Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD). Although Medicare has a lot of moving parts Medicare Parts A and B are the formation of Original Medicare.
Medicare Part A (Hospital Insurance)
Part A includes basic functions of insurance such as inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Keep in mind Part A may require a monthly premium for those who haven’t paid into social security for at least 10 years.
Medicare Part B (Medical Insurance)
Part B helps to cover medically necessary doctor’s expenses, outpatient care, and preventative services like seasonal flu shots and other vaccines. Part B does come with a monthly premium that can be deducted from a social security check every month.
Am I eligible?
Before you can enroll into a Medicare plan you must first make sure you’re eligible.
Most people are automatically eligible if they are 65 years or older and either themselves or a spouse has worked for the past 10 years while paying into social security. You may also be eligible if you’re already getting benefits from social security or the Railroad Retirement Board. People are also eligible under 65 if they have ESRD or other certain disabilities.
When Can I enroll?
Initial Enrollment period. If you are turning 65 and have received your Medicare Card you have 7 months to choose a Medicare Advantage Plan. Your Initial Enrollment Period will begin 3 months before the month of your 65th birthday, the month of your birthday, and 3 months after your 65th birthday.
Open Enrollment Period (OEP)
Every year from October 15th- December 7th you can renew, review, and enroll into a plan of your choosing.
Medicare Part C (Medicare Advantage Plans)
Medicare Advantage Plans are health plans offered by private insurance companies that contract with the government to provide Medicare Parts A and B, as well as extra benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans also offer prescription drug coverage.
Health Maintenance Organization (HMO)
In most HMOs, you must choose a Primary Care Physician (PCP) and use in-network providers. In this type of plan you are traditionally required to obtain an authorization prior to receiving specialty services.
Preferred Provider Organization (PPO)
In a PPO you have the option of accessing services both in-network and out-of-network. However, the cost shared by the beneficiary and the provider will be higher for out-of-network providers.
Special Need Plans (SNP)
These types of plans are designed to service groups and limit enrollment for people with Medicare that meet specific qualifications:
Chronic Special Need Plans (C-SNP)
Dual Special Need Plans (D-SNP)
Institutional Special Need Plans (I-SNP)
Am I eligible for Medicare Advantage Plan?
In order to qualify for a Medicare Advantage Plan you must meet the following criteria:
You must have Medicare Part A (Hospital) & Medicare Part B (Medical)
You must live in a zip code covered by the Medicare Advantage Plan
You must not have End Stage Renal Disease (ESRD)
When Can I Enroll?
Initial Enrollment period
If you are turning 65 and have received your Medicare Card you have 7 months to choose a Medicare Advantage Plan. Your Initial Enrollment Period will begin 3 months before the month of your 65th birthday, and 3 months after your 65th birthday.
Open Enrollment period (OEP)
Every year from October 15th – December 7th you can renew, review, and enroll into a Stand Alone PDP or a MAPD that includes a PDP.