Medicare Made Easy
This article was updated on: 06/05/2019
Most people who are applying for Original Medicare (Part A and Part B) are learning about their Medicare coverage options for the first time. This includes individuals who are age 65 and older, as well as those under 65 who qualify due certain disabilities or illnesses. However, even changing your Medicare plan after years of using the coverage can be tricky. Here is a brief overview of the different Medicare plan options available to beneficiaries, as well as resources for how to apply and answers to some frequently asked questions:
Medicare coverage options
The two main types of Medicare coverage are Original Medicare, Part A and Part B, and Medicare Advantage plans, also called Medicare Part C.
- This coverage option includes both Part A and Part B coverage.
- Medicare Part A is hospital insurance, which includes inpatient hospital care, home-based health care, nursing home care, and hospice care.
- Medicare Part B is medical/physician insurance, and it covers routine and outpatient services, such as blood and other lab tests, surgeries and visits to your physician. Medicare Part B also covers medically necessary durable medical equipment and supplies (such as walkers or artificial limbs). It also covers some preventive services (such as flu shots), mental health services, and ambulance coverage. Some medications can be covered when administered in a physician’s office.
- Individuals with Original Medicare coverage can also buy a Medicare Supplement Insurance (or Medigap) policy. Medigap, as the name suggests, provides coverage for out-of-pocket costs that are not covered by Original Medicare. Medicare Supplement Insurance/Medigap policies are sold by private insurance companies or corporations. The costs of a Medigap policy may vary with each different insurer, making it important to compare Medigap options before deciding on one.
Medicare Advantage plans
Medicare Advantage plans, also known as Medicare Part C, are health-care plans offered by private insurance companies that are approved by and contracted with Medicare. Medicare Advantage plans are legally required to offer at least the same coverage benefits as Original Medicare, but may include additional benefits not covered by Medicare such as routine vision, routine dental, hearing, and even Medicare Part D prescription drug coverage.
Types of Medicare Advantage plans include:
- Health Maintenance Organization (HMO) plans cover services provided by contracted health-care providers and hospitals, also called the plan’s provider network.
- Preferred Provider Organization (PPO) plans provide you with the services of networked doctors, clinics, and hospitals at a lower rate.
- Private Fee-for-Service (PFFS) plans set certain amounts for how much you will pay to see different types of doctors, hospital visits, and other health care specialists. For each service you get, make sure your doctors, hospitals, and other providers agree to treat you under the plan and accept the plan’s payment terms.
- Special Needs Plans (SNPs) are designed for people who have specific diseases or ailments, individuals who live in certain institutions, and others who are enrolled in both Medicare and Medicaid. These plans are designed to provide the most coverage possible.
- Please note, a Medicare Advantage plan’s provider network may change at any time. If you are a member of a Medicare Advantage plan, you will receive notice when necessary from the plan.
How do I enroll in Medicare?
You can enroll in Original Medicare through Social Security or the Railroad Retirement Board (RRB) in the following ways:
- Online at the Social Security website.
- By calling 1-800-772-1213, Monday through Friday, from 7AM to 7PM. For TTY services, call 1-800-325-0778.
- By visiting a Social Security office in person.
- By contacting the Railroad Retirement Board if you worked at a railroad. Call the RRB at 1-877-772-5772, Monday through Friday, 9AM to 3:30PM. For TTY services, call 1-312-751-4701.
If you are already receiving Social Security or Railroad Retirement benefits before you turn 65, then Medicare Part A and Part B enrollment is automatic. You’ll sign up for Medicare at the same time that you apply for retirement benefits, either through Social Security or the Railroad Retirement Board. If this situation applies to you and you’re receiving retirement benefits before you turn 65, you’ll be automatically enrolled in Medicare Part A and Part B the first day of the month that you turn 65. If your 65th birthday falls on the first day of the month, your Medicare coverage starts on the first day of the prior month.
If you’re not yet receiving retirement benefits when you turn 65, you’ll have to manually enroll in Medicare. Your seven-month Initial Enrollment Period is the period you’re first eligible to enroll and starts three months before your 65th birthday, includes the month you turn 65, and ends three months later. Some people may qualify for Medicare before 65 if they’ve been receiving Social Security or certain Railroad Retirement Board disability benefits for 24 months. If you qualify because of disability, you’ll get your Medicare card in the mail three months before the 25th month of disability benefits, and you’ll be automatically enrolled in the 25th month.
Some people may also qualify for Medicare if they have amyotrophic lateral sclerosis (Lou Gehrig’s disease) or end-stage renal disease. Eligibility and enrollment works differently in these situations, and you can contact Medicare for more information at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-486-2048.
Because you must pay a premium for Medicare Part B coverage, you have the option of turning it down or delaying enrollment, but know that you may be assessed a late-enrollment penalty when you do enroll. You will receive a “Welcome to Medicare” packet in the mail a few months before you turn age 65 that will provide you with all the necessary information.
How much does Medicare cost?
The costs of Medicare depend on the type of coverage you choose. For Original Medicare, monthly premiums are dependent on the number of quarters of Social Security credits you have. You’ll get Medicare Part A for free if you’ve worked at least 10 years (40 quarters) and paid Medicare taxes during that time. Otherwise, you may owe a monthly premium for Medicare Part A; the exact amount of your premium will depend on how long you worked.
For Medicare Part B, most beneficiaries pay a monthly premium of $147 in 2015. Your Medicare Part B premium may be higher if you make above a certain income threshold.
The Medicare Part A hospital deductible is $1,260 for each benefit period. Medicare Part B has a yearly deductible of $147 in 2015. Medicare Advantage plans establish the costs, including the monthly premium and deductibles, copayments, and coinsurance for covered services. . If you enroll in a Medicare Advantage plan, you must continue to pay the Medicare Part B premium, in addition to any premium required by the plan.
Why do some people wait to sign up for Medicare?
Some people are partially covered by an employer and may not need all parts of the Medicare coverage. For example, some individuals who are actively employed and have coverage through their employer may not need Part B right away. If they have creditable prescription drug coverage, they may not need Medicare Part D.
What if Medicare doesn’t cover my medical expenses?
If Original Medicare does not provide you with enough coverage for the procedures you need, you may wish to enroll in a Medigap policy for the additional coverage. Alternatively, you may consider enrolling in a Medicare Advantage plan, which covers the same benefits as Original Medicare and could also provide you with additional benefits, such as prescription drugs, routine vision and dental, or hearing.
Now that you know the basics of Medicare, you may be wondering what kind of plan to enroll in. I always enjoy helping people figure that out. If you’d like get some more information in front of you, use the links below, and I’ll email you information about plans or you can schedule a phone appointment with me. To see all the Medicare plans available to you right now, use the Compare Plans button on this page.