Someone who is:
A U.S citizen or legal resident for at least 5 consecutive years
And is one of the following:
- Age 65 or older
- Younger than 65 with a qualifying disability
- Any age with a diagnosis of end-stage renal disease or ALS
Medicare Part A (Hospital Insurance) covers:
- Inpatient hospital care
- Inpatient mental health care
- Skilled nursing services
- Hospice care
- Some blood transfusions
Medicare Part A is known as your basic Medicare coverage. Most people who stay with just Part A do not pay a monthly premium. Individuals can not be turned down because of their medical history or a pre-existing condition. However staying with only your basic Medicare options, individuals run the risk of paying out of pocket for some medical expenses. For example, stays of more than 60 days require a daily co-pay. Also, for those who like to travel, hospital care outside the U.S. isn't usually covered.
Medicare Part B (Doctor and Outpatient visits) covers:
- Physician services
- Outpatient hospital services
- Outpatient mental health
- Laboratory services
- Durable medical equipment (wheelchairs, oxygen, etc.)
- Outpatient physical, occupational and speech-language therapy
- Some preventive care
Medicare Part B must be obtained in an individuals eligibility period. If an individual elects to wait until after their eligibility period to obtain Part B they will encounter a 10% penalty for as long as they have Part B. The monthly premium of Part B is determined by an individuals income. However, Part B offers no out-of-pocket maximum.
Combining Medicare Part A and B does not fully cover everything you may need. For the additional costs individuals may opt to get one of the below plans.
Medicare Part C (Medicare Advantage Plans) covers:
- Combines Part A and Part B and, in many cases, includes prescription drug coverage
- Offered by private insurance companies
- Often include additional benefits like routine vision care, hearing, wellness services and nurse phone line support
Part C brings the convenience over coverage to one single plan. Individuals who are covered with a Medicare Advantage Plan are often limited to a service area unless it is an emergency. This also means that you may be required to see doctors and hospitals that are included in your plan's network.
Medicare Part C offers the following types of plans:
Health Maintenance Organization (HMO) plans
Preferred Provider Organization (PPO) plans
Special Needs Plans (SNP)
Health Maintenance Organization Point of Service (HMO-POS) plans
Medicare Part D (Prescription Drug Plans) covers:
- Helps with the cost of prescription drugs
- Only offered through private insurance companies
- You must continue to pay your Part B premium
Prescription drugs are classified into a tier category. The lower the tier the less expensive the medication will be. Coverage for prescription drug plans will vary from plan to plan. Therefore, individuals obtaining prescription drug coverage should make sure their medications are covered prior to enrolling in a plan.
Medicare Supplement Insurance Plans
- Help cover some of what Medicare Parts A and B don’t
- Offered by private insurance companies
- Plans are named A, B, C, D, F, G, K, L, M, N, and a high‑deductible Plan F
- Benefits vary by plan
- Generally, the more comprehensive the coverage, the higher the premium
- Massachusetts, Minnesota and Wisconsin have different standardized plans than the other states
Medicare Supplement Insurance Plans, also known as Medigap plans, help to fill the gaps that are not covered by traditional Medicare. Individuals have a monthly premium and coverage goes with you anywhere in the U.S. Those who are interest in a Medicare Supplement Insurance Plan must be enrolled in Medicare Parts A and B, reside in the state in which you are applying for coverage and be 65 or older (under 65 may obtain a plan with certain disabilities). Anyone who has end-stage renal disease may also apply for a Medicare Supplement Insurance Plan.
First, an individual needs to enroll in original Medicare, secondly they will need to decide on what additional coverage they may need. There are different enrollment periods throughout the year that help individuals sign up for a Medicare Plan.
Medicare Initial Enrollment Period (IEP):
This period is for individuals who are turning 65 and wish to sign up for Parts A, B, C and D. Individuals who are turning 65 will be eligible to enroll in the month of their birthday along with 3 months prior and 3 months after their birthday.
New to Medicare: Working Beyond 65:
Not all individuals are ready to sign up for Medicare as soon as they turn 65. Some may still be working. In this instance an individual may be eligible for a Special Enrollment Period (SEP). The SEP may allow individuals to enroll in Parts A and B for up to eight months after the month their employment or employer health insurance ends, whichever happens first. It may also allow individuals to enroll in a Medicare Advantage plan or Prescription Drug plan up to two full months after the month their employment or employer health insurance ends, whichever happens first.
Medicare Supplement Open Enrollment:
This period lasts for 6 months and begins on the first day of the month in which an individual is both 65 or older and enrolled in Medicare Part B.
Medicare Open Enrollment Periods:
Commonly referred to as Open Enrollment Period (OEP) or Annual Enrollment Period(AEP), this time happens between October 15th - December 7th. During this time those who have Medicare Advantage Plans are free to switch to another Medicare Advantage plan without any penalties.