Understanding Medicare: 7 Basics for Health Insurance.

By Justin Herland – Medicare Specialist

Founded in 1965, Medicare is a federal health insurance program that ensures eligible participants have access to essential services for diagnosis, treatment and rehabilitation – regardless of income. Coverage extends to those 65 years and older, as well as certain vulnerable individuals with disabilities or end-stage renal disease.

1. Know your A, B, C & D

   Medicare is comprised of four different parts: A, B, C and D. Parts A and B are considered to be “Original Medicare,” with Part A automatically being available to participants who are signed up for Social Security benefits. Here’s how the different parts are broken down:

   Part A
   Part A mostly covers inpatient hospital stays, but it also includes hospice and some skilled nursing facility care. Fun fact: Most people don’t have to pay a premium for Part A if they or their spouse have paid Medicare taxes for 40 or more quarters throughout their career.

   Part B
   Part B takes care of basic medical needs, including doctor visits, ambulance services, outpatient work, lab tests, preventive care and more. There’s a monthly premium, which can usually be deducted from Social Security benefits.

   Part C
   Part C, commonly referred to as “Medicare Advantage,” offers personalized plans through private insurance companies that provide the same coverage as Parts A and B, but with additional benefits. It comes with different rules, costs and restrictions than Parts A and B.

   Part D
   Also available through private insurance companies, Part D helps with prescription drug costs. It’s available as a standalone plan or in association with Part C.

2. Factor in age & enrollment

   When it comes to signing up for Medicare, timing is key. The initial enrollment period lasts for seven months, starting three months prior to your birthday month when you turn 65. Actual coverage begins the first day of your birthday month, unless your birthday happens to be on the first day of that month, in which case your coverage would start on the first day of the previous month. You can make non-supplemental changes each year during the enrollment periods outlined here:

   Special enrollment
   If you miss your initial enrollment period, you may be eligible for a special enrollment period, which is tied to certain life events such as loss of employer coverage, delayed retirement, a move or qualifying for Medicaid.

   Medicare Advantage open enrollment
   This annual period lasts from January 1 to March 31, allowing individuals already enrolled in a Part C plan (Medicare Advantage) to make changes to their coverage.

   Medicare supplement open enrollment
   During this six-month period, which begins when you’re both 65 and enrolled in Part B, you have the green light to purchase any qualifying Medicare supplement policy (also referred to as “Medigap”).

   Annual election period
   Also referred to generally as “open enrollment,” this time frame allows beneficiaries to make changes to both their Part C (Medicare Advantage) and Part D plans. It runs from October 15 to December 7.

3. Avoid penalties

   Be sure to sign up for Medicare on time to avoid any late penalties! A great way to make sure you don’t miss anything is to contact a knowledgeable Medicare advisor who will guide you along the way.

4. Consider the costs

   While Part A is usually free, there are costs like premiums, deductibles and copays for the other Medicare parts. And remember – a supplemental policy can give you extra coverage!

5. Shop around with us!

   It’s important to find a plan that fits your needs. For example, some plans have networks of doctors and hospitals, while others give you more freedom to choose. By talking with your Medicare advisor, you’ll have a better understanding of what works best for you.

6. Have peace of mind – anywhere

   Are you a snowbird during the colder winter months? Or maybe you have a fun vacation coming up? Don’t worry about coverage while traveling! Medicare will still cover you in the U.S., and some plans even help if you have a medical emergency abroad.

7. Schedule a regular check-up

   Remember to meet with your Medicare advisor at least once a year. This will allow you to talk through any questions or concerns you may have about your coverage.