Medicare is the federal health insurance program for people 65 and older, people on disability, and people with End-Stage Renal Disease (ESRD).
Medicare Part A (Hospital Insurance)
Part A includes inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Part A may require a monthly premium for those who have not paid into social security for at least 10 years.
Medicare Part B (Medical Insurance)
Part B helps to cover medically necessary doctor’s expenses, outpatient care, and preventative services like seasonal flu shots and other vaccines. Part B includes a monthly premium which can be deducted from a person’s social security check every month.
Am I eligible?
Before you can enroll into a Medicare plan you must first make sure you are eligible.
Most people are automatically eligible if they are 65 years or older and either themselves or a spouse has worked for the past 10 years while paying into social security. You may also be eligible if you are already getting benefits from social security or the Railroad Retirement Board. People are also eligible under 65 if they have ESRD or are on Social Security Disability Income for 24 months or longer.
When Can I enroll?
Initial Enrollment Period. If you are turning 65 and have received your Medicare Card you have 7 months to choose a Medicare Advantage Plan or a Medicare Supplement Plan (Medigap Plan). Your Initial Enrollment Period will begin 3 months before the month of your 65th birthday, the month of your birthday, and 3 months after your 65th birthday.
Annual Election Period (AEP)
Every year from October 15th- December 7th you can renew, review, and enroll into a plan of your choosing.
Open Enrollment Period (OEP)
Every year from January 1st – March 31st you can review and alter your MAPD plan and change to another MAPD plan or go back onto original Medicare and add a Part D drug plan as well as a Medicare Supplement plan.
Types of Medicare Plans
Medicare Advantage Plans
Medicare Advantage Plans are health plans offered by private insurance companies that contract with the government to provide Medicare Parts A and B, as well as extra benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans also offer prescription drug coverage; these plans are known as Medicare Advantage Part D Plans (MAPD).
Part D Plans
Part D is a supplement to original Medicare (Parts A & B) by providing additional prescription drug coverage. They can be attached to regular Parts A and B, Medicare Supplement Plans (also known as Medigap Plans), some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by private insurance companies approved by Medicare. Prescription drug coverage may also be included by Medicare Advantage Plans and follow same rules Medicare Prescription Drug Plans.
Medicare Supplement Plans (Medigap Plans)
Medicare supplement Plans, also known as Medigap, are designed to fill in the coverage gaps of Original Medicare A & B. Most of them will cover Medicare Co-Insurance, and deductibles. Medigap plans are also provided by private insurance companies who are contracted through the government.
Special Needs Plans
Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics such as limited income. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve. Chronic Condition SNP (C-SNP): You have one or more of these severe or disabling chronic conditions: Cardiovascular disorders Chronic heart failure Diabetes Chronic lung disorders End-Stage Renal Disease (ESRD). These plans can be changed once a quarter every calendar year.