Medicare Explained
Medicare is federal health insurance for people ages 65 and over, under 65 with permanent disabilities, and anyone with End-Stage Renal Disease. To know how Medicare works, it helps to review the different parts of Medicare and the services they cover.
What Are the 4 Parts of Medicare?
- Medicare Part A covers hospitalization expenses (Original Medicare).
- Medicare Part B is general medical insurance for outpatient needs (Original Medicare).
- Medicare Part C (Medicare Advantage) includes benefits not covered by Medicare.
- Medicare Part D only covers prescription drugs.
PART A
Inpatient Hospital Coverage
PART B
Outpatient Medical Coverage
PART C
Medicare Advantage Plans
PART D
Prescription Drug Coverage
Medicare Part A Coverage
Any inpatient hospital care falls under Part A coverage. That includes:
- Nursing services
- Hospital stays up to 60 days (semi-private rooms)
- Intensive care services
- Surgery and recovery costs
- Part-time home nursing care
- Rehabilitation and therapy services
- Lab tests and X-rays taken while hospitalized
Medicare Part B Coverage
Part B covers outpatient needs, including:
- Doctor visits
- Necessary medical supplies
- Tests, screenings, and X-rays
- Outpatient mental health care
- Flu shots and other vaccinations
- Medically necessary preventative care
Medicare Part C Coverage
More Medicare benefits can mean more peace of mind. That’s why many folks choose Part C, better known as Medicare Advantage. These private health plans include Parts and B, and many plans include prescription drug coverage (Part D) — along with additional benefits not covered by Medicare, like:
- Dental cleanings and dentures
- Eye exams, glasses, and contacts
- Hearing aids
- Fitness classes
Medicare Part D Coverage
Parts A and B don’t cover prescription medications. Because of that, you can either pick a Medicare Advantage plan that merges with Part D to include prescription drug coverage or a separate Part D plan that solely covers prescription drugs.
Who’s Eligible for Medicare?
We’re a dedicated team of licensed agents with your best interests at heart. We know signing up for the right Medicare or ACA Marketplace plan can be intimidating, but with our years of experience and our empathetic nature, you can rest assured you are in good hands. We strive to provide the best service to our community, and we look forward to serving you.
Can You Qualify for Medicare
Under 65?
Yes. If you’re permanently disabled and have been receiving Social Security Disability Insurance (SSDI) benefits for two years, you qualify for Medicare and will be auto-enrolled in Parts A and B.
If you have End-Stage Renal Disease (ESRD), you’re eligible for Original Medicare regardless of your age. Enrollment is not automatic though, so you’ll need to sign up when you first become eligible for Medicare. You can contact Social Security for more information.
If you have ALS (Amyotrophic Lateral Sclerosis), aka Lou Gehrig’s disease, you’ll be auto-enrolled in Parts A and B the month that your disability benefits begin.
When Should You Enroll?
If you’re applying for the first time, you’ll want to sign up during your Initial Enrollment Period (IEP) — a 7-month window that begins three months before you turn 65 and ends three months after. It’s best to sign up during this time to avoid late penalties and delayed coverage.
3 Months Before
65th Birthday Month
3 Months After
If you already applied for Parts A and B but realize you need to make changes, you can do so during the fall Annual Enrollment Period (AEP) from October 15 through December 7. AEP is your chance to add, drop, or change your Medicare benefits.
Medicare
Costs
If Medicare was nonexistent, healthcare may become very expensive at 65 and beyond. Most people don’t have to pay a premium for Part A because they paid taxes during their working years. Part B premiums are affordable. You can get additional benefits through independent agencies like us to help you cover services and costs that Original Medicare doesn’t cover. There are also certain programs available if you need more help paying Medicare costs.
Medicare FAQ
Are your services free?
Yes! We’re here to serve you and help you make all the right Medicare choices for you and your family.
Are my prescriptions covered by Medicare?
There’s typically a list of covered drugs with most Medicare Plans. Your out-of-pocket costs for prescription drugs will vary plan to plan. Most Medicare Advantage Prescription Drug Plans do cover Rx costs. Alternatively, you can opt for a supplemental standalone plan to assist with prescription costs.
I have a pre-existing condition; can I still get Medicare?
If you have a pre-existing condition, you can enroll in Original Medicare or a Medicare Advantage Plan as long as you sign up during your Initial Enrollment Period. The period is a seven-month window that starts 3 months before the month you turn 65, through 3 months after.
Can I choose my own doctor?
With Original Medicare you can visit any doctor, hospital, or facility that’s enrolled in Medicare and accepting new Medicare patients.