65th birthday, the month that you turn 65, and the three months after your birthday, during what is called the Initial Enrollment Period.
Once eligible, you’ll need to enroll in Original Medicare, also known as Parts A and B. You also have the option to enroll in additional coverage, like a Medicare Advantage (Part C) or a Prescription Drug Plan (Part D).
Medicare Part A
Also known as hospital insurance, is a part of Original Medicare. You should be automatically enrolled upon your 65th birthday, but if not, you can manually enroll during your Initial Enrollment Period.
Part A covers inpatient hospital care, limited time in a skilled nursing care facility, limited home health care services, and hospice care.
Most Medicare Part A beneficiaries don’t have to pay a monthly premium to receive coverage under this part of Original Medicare; this is called “premium-free Part A.” Generally, if you’ve worked at least 10 years (40 quarters) and paid Medicare taxes while you worked, you’re eligible for premium-free Part A. Otherwise, you will have to pay a monthly premium.
Part A usually doesn’t cover the full amount of a hospital bill, so you’ll probably be responsible to pay for a portion of the cost. You’ll also have to pay a deductible before Medicare benefits kick in. Once your deductible is met, Medicare will then pay 100% of your costs for up to 60 days in the in a hospital or up to 20 days in a skilled nursing facility. After that, you pay a flat amount up to the maximum number of covered days.
Medicare Part B
Also know as medical insurance, Part B is the second part of Original Medicare. Part B covers certain non-hospital medical expenses like doctor’s office visits, blood tests, X-rays, diabetic screenings and supplies, and outpatient hospital care.
You have to pay a monthly premium for Part B benefits and the cost will be determined by your income. If you’re also eligible for Medicaid, you may receive financial assistance to help cover the cost of your Part B premium.
As with Part A, you may also be responsible for a portion of your Part B health care costs. You’ll have to pay a deductible each year before your Medicare Part B benefits kick in and then you’ll generally pay 20% of the bill when you go to a participating Medicare doctor. Medicare pays the full cost of many lab tests and services requested by your doctor.
Medicare Part C
Also known as Medicare Advantage, Medicare Part C is a privately sold health plan that is regulated by CMS (The Centers for Medicare and Medicaid). Medicare Advantage plans are sold as an alternative to Original Medicare and enrollment is optional.
These plans are required to provide the same benefits as Original Medicare (except hospice care), but often times include prescription drug coverage, and may have a lower deductible, allowing you to pay less money out of pocket for hospital or medical care. Medicare Advantage plans may even cover certain health care services that Original Medicare doesn’t, like eye exams, hearing aids, dental care, or health care received while traveling outside the United States.
Even if you enroll in a Medicare Advantage plan, you must still enroll in Parts A and B and continue to part your Part B premium.
Medicare Part D
Also know as a Prescription Drug Plan (PDP), Part D is a stand alone drug plan that is sold through private insurance companies. In addition to a monthly premium, you may also be required to share in the costs of your prescription drugs costs, depending on the plan you choose. Those costs may include a deductible, copayment or coinsurance.
If you need prescription drug coverage, you can purchase it as a stand alone plan or many Medicare Advantage plans (Part C) include this coverage as part of the benefits package.
There is a program called Extra Help that is designed to help people pay for costs associated with prescription drugs. If you cannot afford your medications even with Part D benefits, you may qualify. Click here to learn more.
If you have questions about your Medicare options, please call one of our licensed sales agents at 888-738-6356 (TTY: 711). They are available to help you, Monday – Friday from 6am – 5pm PT.