What are the Different Parts of Medicare?
Hospital coverage under Part A includes hospital services, home health services, hospice, nursing home care, and skilled nursing facility care.
As long as you or your spouse was employed and paid Medicare taxes or you are eligible for Social Security benefits, you will not have to pay a Part A premium. Most people will be automatically enrolled in Part A and will then have to enroll themselves in a Part B plan.
Doctor coverage under Part B includes items like wellness visits, tests, illness checkups, ambulance travel, durable medical equipment (DME), mental health, and more. As long as you see an eligible doctor, you will not have to pay for preventative services, like yearly wellness checkups.
Everyone will have a Part B premium. You will receive a bill for your premium every month. If you receive Social Security or Railroad Retirement benefits, your premium will be automatically deducted from your benefit check. Your premium costs depend on your income level.
Medicare Advantage is an option that combines Part A and B together and adds additional coverage options like prescription drugs (Part D), dental, and vision. They often include incentives like SilverSneakers, a group fitness program for seniors & medicare eligibles. Like Part B, you will be charged a premium.
For Medicare Advantage plans, you will have to choose between an HMO (one primary physician), an HMO-POS (one primary physician but visit any specialist), a PPO (see any doctor, but preferred are cheaper), and PFFS (see any doctor, but not all accept PFFS).
Even though it’s separate from Parts A and B, you are required to purchase prescription drug coverage. You can purchase a Part D plan in addition to your Original Medicare (Parts A and B), which provides prescription drug coverage only, or you can purchase a Medicare Advantage plan.
Prescription Drug plans will have premiums and copayments, just like Part B.
If you do not have Medicare Advantage and you need help paying for Medicare, a Supplement plan may be right for you. Medicare Supplements, also known as Medigap, will provide coverage for your coinsurance, copayments, and deductibles. You will pay a monthly premium.
Some benefits are not included in the aforementioned Medicare plan options. You can, however, buy an extra plan just to cover services like dental, vision, hearing, hospital indemnity, cancer, heart attacks, and strokes.
Life insurance and final expense products are two popular ancillary insurance options that you can purchase during any time of year, no matter what your Medicare eligibility status is.
When Can I Enroll in Medicare?
Initial Enrollment Period (IEP)
The initial enrollment period is the first time you’re eligible for Medicare. You can sign up for Part A and/or Part B then.
You have a 7-month period to enroll. It centers on your 65th birthday. It includes:
- The three months before your birthday month
- Your birthday month
- The three months after your birthday month
If you were born on the first day of the month, Medicare uses the previous month as your birthday month.
For example, if your birthday is August 1, your initial enrollment period is from April 1 to October 31. If your birthday is August 11, your initial enrollment period is from May 1 to November 30.
During your initial enrollment period, you can enroll in either:
- Part C (Medicare Advantage), with or without prescription drug coverage, once you have Medicare Part A and Medicare Part B
- Part D (prescription drug coverage only) once you have Part A or Part B
Once you have Original Medicare (Parts A and B), see if Part C or Part D is right for you.
Annual Enrollment Period (AEP)
Every year from October 15 - December 7, those who are eligible for Medicare (age 65 and up or disabled) can make changes to their coverage or enroll in a new plan.
During this time period you can:
- Join a new Medicare plan
- Change your Medicare plan
- Drop your Medicare plan and return to Original Medicare
If you change plans during this enrollment period, your new coverage begins January 1.
You don't need to re-enroll each year if your current Medicare plan meets your needs.
Special Enrollment Period (SEP)
Those who face special circumstances or receive financial assistance are generally granted an SEP. This means that if you qualify, you can enroll or make changes to your Medicare plan at any time during the year. Qualifications include but are not limited to:
- Moving outside of your coverage zone
- Switching jobs or leaving a job
- Medicaid eligibility changes
- Extra Help eligibility changes
- SNP (special needs plan) eligibility changes
- Moving into our out of a skilled facility
- Leaving imprisonment
- Your plan stops working with Medicare