Medicare Basics

Medicare is health insurance for people 65 or older. You’re first eligible to sign up for Medicare 3 months before you turn 65. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease). 

Medicare is broken into several 'Parts' with each Part covering its own share of services.

Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

Part B (Medical Insurance): Helps cover:

• Services from doctors and other health care providers
• Outpatient care
• Home health care
• Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
• Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)

Part D (Drug coverage): Helps cover the cost of prescription drugs 

Medicare Supplemental Insurance (Medigap): Extra insurance you can buy from a private company that helps pay your share of costs in Original Medicare.

Medicare Part C also known as Medicare Advantage:

Medicare Advantage plans are "all in one" plans that are offered by private insurance companies. With Medicare Advantage plans, you still enroll in Part A and Part B through the federal government, but then you will enroll in a Part C plan with a private insurance company. Once you do that, you will get your Part A and Part B benefits through your Medicare Advantage plan. Most Medicare Advantage plans also include Part D prescription drug coverage, as well as other benefits such dental, vision, hearing and fitness. There are different types of Medicare Advantage plans, and what additional benefits are provided vary from plan to plan.

There are several options that you have for your Medicare coverage.

Original Medicare:

You can select to have original Medicare Parts A & B alone.

Original Medicare + Part D:

You can select to have original Medicare and also enroll in a standalone Medicare Part D plan to cover your prescription drugs.

Original Medicare + Medicare Supplement:

You can choose to have original Medicare and also purchase a Medicare Supplement plan that helps pay for some of your costs in Original Medicare.

Original Medicare + Medicare Supplement + Part D:

You can select Original Medicare and Purchase a Medicare Supplement as well as enroll in a Standalone Part D plan.

Medicare Advantage:

You can enroll in a Medicare Advantage plan. Note: Not all Medicare Advantage Plans have Part D coverage. Discuss these with us and we can go over options and coverages.

Many people have this question or have heard about the Part D Late Enrollment Penalty. Those that are eligible who forego Part D enrollment when first available and who do not have creditable prescription drug coverage for any period of 63 days or longer will likely have to pay a higher Part D premium of one percent (1%) per month for late enrollment. If you have other  drug coverage through a current or former employer or union, for example, you may stay in that plan and choose not to enroll in the Medicare drug plan. If your other coverage is at least as good as the new Medicare drug benefit (we also call this creditable coverage), then you can choose to keep this plan and avoid higher payments later if you sign up for Medicare Part D 

Absolutely! Every year typically from October 15th - December 7th there is an Annual Enrollment Period where you can change your enrollment to another Medicare Advantage plan (or keep your existing plan.  If you miss this time there are certain special circumstances where you may be eligible to enroll or change your enrollment in a plan. If you want to know if you are eligible for one of these Special Enrollment Periods contact us and we can help you!