Are you turning 65 soon, or are you under 65 and eligible for Medicare due to a disability? Understanding Medicare can help you make informed decisions about your healthcare coverage. Here’s a breakdown of how Medicare works, what it covers, and when to enroll.
What Is Medicare?
Medicare is a federal health insurance program primarily for:
✅ People 65 and older
✅ Individuals under 65 with certain disabilities
✅ Those with End-Stage Renal Disease (ESRD) or ALS
Medicare is made up of different parts that cover specific healthcare services:
Medicare Part A (Hospital Insurance)
✔ Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care.
✔ Most people don’t pay a premium if they (or their spouse) worked and paid Medicare taxes for at least 10 years.
Medicare Part B (Medical Insurance)
✔ Covers doctor visits, outpatient care, preventive services, and durable medical equipment.
✔ Has a monthly premium and a deductible before coverage begins.
Medicare Part C (Medicare Advantage Plans)
✔ Offered by private insurance companies approved by Medicare.
✔ Combines Part A, Part B, and often Part D (prescription drug coverage) in one plan.
✔ May offer additional benefits like vision, dental, and hearing coverage.
✔ Costs and coverage vary by plan and location.
Medicare Part D (Prescription Drug Coverage)
✔ Helps cover the cost of prescription medications.
✔ Available as a standalone plan or included in Medicare Advantage (Part C) plans.
✔ Each plan has a formulary (list of covered drugs), premiums, deductibles, and copays.
When to Enroll in Medicare?
Your enrollment period depends on your age and eligibility:
🗓 Initial Enrollment Period (IEP):
✅ Starts 3 months before your 65th birthday and ends 3 months after.
✅ Sign up for Part A and/or Part B during this time to avoid late penalties.
🗓 Special Enrollment Period (SEP):
✅ If you have employer coverage, you may delay Part B and enroll later without a penalty.
✅ SEPs are also available for those under 65 with disabilities or special circumstances.
🗓 Annual Enrollment Period (AEP) (Oct. 15 – Dec. 7):
✅ This is when you can switch, join, or drop a Medicare Advantage or Part D plan.
🗓 Medicare Advantage Open Enrollment (Jan. 1 – Mar. 31):
✅ If you’re already in a Medicare Advantage Plan, you can switch plans or return to Original Medicare.
What Original Medicare Does NOT Cover
Medicare doesn’t cover everything. Some common exclusions include:
❌ Long-term care (nursing home care)
❌ Most dental, vision, and hearing services
❌ Cosmetic procedures
❌ Prescription drugs (unless you have Part D or a Medicare Advantage plan that includes it)
If you need additional coverage for out-of-pocket costs, you may consider:
✔ Medicare Supplement (Medigap) policies
✔ Medicare Advantage (Part C) plans with extra benefits
How to Get Help With Medicare?
✅ Visit Medicare.gov or call 1-800-MEDICARE for official information.
✅ Contact your State Health Insurance Assistance Program (SHIP) for free, unbiased Medicare counseling.
✅ If considering private plans, work with our licensed agent who follows CMS marketing rules and provides clear, accurate information.
Understanding Medicare can feel overwhelming, but knowing your options will help you choose the right coverage for your healthcare needs!
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