What is Medicare and how does it work?

What is Medicare?

In the U.S.A., Medicare is a federally-managed national health insurance program that typically applies to retired seniors and certain disabled individuals who no longer have access to employer-sponsored health insurance benefits.

Primarily, it is designed to assist these groups of people in paying for medical costs associated with doctor’s appointments, medications, and overall health and wellness. 

Who is eligible for Medicare?

Most typically, one becomes eligible for Medicare upon reaching the age of 65. As stated, however, individuals with certain qualifying conditions (such as a long-term disability or End Stage Renal Disease) may also be eligible for Medicare prior to reaching retirement age.

How do I enroll in Medicare?

Due to its status as a federally-managed health insurance program, you should know that there are some restrictions and limitations pertaining to when one can enroll in Medicare benefits for the first time, or make changes to their existing Medicare plan.

To keep things organized, Medicare enrollment is organized by annual enrollment periods. These enrollment periods are as follows:

  • Initial Enrollment Period (IEP) – This is the time when one first qualifies for Medicare coverage; typically the three months before you turn 65, the entire month of your 65th birthday, and the three months following your 65th birthday. IEP also applies to those who have been recently diagnosed with a qualifying medical condition. During this period, you may enroll in Medicare plans immediately.
  • Annual Enrollment Period (AEP) – This enrollment period runs from October 15th to december 7th at the end of each year. This is the time of year where you can enroll in a new medicare or Medicare Advantage plan.
  • Medicare Advantage Open Enrollment Period (OEP) – This enrollment period begins on January 1st at the start of each year, and lasts until March 31st. During Medicare Advantage Open Enrollment, you may either switch to a new Medicare Advantage plan or revert from Medicare Advantage to Original Medicare coverage, but you are not permitted to enroll in a Medicare Advantage plan for the first time, or exchange your Original Medicare plan for a Medicare Advantage plan.

Understanding the Different Parts of Medicare

While the Medicare program has been a lifeline for millions of Americans over the course of it’s nearly six-decade existence, many people are surprised to learn that the Medicare program is actually made up of four different parts, each of which are responsible for providing different levels of coverage for various medical needs.

The four parts of Medicare are described in detail below:

Medicare Part A:

Medicare Part A is one half of what is known as “Original Medicare” coverage. Typically, Part A acts as hospital insurance, covering medically necessary treatment and services received in a hospital setting, such as inpatient surgery.

Medicare Part B:

Medicare Part B is the other half of “Original Medicare”. This part of Medicare acts as medical insurance, covering much of the costs associated with treatment and services received in a doctor’s office and certain outpatient settings, in addition to medical equipment needs.

Medicare Part C:

Also known as Medicare Advantage, Medicare Part C plans are offered by private insurance companies. These plans include all of the same benefits you would have under Original Medicare, and often a few additional benefits for services and treatments that Original Medicare does not cover, such as vision, dental, and hearing needs.

Keep in mind that because Medicare Part C plans are offered by private insurance companies, their exact pricing, benefits, and availability can vary. 

Medicare Part D: 

Medicare Part D encompasses the Prescription Drug Coverage portion of Medicare. Typically, Medicare Part D plans are included in many Medicare Advantage plans. However, Medicare Part D can also be had as a standalone coverage option should you so desire.

How can I determine which Medicare plan is right for me?

The inner workings of Medicare and Medicare Advantage can be quite complex, but with expert-level assistance from experienced, friendly licensed insurance agents, such as those available at MedicareInsurance.com, you can get assistance with researching and comparing all of your available medicare options.

Just contact MedicareInsurance.com today to learn more!

Leave a Comment