What are the parts of Medicare and when do you first enroll?
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Medicare is divided into parts that cover different kinds of medical costs.
Medicare Part A helps cover most inpatient hospital, skilled nursing home, home health and hospice care. There is a monthly premium for Part A, but many people will qualify for premium-free Part A*.
Medicare Part B covers routine doctor visits, including specialists, to treat your medical conditions. It also covers preventative services, which is healthcare meant to prevent illness (like the flu) or to detect at an an early stage, when treatment is most likely to work best.
Medicare Part A and Part B don’t cover everything.
With Medicare Advantage, Medicare Supplement or Prescription Drug Plan, you’re safeguarded from more out-of-pocket costs. Here are the basics that you need to know.
Medicare Part C (Medicare Advantage) plans work in place of your Part A and Part B benefits. Premiums and costs will vary among plans for copayments, coinsurance and deductibles, so it’s important to compare plans in your area.
- Medicare Advantage (MA) plans have an annual limit on out-of-pocket costs for all medical services.
- MA plans usually include prescription drug coverage (Part D), so you don’t have to enroll in a separate stand-alone drug plan.
- Some plans may also include extra coverage such as vision, including benefits for eyeglasses or contact lenses.
- Some plans cover routine dental care, including cleaning and cavity treatment.
- Some plans cover hearing care, including benefits for hearing aids.
- Insurance companies offering Medicare Advantage plans must follow rules set by Medicare.
- Most MA plans are HMO or PPO plans.
Medicare Part D Prescription Drug Coverage helps cover the cost of prescription medications. It can be purchased in addition to Medicare Part A, B or Medicare Supplement Plans, giving you broader healthcare coverage and may save you money.
- Medicare Part D plans are operated by Medicare approved private insurance companies.
- Part D plans provide prescription drug coverage for both generic and brand name medications.
- The cost of prescription drug coverage varies depending on the plan you choose, which medications you use and if your pharmacy is in network.
- Drugs covered and plans can change from year to year.
Medicare Supplement, also called Medigap, is private insurance that supplements Medicare Parts A and B. It helps pay some health care costs Medicare Parts A and B don’t pay for, such as copayments, coinsurance and deductibles.
- Every Medigap policy follows Federal and state laws to protect you and must be identified as “Medicare Supplement Insurance.”
- In most states, companies can only sell a standardized Medicare Supplement policy.
- Each standardized Medicare Supplement policy must offer the same basic benefits, no matter which company sells it.** This allows you to easily compare premiums and choose the plan that best fits your needs.
- Private health insurance companies sell Medicare Supplement plans.
- You must sign up for Medicare Part B in order to get a Medigap plan.
- You can choose your own Part D drug plan to go alongside the Medigap coverage.
- If you have Medicare Part C, you don’t need a Medigap plan because they can’t be used together.
You must be enrolled in Medicare in order to receive benefits. There are designated times you can enroll in Medicare.
Medicare’s Initial Enrollment Period (IEP) is the seven month period surrounding your 65th birthday and when you should begin to look at Medicare options. Enrollment begins 3 months before your 65th birthday and ends 3 months after.
- If you’re not receiving Social Security or Railroad Retirement benefits, you must sign up for Medicare Parts A and B. Otherwise, you will be automatically enrolled. Most people get Part A without a monthly premium but do have to pay for Part B.
- Even if you don’t plan to retire at age 65, you can still sign up for Medicare parts A and B during IEP and elect more coverage after retirement.
- If you plan to retire later than age 65, you can delay your Part B coverage. You may want to delay Part B coverage if you’re paying for an employer-sponsored insurance plan.
*If you have worked and paid Social Security taxes for at least 40 calendar quarters (10 years)
**There are Medicare Supplement insurance plans available in Texas that have new and innovative benefits as allowed under 28 TAC, 3.3306(3(K).
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