Medicare Explained

Medicare is a government program that you have paid into through the years in order to access health insurance once you turn 65. If you have end-stage kidney disease, ALS or a covered disability.

1. What Benefits does Medicare provide?

Original Medicare

• Part A covers inpatient hospital and skilled nursing care.
• Part B covers doctor visits and outpatient care.

Private Medicare plans are optional and provide more coverage.

• Medicare Advantage plans (Part C) combine Part A and Part B coverage. They often include drug coverage and other benefits you don’t get with Original Medicare.
• Medicare prescription drug plans (Part D) help pay for medications. You can get a standalone Part D plan or get a Medicare Advantage plan that includes drug coverage.
• Medicare supplement insurance (Medigap) helps pay some or all costs not paid by Original Medicare (deductibles, copays and coinsurance).

2. What are my Coverage Options?

You can add coverage to Original Medicare or choose a Medicare Advantage plan instead.

Original Medicare

You may add a standalone Part D plan, a Medicare supplement plan or both to Original Medicare (Parts A & B).

• Parts A + B
• Parts A + B plus Part D prescription coverage
• Parts A + B plus a Medicare supplement plan
• Parts A + B plus both Part D prescription coverage and a Medicare supplement plan

3. What Does it Cost?

What does Medicare and many Medicare plans charge premiums—a fixed amount that you pay each month for your coverage.

You also pay a share of the cost for health care services you receive. There are three types of payments you may have:

• Deductible: A set amount you pay out of pocket for covered services each year before Medicare or your plan begins to pay.
• Copay: A fixed amount you pay at the time you receive a covered service. For example, you might pay $20 when you visit the doctor or $12 when you fill a prescription.
• Coinsurance: A percentage of the cost for a covered service that you pay when you receive it. For example, Medicare might pay 80% of the covered service and the remaining 20% would be paid by you.

4. When Can I Enroll?

• Your Initial Enrollment Period (IEP) is 7 months long. It includes your 65th birthday month plus the 3 months before and the 3 months after.
• Your IEP begins and ends one month earlier if your birthday is on the first of the month.
• Your IEP is based on your 25th month of receiving benefits if you become eligible for Medicare due to a qualifying disability.
• You should be enrolled in Part A and Part B automatically at age 65 if you are receiving social security or Railroad Retirement Board benefits. Medicare will mail your card to you.

5. How should I choose my coverage?

Think about your needs so you can see how different coverage options might work for you.

Your health

• How often do you go to the doctor?
• What health problems do you have?
• What medications do you take regularly?

Your budget

• What are you able to pay each month in premiums?
• How comfortable are you covering copays or coinsurance for services?
• How willing are you to accept the risk of high out-of-pocket costs?

Your preferences

• Which doctors, hospitals and pharmacies do you like to go to?
• How important is it for you to have access to health care while traveling?
• What other coverage do you have, such as an employer or retiree plan?

References:

Medicare 101 Medicare Coverage Me