Medicare Explained
As you begin nearing age 65 which will mark your eligibility for Medicare, it’s important that you understand the different parts of Medicare and when you should enroll.
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Original Medicare
Original Medicare is made up of two parts: Part A and Part B. Part A is your hospital insurance and will provide coverage for:
✔ Inpatient hospital care
✔ Home health care
✔ Hospice care
✔ Skilled nursing facility care
✔ Nursing home care (not long-term care)
Part B is your medical insurance and will provide coverage for:
✔ Outpatient medical care
✔ Ambulance services
✔ Durable medical equipment
✔ Medicare necessary services
✔ Mental health services
✔ Preventive services
You don’t have to have both parts of Original Medicare, but having both just increases your coverage and gives you the chance to add on other Medicare plans, such as Medicare Supplement plans.
Medicare Supplement (Medigap) plans will provide coverage for out-of-pocket costs that are not covered by Original Medicare, which can include coverage for deductibles, copayments, coinsurance, excess charges, and more.
Medicare Advantage
Medicare Advantage is also known as Medicare Part C. This part of Medicare will provide the same coverage as Original Medicare, but will also include additional benefits such as:
✔ Prescription drug coverage
✔ Dental, vision, or hearing coverage
✔ Adult daycare services
✔ Transportation services to doctor visits
✔ Gym memberships
✔ Nutrition and wellness programs
✔ And more
To enroll in a Medicare Advantage plan, you must first be enrolled in Original Medicare and live within the plan’s service area.
Medicare Part D
Medicare Part D is the prescription drug coverage plan of Medicare. You can enroll in Part D if you are already enrolled in either Part A or Part B. Each plan must cover two drugs from each class. They are also required to cover all drugs in these categories:
✔ Immunosuppressants
✔ Anticonvulsants
✔ Antipsychotics
✔ Anticancer
✔ Antidepressants
✔ HIV/AIDS drugs
Enrollment Periods
Now that you have an understanding of how the coverage works with each part of Medicare, let’s go over the enrollment periods you should know.
- Initial Enrollment Period (IEP)– This period starts three months before you turn 65 and then ends three months after you turn 65. You can enroll in Original Medicare, Medicare Advantage, or Part D during this period.
- General Enrollment Period (Jan. 1 – March 31) – Missing your IEP means you can enroll during the General Enrollment Period. Take note that enrolling during this period could cause you to pay late enrollment penalties.
- Special Enrollment Period – You can also enroll in Medicare during the Special Enrollment Period if you missed your IEP because of a special circumstance. You won’t have to pay late enrollment penalties by enrolling in this period.
- Annual Enrollment Period (Oct. 15 – Dec. 7) – This period gives you the opportunity to review your Medicare coverage each year and make changes if necessary. You can switch, drop, or enroll in new plans.
Hamil Legacy Will Find You The Coverage You Need
We understand how important it is for you to get the coverage you need. That’s why we’re here to help! Our services are available and no cost to you so you can put your overall focus into getting the best coverage that meets your unique needs and personal budget. For more information about Medicare and how we can help you, give us a call today at 972-332-8054!