Medicare can be quite confusing for beginners. It has many different sections, options, and plans involved under one name. However, knowing how Medicare works can be quite beneficial whether you are trying to obtain insurance or just want to know more about the government’s insurance program. Even if you have no knowledge about Medicare now, you will have all the information you need about the program after reading this article.
Medicare For Dummies: Key Takeaways
- Medicare is the federal health insurance program that provides health insurance benefits to millions of people across the U.S.
- Parts A,B, C, and D of Medicare cover a variety of health services.
- Eligible Medicare beneficiaries are people over 65, people with disabilities, and people with End-Stage Renal Disease.
- Medicaid provides coverage for low-income individuals, while Medicare provides coverage to a specific group.
- You can enroll in Medicare during the Initial, General, or Special Enrollment periods.
What is Medicare?
Medicare is the federal health insurance program whose goal is to provide basic health insurance benefits to qualified individuals. Qualified individuals are mainly people who are 65 years old or older, people with disabilities, and people with End-Stage Renal Disease. The Original Medicare plan consists of Hospital and Medical insurance (also known as Part A and Part B). Alternatively, the federal government vets and approves private health insurance plans known as Medicare Part C (or Medicare Advantage). A Medicare Advantage Plan is a bundle of Part A, Part B, and Part D. Do not worry if you are not sure about what each part means. Below are informative descriptions of each Part and more information on Medicare Advantage Plans.
Medicare Part A
Part A is the Hospital Insurance segment of Medicare plans. This part is responsible for covering any inpatient hospital stays, care in a nursing facility, hospice care, and certain home health care services. Both Original Medicare and Medicare Advantage include Part A.
Medicare Part B
Part B is the Medical Insurance section of Medicare. Doctor visits, outpatient care, medical supplies, and preventative services are all included in this part. Original Medicare and Medicare Advantage plans both include Part B.
Medicare Part D
Part D covers all prescription drug-related costs. Part D is not offered directly through Medicare but is instead offered by insurance companies that are approved by Medicare. This plan is not included in the Original Medicare Plan, but can be added onto it. However, Medicare Advantage plans already include Part D.
What is Medicare Advantage?
We have been discussing Medicare Advantage plans, but what exactly does it entail? It is important to note that the Medicare Advantage option is also known as the “Part C” of Medicare plans. As mentioned before, Medicare Advantage bundles Part A, Part B, and Part D all under one plan option. These plans are only offered by private insurance companies that contract Medicare to offer Part A and B benefits. These plans are commonly seen as HMO, PPO, PFFS, and SNP plans, which are common insurance options that are approved by Medicare.
Choosing Between Original Medicare and Medicare Advantage
The best Medicare option for you is based on your needs, lifestyle, and budget. If you frequently need prescription medication, Medicare Advantage is a great option because of its inclusion of prescription drug coverage. In addition, Medicare Advantage offers more benefits depending on the plan which can include vision services, dental services, hearing services, fitness programs, and more. If you are in need of routine visits under any of these areas, finding a Medicare Advantage program with these added benefits may be a better option for you than the Original Medicare Plan.
When it comes to costs, most services in both Medicare options require copayments. Additionally, both plans have a monthly premium required for Medicare Part B. However, dependent on the plan, there may be other monthly premiums. It is more common to have more monthly premiums associated with Medicare Advantage since most people are not required to pay the premium for Medicare Part A. An important difference to note is that Original Medicare requires deductibles and Medicare Advantage may not depend on your plan.
Medicare Vs. Medicaid
Another commonly heard federal insurance program is Medicaid. Medicaid differs from Medicare since it is not just a federal program, but instead it is a joint federal and state insurance program. Additionally, the purpose of Medicaid is to provide basic health coverage to low-income individuals, as opposed to Medicare whose main focus is to provide for the population who are 65 and older, have disabilities or ESRD. Both programs provide basic healthcare for their specific group and are included in the Social Security Act.
Why Enroll In Medicare?
Medicare is a great insurance option if you qualify for its benefits. The rates for Medicare are typically much lower than other insurance options and have a broad range of coverage and doctors within their network. Since it is specified for a certain population, it has specialized benefits depending on your lifestyle and the age at which you enroll.
Initial Enrollment Period (IEP)
Enrollment Period Requirements: 7 months after you turn 65 (3 months before you turn 65 and 3 months after)
How To Obtain: If you are already getting Social Security or Railroad Retirement Benefits, enrollment for Part A automatically occurs when you turn 65. For Part B, you must sign up for it during the specified time period around your 65th birthday.
General Enrollment Period (GEP)
Enrollment Period Requirements: January 1 – March 31 every year
How To Obtain: If you missed the Initial Enrollment Period, you can still sign up to enroll for Medicare during their General Enrollment Period that occurs at the beginning of every year.
Special Enrollment Period (SEP)
Enrollment Period Requirements: Begins the month you are notified you do not qualify for SNP and lasts for two months
How To Obtain: Sign up in the specified period through your social security
Medicare Enrollment Process
- Sign up for Medicare through your Social Security – If you qualify for one of the enrollment periods listed above, you simply go to the Social Security sign up page and enroll.
- Choose your coverage – Using the information above, it is now time to determine if you are going to choose the Original Medicare plan or Medicare Advantage. Choose your coverage plan and continue with the guided instructions on the website.
Where/How to Enroll in Medicare
There are many ways to enroll in Medicare! As listed above you can enroll online through Social Security’s page. If you choose not to go through the online route, you can call the Social Security Office at 1-800-772-1213. You can even go in person at a local Social Security Office near you. No matter which way you choose, make sure to do it in your specified enrollment period to get the most benefits out of your plan.