There are many terms to understand and options to consider when it comes to Medicare insurance. Here’s a guide to help you make better sense of it all.
Medicare Insurance Explained
Medicare is a federal health insurance program that pays for a variety of health care expenses and services such as hospitalizations, physician visits, prescription drugs, preventative services, skilled nursing facility and home health care as well as hospice care. It was created for people ages 65 and over, regardless of income, medical history or health status. It also covers those under age 65 who have a long-term disability.
Medicare Parts and Plans
Medicare Part A and Part B, also known as Original Medicare, only covers about 80% of your medical expenses. Medicare Part C, Part D or a Medicare Supplement plan can give you a safeguard against high out-of-pocket costs for services not covered by Original Medicare.
Medicare Part A (Hospital Insurance)
Medicare Part A covers most inpatient hospitals, skilled nursing homes, home health and hospice care. There is a monthly premium for Part A, but many people will qualify for a premium-free Part A.*
Medicare Part B (Medical Insurance)
Medicare Part B covers routine doctor visits, including specialists to treat your medical conditions. It also covers preventative services, which is meant to prevent illness (like the flu) or to detect at an early stage, when treatment is likely to work best.
Medicare Part C (Medicare Advantage Plans)
Medicare Part C—also known as Medicare Advantage plans—are an alternative to Original Medicare, offering at least the same benefits but can often include additional coverage such as routine vision or dental benefits, prescription drugs or health wellness programs.
Medicare Part D (Prescription Drug Plans)
Medicare Part D, also referred to as Medicare Prescription Drug Plans, provides Medicare beneficiaries access to retail prescription drugs at affordable copays. Part D plans are operated by Medicare-approved private insurance companies and are available to everyone who has Medicare. A Medicare Part D plan can be purchased either as a standalone plan to supplement Medicare Parts A and B or to accompany a Medicare Supplement Insurance plan.
Medicare Supplement Plans
Medicare Supplement plans—also known as Medigap Insurance—help cover the gaps in coverage from Original Medicare. In most states, there are eight Medicare Supplement plans to choose from and all policies have been standardized. Medicare Supplement insurance plans are available through private insurance companies and are denoted by the letter A through N (plans C, E, F, H, I and J are no longer sold).
Additional Medicare Coverage Options
When it comes to coverage for routine dental care, Original Medicare does not offer coverage for annual exams, cleaning, crowns, bridges or dentures. However, a Medicare Advantage Plan may offer routine dental care or another viable option is a stand-alone dental plan.
When it comes to Medicare coverage and vision, Original Medicare also doesn’t cover routine vision care such as annual exams, eyeglasses or contacts. Medicare Part B can sometimes cover a handful of services related to vision needs like eye exams for diabetic patients, glaucoma tests and macular degeneration tests and treatment. Similar to dental, Medicare Advantage might include routine vision care and there are also stand-alone vision insurance options that are available.
Original Medicare also does not cover the cost of hearing exams or hearing aids. A Medicare Advantage plan may offer hearing aid coverage for certain device purchases through approved vendors. If you’re on Medicaid, you may be covered for hearing aids spending on your coverage plan and wear you live. There are also affordable over-the-counter options for seniors with mild hearing loss.
Medicare Enrollment Periods
Each year, there are five set times you can enroll in a Medicare plan or change your existing coverage.
Medicare Initial Enrollment Period (IEP)
The Medicare Initial Enrollment Period begins three months before the month your 65th birthday and continues through the three months following. This is the first time you can enroll in Medicare Part A and Part B.
Medicare Annual Enrollment Period (AEP)
The Medicare Advantage and Prescription Drug Plan Annual Enrollment Period (AEP) runs from October 15-December 7 each year. Medicare plan details often change annually, so it’s a good idea to compare your Medicare plan options during this time each year to make sure your health and prescription drug needs are covered. During this period, Medicare recipients can:
- Switch from Original Medicare (Part A and Part B) to a Medicare Advantage plan (Part C).
- Change from one Medicare Advantage plan to another Medicare Advantage plan.
- Switch from one Prescription Drug plan (Part D) to another.
- Add a Prescription Drug plan if you didn’t enroll when first eligible for Medicare.
Medicare Advantage Open Enrollment Period (OEP)
The Medicare Advantage Open Enrollment Period (OEP) takes place from January 1-March 31 each year. During this period, Medicare Advantage participants can make a one-time plan change. This opportunity allows Medicare Advantage enrollees to:
- Switch to a different Medicare Advantage Plan
- Drop a Medicare Advantage plan and return to Original Medicare (Part A and Part B)
- Sign up for a stand-alone Medicare Part D Prescription Drug plan, if electing to return to an Original Medicare plan
Medicare Special Enrollment Period (SEP)
The Medicare Special Enrollment Period (SEP) takes place when certain events or life changes occur, giving Medicare beneficiaries the opportunity to make changes to their existing Medicare Advantage and Medicare Prescription Drug coverage. There are several types of Medicare Special Enrollment Periods with different qualification standards for each. Some of the most common Special Enrollment Period events for Medicare Advantage include:
- Moving to a new address that isn’t in your current Medicare plan’s service area
- Moving to a new location where new Medicare plan options are available, even though your current Medicare plan also includes coverage for your new address
- Returning to the U.S. after living outside the country
- Moving in or out of a skilled nursing facility or long-term care hospital
- Being released from jail
Medicare General Enrollment Period (GEP)
The Medicare General Enrollment Period runs from January 1-March 31 each year. This period provides an enrollment opportunity for individuals who didn’t sign up for Original Medicare (Part A and Part B) when they were first eligible.
Let SelectQuote help answer your Medicare questions today.
We specialize in helping consumers understand the ins and outs of Medicare. We can ensure you’re getting all of the available Medicare benefits you deserve. In just minutes, we can compare all the Medicare options available for you. There’s no obligation to enroll.
*This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
SelectQuote is a licensed and certified representative of a Medicare Advantage HMO, PPO and PFFS organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any plan depends on contract renewal.
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