What to Know Before Enrolling in Medicare

Medicare is the government-sponsored health coverage for people who are 65 years of age or older or those who are under 65 but are disabled. People whose spouses have worked at least 10 years in the United States or people who have received SSDI benefits for two years may be eligible for both Part A and Part B coverage. There are four parts of Medicare.

Part A
This is also known as hospital coverage, and it compensates for inpatient hospital visits, some extended home health care and skilled nursing care.

Part B
This is the medical insurance part of Medicare, which covers doctor visits and most outpatient treatments. It also covers some home health care, physical therapy and medical equipment.

Part C
This is the Medicare Advantage Plan, and private insurers with Medicare contracts offer it. Part C coverage may be offered as POS, PPO, HMO or MSA plans. It may also be offered in a plan featuring fees for services. There are more benefits than found in original Medicare in Part C coverage, and there are low premiums or no premiums depending on circumstances and insurers. Copay amounts and out-of-pocket maximums vary.

Part D
This form of Medicare coverage applies to prescription drugs. It may be combined with Part C coverage or purchased as a standalone policy. The types of drugs covered and the percentages vary from one insurer to another, and the premiums also vary depending on several factors.

How To Enroll In Original Medicare

During the three months before a person turns 65, he or she can apply for Medicare. The best way to do this is to discuss the details with an agent. Every person’s circumstances vary, and agents can recommend options that will fit each person’s needs best. In addition to Advantage plans, there are also supplemental plans and retiree plans. After being approved for Medicare, coverage will begin on the first day of the following month. People who do not enroll in Part A, Part B and Part D when eligible may be subject to a penalty for late enrollment, which is added to the premium amount. It is important to note that Part C and Part D plans have regulated enrollment, so there are open enrollment periods. These usually occur during the fall each year. In most states, enrollment can occur during any time of the year for Part A and Part B. Failing to apply on time will result in medical questions being asked for these parts. However, Part C and Part D plan sponsors cannot ask medical questions aside from whether a person has been diagnosed with end-stage renal disease.

How Much Does Each Part Cover?

Coverage amounts are subject to change from one year to the next, so it is best to discuss the current copay amounts, coverage limits and out-of-pocket limits for each plan with an agent. Premiums will vary depending on circumstances and plan details. Some people may also be eligible for extra help. People who have low income may qualify for special plans that pay the Part B premiums or offer reduced fees for prescription drugs through Part D. To learn more about these options, discuss concerns with an agent.

Not all people may need full Medicare coverage. Those who have employer-sponsored health plans may not need coverage from multiple Medicare parts. In some situations, people who are working may be able to delay their Medicare enrollment. Individuals who receive Railroad benefits or Social Security will automatically receive their cards, but a person does not have to be receiving Social Security to sign up for Medicare.

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