Medicare 101

Medicare 101

Oct 16, 2023

Medicare Plans


What is Medicare?


Medicare is a federal health insurance program in the United States, primarily for people age 65 or older. However, certain younger individuals with disabilities or specific diseases, such as end-stage renal disease (permanent kidney failure requiring dialysis or a transplant), can also qualify.

Parts of Medicare:


Medicare is divided into different parts, each covering specific services:


  1. Part A (Hospital Insurance):
  • Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
  • Most people don't pay a premium for Part A because they or a spouse paid Medicare taxes while working.

  1. Part B (Medical Insurance):
  • Covers certain doctors' services, outpatient care, medical supplies, and preventive services.
  • There's a monthly premium for Part B, which can vary based on income.


  1. Part C (Medicare Advantage Plans):
  • Offered by private companies approved by Medicare.
  • Includes both Part A and Part B coverage.
  • Often includes prescription drug coverage and other benefits not covered by original Medicare.
  • Comes with a premium in addition to the Part B premium.
  1. Part D (Prescription Drug Coverage):
  • Offered by private insurance companies approved by Medicare.
  • Helps cover the cost of prescription medications.
  • Requires a separate premium.


Medicare Supplement Insurance (Medigap):

  • Sold by private companies.
  • Helps cover some out-of-pocket costs that Original Medicare doesn't cover.
  • Separate from a Medicare Advantage Plan. You can't have both at the same time.

Enrollment:

  • Initial Enrollment Period (IEP): Starts three months before you turn 65, includes the month you turn 65, and ends three months after you turn 65. It's advisable to enroll during this time to avoid potential penalties.
  • General Enrollment Period: If you miss your IEP, you can sign up from January 1 to March 31 each year, but you may face late penalties.
  • Special Enrollment Periods: Allow you to enroll outside the IEP or General Enrollment Period under specific circumstances, such as losing other health coverage.

Costs:

  • Medicare isn't free. Beneficiaries typically have to pay premiums, deductibles, and co-payments.
  • Costs vary based on the coverage you choose, where you live, and other factors.

Who Runs Medicare?

  • The Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. federal government, administers Medicare.
  • Social Security offices handle enrollment.

Conclusion:

Medicare offers a range of health coverage options for eligible individuals. It's essential to research and understand these options, especially during the enrollment periods, to select the best coverage for your needs and financial situation.


This overview is a very basic introduction to Medicare. If you're considering Medicare coverage, it's important to delve deeper into each section, as the details, rules, and regulations can be complex.