What is Medicare?

MedigapMedicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage RenalDisease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

The different parts of Medicare help cover specific services:

Medicare Part A (Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance)

Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.

Medicare Part C (Medicare Advantage Plans)

A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B 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 offer prescription drug coverage.

Medicare Part D (prescription drug coverage)

Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans.  These plans are offered by insurance companies and other private companies approved by Medicare.  Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

When & how to sign up for Part A & Part B

You may qualify for Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) if one of the following applies to you:

  • I'm already getting benefits from Social Security or the Railroad Retirement Board (RRB).
  • I'm under 65 and have a disability.
  • I have ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig's disease).
  • I live in Puerto Rico and get benefits from Social Security or the RRB.

If you get Medicare automatically

If you're automatically enrolled, you'll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday or your 25th month of disability.

Some people need to sign up for Part A & Part B

You need to sign up for Part A and Part B if:

  • You aren't getting Social Security or Railroad Retirement benefits (for example, because you're still working).
  • You qualify for Medicare because you have End-Stage Renal Disease (ESRD).
  • You live in Puerto Rico and want to sign up for Part B (you automatically get Part A).You must already have Part A to apply for Part B.

When will my coverage start?

If you sign up for Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) during the first 3 months of your Initial Enrollment Period, your coverage starts the first day of your birthday month, unless your birthday is on the first day of the month.

Example

Mr.  Green's 65th birthday is July 20, 2015.  If he signs up for Medicare in April, May, or June, his coverage will start on July 1, 2015.

If your birthday is on the first day of the month, your coverage starts the first day of the prior month.

Example
Mr.  Kim's 65th birthday is July 1, 2015.  If he signs up for Medicare in March, April, or May, his coverage will start on June 1, 2015.

When will my Medicare coverage start?

If you sign up for Part A/ B in this month: Your coverage starts:
The month you turn 65 1 month after you sign up
1 month after you turn 65 2 months after you sign up
2 months after you turn 65 3 months after you sign up
3 months after you turn 65 3 months after you sign up
During the January 1–March 31 General Enrollment Period July 1

Your Medicare coverage choices

There are 2 main ways to get your Medicare coverage - Original Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C).  Use these steps to help you decide which way to get your coverage:

You can choose Original Medicare.

Here are some things you should know:

What is Original Medicare?
Part A (Hospital Insurance) and Part B (Medical Insurance).

Who provides coverage?
Medicare provides this coverage.

How do you choose your providers?
You have your choice of doctors, hospitals, and other providers that accept Medicare.

Who pays the premiums?
You usually pay a monthly premium for Part B.

Who pays deductibles and coinsurance?
Generally, you or your supplement coverage pay deductibles and coinsurance.

You can choose a Medicare Advantage Plan (like an HMO or PPO).

Here are some things you should consider about Medicare Advantage Plans:

What is it?
Part C – includes both Part A (Hospital Insurance) and Part B (Medical Insurance).

Who provides coverage?
Private insurance companies approved by Medicare provide this coverage.

How do you choose your providers?
In most plans, you need to use plan doctors, hospitals, and other providers or you pay more or all of the costs.

Who pays the premiums?
You usually pay a monthly premium (in addition to your Part B premium).

Who pays deductibles and coinsurance?
You may pay a copayment or coinsurance for covered services.  Costs, extra coverage, and rules vary by plan.

Step 2: Decide if you want prescription drug coverage (Part D)

You choose Original Medicare.

If you want this coverage, you must choose and join a Medicare Prescription Drug Plan.  You usually pay a monthly premium.

These plans are run by private companies approved by Medicare.

You choose a Medicare Advantage Plan.

If you want prescription drug coverage, and it's offered by your plan, in most cases you must get it through your plan.

In some types of plans that don't offer drug coverage, you can join a Medicare Prescription Drug Plan.

Step 3: Decide if you want supplemental coverage (Original Medicare only)

You may want to get coverage that fills gaps in Original Medicare coverage.  You can choose to buy a Medicare Supplement Insurance (Medigap) policy from a private company.

  • Costs vary by policy and company.
  • Employers/unions may offer similar coverage.
Note
If you join a Medicare Advantage Plan, you can't use Medicare Supplement Insurance (Medigap) to pay for out-of-pocket costs you have in a Medicare Advantage Plan.  If you already have a Medicare Advantage Plan, you can't be sold a Medigap policy.  You can only use a Medigap policy if you disenroll from your Medicare Advantage Plan and return to Original Medicare.


Source: Medicare.gov

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