Ten Things You Need to Know About Medicare

Find out now what it means to become eligible for Medicare and how to choose the best option for you or your loved one.

November 23, 2018 | HF Healthy Living Team

Find out now what it means to become eligible for Medicare and how to choose the best option for you or your loved one.

What is Medicare?

Medicare is a federal health insurance program for people:

  • Age 65 and older
  • Under 65 with certain disabilities
  • With End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant)

Who Can Sign Up?

You can sign up if you:

  • Are 65 or older
  • About to turn 65
  • Have certain disabilities
  • Have a disability or End-Stage Renal Disease

When Can I Join a Plan?

You can join a plan for the first time during your initial coverage election period (when you age in), or during the General Enrollment Period (GEP).

Your initial enrollment period begins three months before and ends three months after your 65th birthday. You can enroll at any time during this period. If you enroll before your 65th birthday, your health insurance coverage will begin on the first day of your birth month.

For example, if your birthday is June 19, your initial enrollment period is March 1 through September 30. If you sign up within the first three months (March–May), your coverage will begin on June 1.

If you get Medicare due to a disability, you can join during the three months before to three months after your 25th month of disability.

If you don’t enroll in Medicare during your initial enrollment period, you can enroll during the GEP, which happens each year from January 1 through March 31. You can enroll in Part A at any time, but if you enroll in Part B during the GEP you may have to pay a 10% premium penalty for each year you wait beyond your initial enrollment period. Your Part B coverage will begin on July 1.

If you’re enrolled in a Medicare Advantage (MA) plan, you can make changes to your current plan or benefits during the Annual Enrollment Period (AEP), from October 15 through December 7 each year. You’ll also have an opportunity during Medicare Advantage Open Enrollment Period (MA OEP), from January 1 through March 31, to enroll on another MA plan or disenroll from your current MA plan and return to Original Medicare.

If you’re enrolled in any Medicare plan, you can make changes to your current plan or benefits during the Special Enrollment Period (SEP) if you have a life change (also known as a qualifying life event) that makes you eligible to change your coverage. You can learn more about life events that make you eligible for the SEP here.

What Does Medicare Cover?

Medicare is a fee-for-service health insurance plan that covers certain healthcare services and expenses. As a Medicare member, you may be responsible for fees such as premiums, copays, and deductibles.

Original Medicare (Medicare Part A and Part B) provides coverage for hospital (inpatient) care—like hospital stays—and for medical (outpatient) care such as doctor appointments and preventive exams and screenings.

Medicare Advantage plans cover the same benefits as Medicare Parts A and B, but in some cases, for a higher monthly premium. Additional benefits may include vision and dental benefits, hearing aids, and podiatry.

Prescription drug coverage (Part D) can be added to Original Medicare plans and to Medicare Advantage plans that do not already provide this coverage.

What Is Original Medicare vs. Medicare Advantage, and What Are Parts A, B, C, and D?

Medicare includes four parts: Part A, Part B, Part C, and Part D.

Original Medicare includes Parts A and B and is administered by the federal government.

Part A, Hospital Insurance, covers inpatient care, including hospital stays, skilled nursing facility care, hospice care, and some home healthcare services.

Part B, Medical Insurance, covers outpatient medical care, including preventive care, doctor and provider services, and some medical supplies.

Medicare Advantage plans include Part C

Medicare Advantage plans include Part C, and are health insurance plans offered by private insurance companies that contract with Medicare to provide Medicare benefits. Part C plans include Parts A and B; some Part C plans include prescription drug coverage (Part D).

Part D, prescription drug coverage, is offered by private insurance companies to help you pay for your prescription drugs. Some Medicare Advantage plans include prescription drug coverage as a benefit. Part D is not included in Original Medicare plans, so if you want prescription drug coverage and it’s not included as a part of your Medicare Advantage plan, you’ll need to sign up for a standalone Prescription Drug Plan (PPD) or a Medicare Advantage Prescription Drug Plan (MAPD).

What is Medical Supplemental Insurance (Medigap)?

Medigap is private health insurance that can be added to Original Medicare to help you cover costs of healthcare like copays, coinsurance, and deductibles for Original Medicare-covered services. Medigap is sold by private insurance companies only.

In New York, Medigap prescription drug coverage isn’t provided. These plans usually don’t offer dental and vision care, hearing aids, and private nursing.

Can I Get Help Paying for My Medicare Costs?

Yes, if you qualify. Medicare recipients who qualify for Extra Help can get financial assistance for Medicare-related costs like copays on prescription drugs, premiums, deductibles, and more. You can find out more about the level of Extra Help you may be able to get here.

You may also be able to get financial help from your state for your premiums. In some cases, Medicare Savings Programs may also pay Medicare Part A and Medicare Part B deductibles, coinsurance, and copayments if you meet certain conditions. Find out more about how you can qualify for these programs here.

Will the Affordable Care Act (On Exchange Plans) Premium Increase Affect My Medicare Costs?

No. Affordable Care Act (ACA) plans are completely separate from Medicare plans. Changes to their premiums will not affect your Medicare premium.

Where Can I Sign Up for Medicare?

You can sign up for Medicare Parts A and B here. You can also sign up for a Part C Medicare Advantage plan or PPD from a private health insurance company, or look for one online here.

Where Can I Learn More?

Visit this website to learn more about finding a health insurance plan, applying for Medicare, getting help with costs, and more!

What’s a copay, premium, or deductible? Find out what these common health insurance words mean.

 

© 2018 HF Management Services, LLC.

Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”).

Healthfirst is the brand name used for products and services provided by one or more of the Healthfirst group of affiliated companies.

This health information or program is for educational purposes only and not intended to treat, diagnose, or act as a substitute for medical advice from your provider. Consult your healthcare provider and always follow your healthcare provider’s instructions.

Sources
“10 Things You Need to Know About Medicare Now,” Healthfirst © 2016.
http://online.fliphtml5.com/rgau/cins/#p=1

“Medicare Open Enrollment,” Centers for Medicare & Medicaid Services. October 31, 2017.
https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-help-others/Medicare-Open-Enrollment.html

Medicare.gov: The Official U.S. Government Site for Medicare. Accessed November 7, 2017.
http://www.medicare.gov

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