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Medicare doesn’t have to be complicated.
Medicare is broken down into parts known as: Part A, Part B, and Part D. Additional coverage, known as Medicare Advantage is referred to as Part C, or all-in-one insurance. It gets this name because Part C incorporates many of the other benefits of Medicare, along with some additional services. Part C, along with MedSupp, and Medicare + Medicaid, cover out-of-pocket expenses original Medicare does not.
Let’s take a closer look at Medicare, and all of its parts.
Who gets Medicare?
If you’re an adult 65+ you’re eligible for Medicare. People with disabilities who are under 65 are also able to enroll. You can first sign up for Medicare 3‑months before you turn 65, the month of your 65th birthday, and 3- months after. You can also choose to enroll in a Medicare Advantage plan, Part D or Medicare Supplement plan.
Medicare Annual Enrollment falls between October 15th and December 7th. This is the time that any Medicare recipient can choose to enroll in or change their Medicare Advantage plan or Part D. This is the only time of year that these changes can be made unless you’re eligible for a Special Election Period.
Special Enrollment Period
Once the initial enrollment period ends, you can still sign up during a Special Enrollment Period (SEP). There is usually no penalty if you sign up during this time. You’re eligible for SEP if you are:
- Covered by a group health plan based on current employment
- Or if your spouse or family member is working
You also have an 8‑month SEP to sign up for Medicare that begins at the onset of one of these two events:
- A month after your employment ends
- Or a month after your group health insurance plan ends
Breaking down the parts
Part A, known as hospital insurance
You receive Part A automatically when you turn 65, and after at least 10 years of work. It has a $0 monthly premium. It covers:
- Skilled nursing facilities
- Hospital visits
- Home healthcare
Part B, known as medical insurance
Part B covers 80% of all medical costs not covered by Part A, and typically carries a monthly premium. However, unlike Part A, you need to elect Part B when you turn 65. It covers:
- Doctor visits
- Preventative services
- ER visits
- Outpatient procedures
- Durable medical equipment
- And more
Part D, known as prescription drug coverage
You need to enroll in Part D when you turn 65. Waiting will cost you extra. Part D comes with:
- An average monthly premium of $35
- Deductibles and copays depend on plan selection
Medicare + Medicaid
It is possible to have both Medicare and Medicaid, if you qualify. This means, Medicare is your primary coverage and Medicaid becomes your secondary coverage. This is called “dual eligible”. Having dual coverage generally will not cost you anything more, and comes with additional benefits, as well:
- Over-the-counter drug benefits
- And more
These plans are usually $0 per month with $0 copays. You must stay in the plan’s network, but people with Medicare and Medicaid are not restricted to Medicare’s open enrollment, so you can enroll into this plan or change plans quarterly.
Shop, compare, and learn more about the Medicare plans in your area
Coverage for the unexpected.
Original Medicare alone does not cover everything, meaning your out-of-pocket expenses may cost more than expected. Medicare Advantage may help keep those expenses down.
Part C, known as Medicare Advantage often covers:
- Part A, Part B and Part D
- Gym memberships
- And more
These services may come at little to no cost, with fixed copays, so you’ll know how much you need to pay before anything is done. Plus, these plans usually come with maximum out-of-pocket limits and premiums that never rise.
Another way of covering expenses original Medicare doesn’t is through a MedSupp or Medigap plan. These plans work with Medicare and generally pay 20% of the coinsurance and a large part of the Part A deductible.
- Plans do not offer extra benefits besides what you already receive with original Medicare
- Plans do not cover Part D
- Monthly premiums typically run $180 — $500 per month
- Your network will remain the same as your Medicare network
- Enrollment occurs any time of the year
- If you sign up after you turn 65, any pre-existing conditions can factor into higher premiums and even being denied coverage