The Basics of Medicare
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As you approach age 65, it’s normal to have anxiety about Medicare decisions. You’ll have several different plans/options to choose from when the time comes, plus there are application timelines to keep in mind.
Instead of putting your Medicare choices off until the last minute, use our handy guide to navigate your options, determine when to apply and get a sense of which plans could be best for you.
Who’s Eligible for Medicare?
Most people are eligible for Medicare once they’re 65, but you might qualify sooner if you have a disability: if you have End-Stage Renal Disease, or Lou Gehrig’s disease (ALS).
How to Apply for Medicare
If you’re receiving retirement or disability benefits from Social Security at least four months before you turn 65, you’ll automatically be enrolled for Medicare Part A and B. If not, you have to sign up.
You can sign up for Medicare during the seven-month Initial Enrollment Period. This timeframe starts three months before you turn 65 and lasts until three months after the month of your birthday. So for example, if you turn 65 on January 15 of 2024, you can sign up between October of 2023 and April of 2024.
You can apply for Medicare by calling 1-800-772-1213, or by following these steps online:
- Visit SSA.gov to create a my Social Security account.
- Answer a series of questions to verify your identity.
- Provide requested information, such as details of your taxes and income and your bank account information (for direct deposit).
- If requested, provide your Social Security representative with follow-up information about your application.
- Receive your Medicare card with your Medicare Number.
- Visit Medicare.gov to create a Medicare account and join a plan or buy supplemental coverage.
What Happens if I Miss the Initial Enrollment Period for Medicare?
If you miss the Initial Enrollment Period, you may end up facing several unfortunate penalties for the rest of your life. The longer you wait to enroll, the pricier the penalties can get. They can include:
- Having to wait even longer to sign up for Medicare.
- A penalty of 10% for each year you could have signed up for Part B but didn’t, charged monthly for as long as you have Part B coverage.
- An additional penalty if you have a Part A premium.
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What Does Medicare Cover?
According to Medicare.gov, Medicare covers services that are “medically necessary.” But each of the four Medicare plans covers different medical needs. Here’s a breakdown of the plans:
Original Medicare
Original Medicare includes Medicare Parts A and B. You can use this coverage when you visit any doctor or hospital in the U.S. that accepts Medicare.
Part A
Premium: $0 for most people
You’ll be automatically enrolled in Medicare Part A (Hospital Insurance) when you turn 65. Part A helps cover inpatient care in hospitals and skilled nursing facilities, as well as hospice and certain home health care services.
Part B
Premium: $174.70 or more per month in 2024, but it varies annually and based on income
Like Part A, you automatically get Medicare Part B (Medical Insurance) when you turn 65. Part B can help cover services you receive from doctors and other providers, including preventative screenings, diagnostics and treatment.
Additional Coverage
Depending on your needs, you may elect to buy additional coverage beyond Original Medicare. These are the options you can choose from:
Part C
Premium: Varies based on the plan you choose.
Also known as Medicare Advantage plans or MA plans, Medicare Part C is an alternative to Original Medicare that’s offered by private companies.
Part C plans include all the benefits of original Medicare, plus extra coverage, such as hearing, vision or dental, and they often have lower premiums. It can be hard to find a good Part C plan, however, since you’ll be limited to in-network doctors, and Part C providers are notorious for deceptive and fraudulent tactics, including denying necessary care.
If you need help choosing an MA plan or making other Medicare decisions, you can contact the Medicare Rights Center at 800-333-4114.
Part D
Premium: $55.50 or more per month in 2024, but cost varies annually by plan and based on your income.
Medicare drug coverage, or Part D, is available through private providers to help cover the cost of prescription drugs. Each plan has its own list of what drugs are covered under the plan, also known as a formulary.
You can choose to add Part D to your original Medicare plan as long as you have either Part A or Part B.
Medicare Supplemental Insurance
Premium: Varies by policy, location and more.
You can buy Medicare supplemental Insurance, also known as Medigap, Plan G or Plan K, from private insurance companies as long as you have Part B. This supplement helps cover your share of Original Medicare costs, and may include coverage for copayments, coinsurance and deductibles.
What if I Can't Afford Medicare?
If you’re cash-strapped, there are programs that can help with your Medicare expenses. Medicare has four Medicare Savings Programs (MSPs) that cover some or all of the Part A or Part B premiums, and potentially your deductibles, coinsurance and copayments. You can check through your state to see if you qualify for one of these programs based on your income.
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