10 key facts you should know about Medicare
Choose Original Medicare (Part A and Part B), with the option to add a prescription drug plan (Medicare Part D) and/or a Medicare supplement insurance plan (also known as a Medigap plan) for more complete coverage. Or choose a Medicare Advantage (Medicare Part C) plan that combines Part A and Part B coverage with additional benefits, such as coverage for dental, vision and hearing care, into one plan. Many Medicare Advantage plans also include Part D prescription drug coverage. Once you’ve made this decision, it’s time to compare plans and pricing and make a selection that meets your needs.
Original Medicare doesn’t include prescription drug coverage. That’s where Medicare Part D comes in. You can add Medicare Part D prescription drug coverage as a standalone plan or you can choose a Medicare Advantage plan that includes prescription drug coverage.
Important: You may have to pay a penalty if you sign up for Part D coverage after your Initial Enrollment Period (IEP) unless you qualify for Extra Help. However, if you have had other prescription drug coverage at least as good as Medicare (also known as creditable coverage), and have not been without that coverage for more than 63 days, you may not have to pay the higher premium. .
How much does Medicare cost? You contributed to Medicare by paying taxes while you worked. When you enroll in Medicare, you and Medicare share the cost of the care you receive. You'll pay your share through monthly premiums, deductibles, copays or coinsurance. The amount you pay depends on the plan and coverage you choose.
Many people who choose Original Medicare add a Medicare supplement insurance plan, which helps with the deductibles, copays and coninsurance that Original Medicare charges. Others choose a Medicare Advantage plan, which can also help fill these gaps.
The benefits that you get with Original Medicare (Parts A and B) from the federal government are the same across the United States. However, Medicare Advantage, Medicare Part D and Medicare supplement insurance are all offered by private insurance companies, and the benefits and costs may vary depending on where you live.
You’ll find that each part of Medicare has things it doesn’t cover. Understanding Medicare will help you decide on the coverage that's right for you.
Reviewing your or your loved one's current health coverage can help you decide what you want in a Medicare plan. For example, if you have group coverage from your current job, or retiree insurance from a former employer, you'll want to see how this coverage works with Medicare. Ask your benefits administrator for advice on next steps based on your individual situation.
Your Medicare Initial Enrollment Period (IEP) begins three months before the month you turn 65 or when you become eligible for Medicare due to disability. If you wait until after your IEP to join, you may find you'll pay more and have fewer choices.
Once you choose your Medicare coverage, you're not locked into that choice forever. You'll have the chance to change your choices during the Medicare Annual Enrollment Period (AEP). AEP is October 15 through December 7 each year. Your health status and your budget can change in a year. That's why it makes sense to review your coverage annually to see if it still fits your needs.
Help is available for everyone making Medicare choices. And financial assistance programs can help with the cost of Medicare for people with limited income and assets. Choosing your Medicare plan is an important decision. Talking through your options with an expert can help you find the coverage that's right for you.
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Original Medicare (Parts A and B) automatically includes prescription drug coverage (Medicare Part D).
Parts A and B are federal health insurance programs and are often used together to cover hospital and outpatient care. They're both part of Original Medicare.
Medicare Part D prescription drug coverage is offered by private insurance companies and must be purchased separately. It can be paired with Original Medicare, or with certain Medicare Advantage (Part C) plans. Most Medicare Advantage plans come with prescription drug coverage already built into the plan.
Medicare supplement insurance (Medigap) plans help pay for some of the things Original Medicare (Parts A and B) does not cover, such as out-of-pocket costs or coverage when you travel out of state or outside the U.S.
Original Medicare helps pay for hospitalization, skilled nursing and outpatient care, but it doesn't pay for everything. Medicare supplement insurance plans can help fill in the gaps. They're offered by private insurance companies, so plans vary by state and you may have many choices. Be sure to check what's available in your area.
Medicare Advantage (Part C) plans provide the same level of coverage as Original Medicare (Parts A and B) and often Part D prescription drug coverage and other extras.
Medicare Advantage plans include the same benefits as Medicare Part A and Medicare Part B, and may include extras like eyeglasses, dental coverage, hearing coverage or even gym memberships. In many cases, they also include prescription drug coverage (Medicare Part D). Because these plans are offered by private insurance companies, plans will vary, so compare carefully.
Original Medicare (Parts A and B), Medicare Advantage (Part C) plans and Medicare Part D prescription drug plans offer the same coverage nationwide. Medicare supplement insurance (Medigap) plans vary by state.
Original Medicare is a federal health insurance program and provides the same coverage no matter where you live.
Medicare Advantage, Medicare Part D and Medicare supplement insurance plans are issued through private insurance companies, so different plans will be available in each state. Medicare supplement insurance plans and benefits are standardized by federal law, so every insurer’s Medicare supplement insurance Plan A is identical to every other insurer’s Plan A, and the same for every other Medicare supplement insurance plan in turn. The exceptions are Massachusetts, Minnesota and Wisconsin (known as the “waiver” states), which have their own standardized plans.
Once you enroll in Medicare, you must give up any other health care coverage you have.
If you have employee, retiree or union health care coverage, check with your plan administrator to discuss the best arrangement for your situation. You may want to sign up for Medicare Part A regardless of having other coverage, since it's usually premium free.
You can choose to disenroll from Medicare Part B when you're first eligible to delay having to pay the Part B premium. If this is the case, you can sign up for Part B during the Special Enrollment Period (SEP) after your employer coverage ends. Your SEP is 63 days from the day you retire or lose your employer health insurance, whichever comes first.
It's possible that your current plan complements what you'll get with Medicare. In any case, you don't need to give up your outside coverage once you enroll in Medicare.
You can enroll in Medicare without penalty anytime after you turn 65.
For most people, you're eligible to first enroll in Medicare during your Initial Enrollment Period (IEP), 3 months before your 65th birth month*, during your birth month, and 3 months after your birth month. If you miss your IEP, there are still opportunities to enroll, but you may pay higher premiums or have fewer plan choices unless you qualify for an exception.
*If your birthday is on the first day of the month, your Part B coverage will start the first day of the prior month. If this is true for you, use the month before you turn 65 as your birth month.
Learn more about enrollment by exploring this site.
You have an OEP for Medicare supplement insurance in all states that begins when you are first enrolled in Medicare Part B at age 65 or older. It begins the month you enroll in Part B and ends six months later. Many states provide an OEP for beneficiaries under age 65, which begins the month you enroll in Medicare Part B and ends six months after. You can apply for a Medicare supplement insurance plan at any time after your OEP as well, but you could be denied coverage or pay a higher premium.
You can switch Medicare plans once a year during the Annual Enrollment Period (AEP) from October 15 through December 7.
You can change your plan choices without penalty during the AEP each year, so it's a good idea to review your coverage annually. (You may also switch from a Medicare Advantage plan back to Original Medicare from Jan. 1st through Feb. 14th.)