Understanding Your Medicare Options

Understanding your Medicare options is vital to getting the healthcare you need and deserve. Read a guide about understanding your Medicare options today.

Understanding your Medicare options is vital to getting the healthcare you need and deserve. If you are age sixty-five or older you are automatically enrolled in specific Medicare coverages. People with qualified disabilities are also eligible to enroll albeit with more procedural steps and application requirements. Conceptually, Medicare is basic enough to understand. The details of each Medicare part and their overall enrollment process are complex, however. Read ahead for a comprehensive guide on understanding your Medicare options today.

Medicare 101 - Who Qualifies?

Medicare eligibility involves both simple and complex aspects. The program consists of four major sections or programs, which are labeled as parts. The first two parts were established in 1965 and together comprise “Original Medicare.” The second two parts (Parts C and D) were added to the program in 1997 and 2006 respectively. Every U.S. citizen who paid taxes is automatically enrolled Medicare Parts A and B when they turn sixty-five. Part A is free to enrollees with a verifiable tax payment history during their working years. Part B requires a paid premium and is slightly more complicated. Qualified people are still enrolled in Part B automatically when they turn sixty-five but an option is provided for them to defer or opt out of their enrollment status. Parts C and D also both require paid premiums. All premium prices are determined based on prior taxes paid, income and additional factors.

Medicare eligibility is not entirely dependent on age. Any U.S. resident who has received verifiable Railroad Retirement Board disability benefits for a minimum of twenty-four months after retiring from a Railroad job is also enrolled in Part A for free. U.S. residents suffering from Lou Gehrig’s disease (ALS), End-Stage Renal Disease (ESRD) or who otherwise received Social Security benefits for a minimum of twenty-four months are also eligible for free Part A coverage. 

When Can I Apply for Medicare Benefits? (Medicare Open Enrollment Periods)

Medicare enrollment begins automatically for some people but this is not true for everyone or for all coverage options. The enrollment process for all four parts is similar, albeit with a few distinct differences. Open Enrollment is conducted over the same dates and lengths of time every year (barring extensions for major disasters or events). Applications must be submitted either online, in-person or via U.S. mail during the appropriate Open Enrollment period for each applicable part.

Commencement of the Initial Enrollment Period (IEP) begins seven months prior to your sixty-fifth birthday. The IEP continues for three months past your sixty-fifth birthday. Medicare Part C is more commonly referred to as Medicare Advantage. General Enrollment for Medicare Advantage is conducted between January 1 and March 31 of each year. The Special Enrollment Period (SEP) is conducted February 15 and May 15 of each year for people who failed to complete their IEP for approved reasons. The Open Enrollment period conducted between October 15 and December 7 is dedicated to current enrollees who need to add new plans or change their already-existing coverages.

Every Medicare applicant must also have a valid active Social Security Administration (SSA) account. Recipients of Social Security Disability Income (SSDI) must submit all SSDI-related documentation during online Medicare enrollment processes. All online applications are accepted via the Medicare.gov website. Additional information including how and where to apply in-person or via mail is available by calling your local Social Security office at 1-800-772-1213 (TTY 1-800-325-0778).

Medicare Parts A, B, C and D - An Overview

Medicare Part A is the primary Medicare coverage option and is free for most enrollees who paid taxes as required before reaching retirement. Applicants with qualified mental or emotional disorders or disabilities are also potentially eligible for free Part A coverage. Services and expenses Part A covers (at no cost to you) include inpatient hospital stays and related treatments due to debilitating diseases, traumas, accidents, illnesses, and injuries. Hospice stays are also covered under Part A at no charge. Part A is purchasable for approximately $250-$450 per month for those unqualified to receive it for free.

Medicare Part B covers specified terminal or otherwise serious illnesses and diseases. Coverage includes the treatments pursuant to those illnesses and diseases or causing the need for hospice care. Part B premiums cost an average of $144.60 per month but do not include additional coinsurance, copay and deductible expenses. 

Medicare Part C (Medicare Advantage) is available to people already enrolled in Parts A and B. Part C includes coverages and features found in both Part A and B along with additional features. Part C premiums cost between $33 and $500 per month and plans are sold on the open market through third-party insurance providers. Certain dental, vision, hearing and health and wellness programs are covered by Part C in addition to limited prescription coverage. Part C is only free to enrollees with qualified debilitating disabilities. 

Medicare Part D covers prescription medications. Premiums and out-of-pocket expenses vary based on numerous factors including your income and if you have additional benefits or assistance pursuant to paying for medications via third party plans. 

Medigap - Overview and Benefits

Medigap, also referred to as Medical Supplemental Insurance, is a way to obtain Medicare coverage if you do not otherwise qualify for it. Medigap also helps pay for out-of-pocket costs your Part A, B, C or D plans do not cover. Essentially, Medigap is a supplementary coverage option to use in addition to the primary four parts of Medicare. What does Medigap pay for? Medigap covers deductibles, copayments, coinsurance and potential other expenses not covered in parts A, B, C or D. What is Medigap’s primary benefit? Medigap helps ensure you have complete healthcare coverage when you need it most by paying for expenses other elements of Medicare do not. Plans are sold on the open market by private insurance companies, which you can find by entering your zip code and following the prompts provided HERE

Nationwide Insurance Providers Selling Medicare Plans Today

Medicare is facilitated by the U.S. federal government but paid plans are still available for purchase on the open market. The Affordable Care Act (ACA) helped created the Health Insurance Marketplace, where plans are sold at wide variety of prices. The State Health Insurance Assistance Programs (SHIP) and MedicareSupplement.com are reliable resources for locating plans for sale. A few top nationwide Medicare insurance providers include: