Start Here: Medicare

If there is anything we can count on at the Resource Center, it’s getting questions about Medicare, particularly from individuals approaching their 65th birthday. Medicare may seem daunting and complex but breaking it down can simplify the whole process. 

If you can make time, we recommend meeting with one of our Medicare Counselors (SHIP Counselors) here at Evergreen Commons. They’re an excellent resource for discussing Medicare questions, options, and getting help enrolling in certain plans. We’ve even written an article about preparing for that meeting, which you can read HERE.  In the meantime, let’s go over some Medicare basics: 

Medicare Parts 

1. Medicare Part A (Hospital Insurance): 

• Coverage: Inpatient hospital stays, skilled nursing facility care, hospice care, and skilled home health care.
• Costs: Most people qualify for Part A without having to pay a premium if they or their spouse paid Medicare taxes while working. However, there may be deductibles and coinsurance costs for services. 

2. Medicare Part B (Medical Insurance): 

• Coverage: Outpatient services, doctor visits, preventive services, and some home health care. It also covers some medical supplies and equipment.
• Costs: Part B typically requires a monthly premium, which is based on your income. There are also deductibles and coinsurance costs associated with Part B services. 

3. Medicare Part C (Medicare Advantage): 

• Coverage: An alternative to Original Medicare (Parts A and B) and is offered by private insurance companies approved by Medicare. It includes all benefits of Part A and B as well as usually including prescription drug coverage. It often includes additional benefits like vision, dental, hearing care, over-the-counter drug coverage, and fitness memberships.
• Costs: Premiums for Part C plans vary by plan and location. These plans often include out-of-pocket maximums, which can help manage costs. 

4. Medicare Part D (Prescription Drug Coverage): 

• Coverage: Prescription drug coverage that is offered through private insurance companies. It helps reduce the cost of medications by covering a portion of prescription drug expenses.
• Costs: Part D plans require a monthly premium, which varies depending on the plan chosen. There are also deductibles and copayments associated with drug coverage. 

Enrollment 

Medicare enrollment begins three months before you turn 65 and continues for a total of seven months—three months before your 65th birthday, the month of your birthday, and three months after. If you’re already receiving Social Security benefits, you’ll be automatically enrolled in Parts A and B. Otherwise, you need to sign up through the Social Security Administration during the Initial Enrollment Period. 

For those under 65 who qualify due to disability, enrollment typically begins 24 months after receiving Social Security Disability Insurance (SSDI) benefits. 

Medigap 

Medigap, or Medicare Supplement Insurance, is offered by private companies and helps cover costs that Original Medicare (Parts A and B) does not, such as deductibles, copayments, and coinsurance. These plans are designed to work alongside Medicare and a stand-alone Part D plan, and they vary in coverage and cost. 

Choosing a Plan 

• Selecting the right Medicare plan involves considering your healthcare needs, budget, and preferences. Follow these guidelines while choosing a plan:
• Assess Your Health Needs: Review your current health conditions and anticipated medical needs.
• Compare Plans: Look at the benefits, premiums, deductibles, and out-of-pocket costs for each plan.
• Consider Prescription Drugs: Ensure that the Part D plan or Medicare Advantage plan you choose covers your necessary medications.