Medicare 101 – The Bullet Points

This is the 1st of 3 basic Medicare educational modules.


Go Forward to Medicare 102 – Medicare Advantage

How Medicare Works and who is eligible

  • MEDICARE IS A FEDERAL PROGRAM THAT OFFERS HEALTH INSURANCE TO AMERICAN CITIZENS AND OTHER ELIGIBLE INDIVIDUALS. THE PROGRAM IS OFTEN REFERRED TO AS ORIGINAL MEDICARE. IT HAS TWO PARTS — PART A AND PART B
  • LEGAL RESIDENTS MUST LIVE IN THE U.S. FOR AT LEAST 5 YEARS IN A ROW, INCLUDING THE 5 YEARS JUST BEFORE APPLYING FOR MEDICARE.

You must also meet one of the following requirements

  • AGE 65 OR OLDER
  • YOUNGER THAN 65 WITH A QUALIFYING DISABILITY
  • ANY AGE WITH A DIAGNOSIS OF END STAGE RENAL DISEASE (ESRD) OR AMYOTROPHIC LATERAL SCLEROSIS (ALS)

What benefits does Original Medicare provide?

  • PART A COVERS INPATIENT HOSPITAL AND SKILLED NURSING CARE
  • PART B COVERS DOCTOR VISITS, OUTPATIENT CARE, AND SOME DRUGS ONLY COVERED BY PART B

What are my coverage options?

You can add coverage to Original Medicare or choose to enroll in a Medicare Advantage plant instead.

ORIGINAL MEDICARE

You can add a standalone Part D plan (prescription drug plan), a Medicare supplement plan or both combined to Original Medicare (Part A and B).

Your options include:

  • Parts A + B
  • Parts A + B plus a Part D prescription drug plan
  • Parts A + B plus a Medicare Supplement Insurance (aka Medigap) plan
  • Parts A + B plus a Part D prescription drug plan and a Medigap plan combined

OR

MEDICARE ADVANTAGE

You may decide to receive your coverage through a Medicare Advantage plan (commonly known as Part C). Many plans include built-in prescription drug coverage.

Your options include:

  • Part C without drug coverage
  • Part C with Part D prescription drug coverage built-in
  • Part C with a standalone Part D prescription drug plan in certain situations

When can I enroll?

  • YOUR INITIAL ENROLLMENT PERIOD, COMMONLY REFERRED TO AS YOUR IEP, IS 7 MONTHS LONG. IT BEGINS 3 MONTHS BEFORE YOUR 65TH BIRTHDAY, THE MONTH OF YOUR 65TH BIRTHDAY, AND CONTINUES FOR THREE MONTHS AFTER.
  • YOUR IEP WILL BEGIN AND END ONE MONTH EARLIER IF YOUR BIRTHDAY IS ON THE FIRST OF THE MONTH.
  • YOU MAY ALSO HAVE AN IEP IF YOU ARE CURRENTLY RECEIVING BENEFITS FOR A QUALIFYING DISABILITY FOR 24 CONSECUTIVE MONTHS.
  • YOU SHOULD BE ENROLLED IN PART A AND B AUTOMATICALLY AT AGE 65 IF YOU ARE RECEIVING SOCIAL SECURITY OR RAILROAD RETIREMENT BOARD BENEFITS. YOUR CARD WILL BE MAILED TO YOU BY MEDICARE.

Reprinted with permission from Walden Insurance Services

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