What is Medicare? Medicare is the nation's largest health insurance program. It's funded by the United States government. It provides high-quality health care to people 65 and over, as well as to people under 65 with certain disabilities.
Will Medicare cover all of my health care costs? There are some costs that Medicare doesn't cover. That's why private insurance companies offer plans with broader coverage. These plans help manage your costs.
How do I decide which plan is right for me? You should think about your answers to the three questions below. +Step 1: Does Original Medicare (Parts A & B) provide enough coverage for me? Original Medicare:
> Helps cover medical and hospital benefits (inpatient and outpatient)
> Gives you your choice of doctors
> Helps cover skilled nursing facility care, home health agency services and hospice benefits
> Pays a percentage of health care expenses after Part A and B deductibles are met
> Doesn't include prescription drug coverage
+Step 2: What kind of additional coverage is available? Medicare Advantage plans (Part C):
> Cover the same services as Original Medicare, but hospice is still covered by Original Medicare
> Are offered by private companies.
> Provide more complete coverage, including medical, often prescription drugs, and may include eyeglasses, hearing aids, fitness club membership and optional dental plan
> May require you to see doctors in their network
> Usually have a monthly plan premium and/or a copayment for covered services
> Require you to have Original Medicare (Part A and Part B) to choose this plan
Medicare Supplement plans (Medigap):
> Help to pay for some health care costs not covered by Original Medicare, including Medicare deductibles and coinsurance payments
> Allow you to use any doctor, specialist or hospital that accepts Medicare patients without needing a referral or precertification
> Are standardized plans provided by private insurance companies, such as Aetna
> Aren't needed or combined with Medicare Advantage plans
> A separate premium required
> Let you take your coverage with you if you move or travel anywhere in the U.S
> Require you to have Original Medicare (Part A and Part B) to choose this plan
+Step 3: Do I need extra coverage for prescription drugs? Prescription drug coverage (Part D):
> Provides prescription drug coverage at a network of contracted pharmacies
> Is provided by private companies, such as Aetna
> Usually has a monthly premium
> May be included as part of a Medicare Advantage plan. Can be added to Original Medicare, Medicare Supplement plans, a Private Fee-for-Service (PFFS) plan without prescription drug coverage, some Medicare Cost Plans, or Medicare Medical Savings Account (MSA) Plans
> Requires you to have Original Medicare Part A and/or Part B to choose this plan. When am I eligible? For the most part, you're Medicare eligible if:
> You're age 65 or older
> You're under 65 with certain disabilities
> You have ESRD (end-stage renal disease – permanent kidney failure treated with dialysis or a transplant) or ALS (Lou Gehrig disease), regardless of your age
You can apply for Medicare:
> Starting three months before your 65th birthday
> The entire month of your 65th birthday
> Ending three months after your 65th birthday
> For a total enrollment period of seven months
It's easy to apply using one of the ways below:
> Sign up for Social Security benefits at your local Social Security office
> Call 1-800-772-1213 (TTY/TDD: 1-800-325-0778), Monday through Friday, 7 a.m. to 7 p.m.
> You'll get your Medicare card in the mail once your eligibility is confirmed. Then you can make your plan selections and enroll in the Medicare plan that’s right for you.
If you already receive Social Security benefits, you don't need to do anything. A Medicare card should be sent to you:
Three months before your 65th birthday or
The 25th month of receiving disability benefits
Overview What type of plan is best for me? There are three types of Medicare plans.
1. The first is managed by the federal government and helps with hospital costs (Part A) and medical bills (Part B). This type is called Original Medicare.
2. The next type is managed by private insurance companies who have a contract with the federal government, like Aetna. Medicare Part C covers the same things as Original Medicare (Parts A and B). Plus it includes additional benefits and may have prescription drug coverage. Part C is also known as Medicare Advantage.
Medicare Part D covers prescription drugs.
3. The last type supplements Original Medicare and is provided by private insurance companies. These plans are health insurance plans called Medicare Supplement and are approved by the individual states. They're often referred to as Medigap plans.