Medicare
Eligibility
Age
You can qualify for Medicare by age once you are 65 years or older. You will become eligible to enroll three months before your 65th birthday until three months after turning 65. This window is called the Initial Enrollment Period. You can apply for Original Medicare during this period if you are eligible. If you decide to delay your enrollment, you may face a late enrollment penalty whenever you decide to enroll for Medicare at a later time.
Disability
People who receive Social Security Disability benefits can qualify for Medicare once they have received benefits for 24 months. Individuals in this category become automatically eligible on the 25th month.
Health Condition
People suffering from End-Stage Renal Disease and Amyotrophic Lateral Sclerosis may become eligible for Medicare even when under 65. Those with kidney failure who need a transplant or frequent dialysis qualify for Medicare automatically. Medicare will begin coverage after the first dialysis.
Types of Medicare
Medicare Part A
Hospital Insurance
Helps cover expenses such as:
- Inpatient care in hospitals
- Skilled nursing facility care
- Hospice care
- Home health care
Medicare Part B
Medical Insurance
Helps cover expenses such as:
- 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)
Medicare Part C
Medical Advantage
- Medicare Advantage is an “all in one” alternative to Original Medicare.
- These “bundled” plans include Part A, Part B and usually Part D.
- Plans may have lower out-of-pocket costs than Original Medicare.
- In most cases, you’ll need to use doctors who are in the plan’s network.
- Some plans may offer additional benefits that Original Medicare doesn’t cover – like vision, hearing, dental, and more.
Medicare Part D
Prescription Drug
This part of Medicare helps with the cost of prescription drugs (including many recommended shots or vaccines).
Part D plans are run by private insurance companies that follow rules set by Medicare.
Medicare Supplement
Get help with unexpected medical costs that aren’t covered by Medicare with supplement coverage. Speak with an expert on medicare supplement insurance today.
Medicare Supplement (Medigap) insurance can help pay some of the health care costs that original Medicare does not cover, like copayments, coinsurance, and deductibles.
Some policies also offer coverage for services that Original Medicare doesn’t cover, such as medical care when traveling outside the United States. If you currently have existing Medicare, you can then buy a Medicare Supplement Insurance, Medicare will pay its share of the approved expenses for covered health care costs, and then supplemental coverage will then pay its share.
These policies are different than Medicare Advantage Plans. Those plans are ways to get Medicare benefits, while a supplemental policy only supplements your Original Medicare benefits.
Important Things to Know About Medicare Supplement Coverage
- If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy begins.
- You pay the private insurance carrier a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.
- A Medigap policy covers one person. If you and your spouse both want Medigap coverage, we’ll work with you to setup two separate policies.
- Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you pay the premium.
As a Medicare beneficiary, you may also be enrolled in other types of coverage, either through the Medicare program or other sources, such as an employer. When you first sign up for Original Medicare, you’ll fill out a form called the Initial Enrollment Questionnaire and be asked whether you have other types of insurance. It’s important to include all other types of coverage you have in this questionnaire. Medicare uses this information when deciding who pays first when you receive health-care services.
Below is a list of other types of insurance you may have. Please note that these types of coverage are different from Medicare Supplement plans:
Medicare Advantage plans (like an HMO or PPO)
- Medicare Prescription Drug Plans (Part D)
- Medicaid
- Employer-or union-sponsored group coverage
- TRICARE
- Veterans’ benefits
- Long-term
- Care insurance policies
Coverage levels and premiums vary, but the benefits of each plan within a lettered category remain the same despite the insurance company or location. For example, Plan A benefits are the same in New Jersey as they are in Oregon. If a Medicare Supplement plan includes a certain benefit, this benefit is covered 100% unless otherwise specified.
Medicare Advantage Plans
Medicare Advantage plans, also known as Medicare Part C, is a health insurance plan offered by private insurance companies with a Medicare contract with the federal government. It provides at least the same coverage as Original Medicare—Part A and Part B, and often includes additional benefits, such as prescription drug coverage (Part D). Not all Medicare Advantage plans replace Part D. These extra benefits can sometimes be provided at no additional cost to you, and individuals diagnosed with End Stage Renal Disease (ESRD) are also eligible to enroll in almost every Medicare Advantage plan as of 2021. To be eligible for a Medicare Advantage plan, you must be enrolled in both Medicare Part A and B and reside in the network area of the provider you are considering. The same eligibility criteria for Original Medicare are also applied to Medicare Advantage plans.
Types of Advantage Plans
Health Maintenance Organization Plans
HMO plans typically limit their coverage to in-network healthcare providers. This means there is a list of health providers to choose from, but you may cover all the out-of-pocket costs for the services if you choose to receive care out-of-network.
These plans may also require you to select a primary care physician from one of their networks and get referrals when a specialist is needed.
Preferred Provider Organization Plans
PPO plans offer more flexibility than HMO plans but at a higher cost. Though each PPO plan has a list of in-network providers, you will typically have the option to get healthcare services from out-of-network providers. However, you will pay more for these services but will still get more coverage than you would with an HMO plan. Also, you don’t need a referral to go to a specialist, nor are you required to choose a primary care physician.
Special Needs Plans
Medicare Advantage Special Needs Plans are available to individuals with chronic health conditions and specific healthcare needs. These plans will cover everything that Original Medicare does, and they are required to provide prescription drug coverage. The three types of Special Needs Plans are:
- Chronic Condition Special Needs Plans.
- Institutional Special Needs plans.
- Dual Eligible Special Needs Plans.
Private Fee-For-Service Plans
This type of Medicare Advantage plan allows you to keep or choose any healthcare provider as long as they accept the terms of your Medicare Advantage plan. You won’t be required to choose a primary care physician or get referrals to visit a specialist. However, this plan will decide how much they will pay for your services, as well as how much you will pay.