Medicare 101

Medicare provides health insurance benefits for people age 65 years and older, as well as certain people under 65 with disabilities or specific medical conditions. Becoming eligible for Medicare creates a lot of new opportunities – but you need to know how to make the most of them.

1. What does Medicare Part A mean (or Part B, C or D)?

Part A is for Hospital Care

This part of Medicare helps cover inpatient hospitalization, certain care in skilled nursing facilities, hospice care and some home health care. Most people who have been employed for at least 10 years, currently have health care coverage through an employer and paid Medicare taxes qualify for Part A at no cost, but you may still have to pay for some services, including a deductible. 

Part B is for Doctor Visits

Part B helps cover medical services such as visits to a doctor’s office, durable medical equipment and outpatient care. You pay a monthly premium based on income for Part B, which is usually deducted directly from your Social Security check each month. 

Some people refer to Parts A and B as “Original Medicare.”

Part C is a Medicare Advantage Plan

For many people, Medicare doesn’t cover everything they want or need. A Medicare Advantage plan includes the benefits of Parts A and B, but can also offer extra benefits like dental and vision coverage. Some even include Part D prescription drug coverage (see Part D below). You may pay a monthly premium for a Part C plan, and would continue to pay your Part B premium.

There are advantages to a Medicare Part C plan:

• Provides more coverage – one plan provides Parts A, B and C, and may include Part D coverage. 
• May provide coverage for vision care, dental care or hearing aids, as well as other benefits, like a free fitness membership. 
• Eliminates the need to submit claims paperwork.
• One monthly bill.

Part D is Prescription Drug Coverage

Part D is prescription drug coverage that includes many commonly used brand name and generic drugs. Original Medicare does not include any coverage for prescription drugs, but Medicare Advantage plans may include Part D coverage. 

2. When do I qualify for Medicare?

You can enroll in Medicare starting three months before your 65^th birthday. To enroll in Part A and Part B (also known as "Original Medicare"), go to Medicare.gov. To enroll in Part C and Part D, contact a health insurance company. 

3. Do I have to sign up for Medicare?

Yes. If you haven’t signed up for Medicare by your 65^th birthday, you have three more months to shop around and select a Medicare plan. You must be enrolled in Parts A, B and D (or have prescription drug coverage that’s as good as Medicare’s standard plan) in order to avoid possible late enrollment financial penalties. To sign up for a plan, go to Medicare.gov.

4. Once I select a plan, can I change it?

Yes. You can change plans once a year. If the Medicare plan you chose is not meeting your needs, you can change plans, typically in the fall, during the Medicare Annual Enrollment Period (AEP).

5. How do I decide which Medicare plan is right for me?

When deciding your Medicare plan, it’s important to consider your lifestyle, health and goals to ensure your plan meets your needs now and into the future. Make a list of your regular doctors and prescription drugs to make it easy to compare plans. Consider your health care history: What did you pay in the past year? How many times did you go to the doctor? What prescriptions are you taking? Knowing these details will make it easier to find the right plan when you’re ready to enroll.

Here are important questions to ask before selecting your Medicare plan:

Do I need coverage for prescriptions? Original Medicare and Medicare Supplement plans don’t include coverage for prescriptions, so if you choose those, you may need to purchase a separate Part D prescription drug plan. Medicare Advantage plans often include bundled prescription drug coverage without a separate premium.

Do I want coverage for dental, vision, or hearing? Medicare won’t cover routine dental or vision care and it doesn’t include other extra benefits. And while both Medicare Advantage and Medicare Supplement plans may include some of this coverage, only Medicare Advantage plans can include extras like a fitness membership.

Do I need health coverage away from home? Medicare provides no coverage outside the U.S. Medicare Supplement plans offer national coverage for doctors and hospitals along with some coverage outside the U.S. Medicare Advantage plans can offer national coverage, plus worldwide coverage for emergency and urgent care.

Are my doctors in the network? Most plans have a defined network of doctors, so it’s important to check if the doctors and specialists you currently see are included in the network of any plan you are considering.

Does my insurer have a good reputation? Quality of care is very important, so be sure to check the ratings of any plan you’re looking at. 

For more information, go to Medicare.gov.