The ABCs may be as easy as 1, 2, 3, but the ABCs of Medicare can be confusing! Especially for someone new to Medicare health plans. Here are the ins and outs of what you need to know about those Medicare ABCs!
What is Medicare?
Before we get into the different parts of Medicare, let’s define what Medicare is and who qualifies.
Medicare is a federal public health insurance program for people 65 and older or those with specific medical conditions. Medicare plans cover most medical needs, but there are differences in coverage between Original Medicare, Medicare Advantage Plans, and Medicare Supplemental “Medigap” insurance policies.
You are eligible for Medicare coverage if you are:
- 65 years old or older.
- Under 65 with permanent kidney failure on dialysis or needing a transplant.
- Under 65, permanently disabled, and have collected Social Security disability benefits for 24 months before applying.
Medicare ABCs
Medicare programs offer coverage for different types of medical services and care. These are broken into parts, labeled by letters, the ABCs of Medicare, and they include:
Part A covers inpatient hospital and skilled nursing facility visits and stays, and some limited home health care options. Most people do not pay for Part A. If you don’t sign up for Part A when you’re first eligible for Medicare (usually when you turn 65), you might pay a penalty.
Part B covers medical care, such as visits to see your primary care provider (PCP) or a specialist. It also covers most home health care options. Together, Part A and Part B make up what is sometimes called Original Medicare. There is a premium for Part B coverage. The amount can change year to year. You might pay a penalty if you don’t sign up for Part B when you’re first eligible for Medicare.
Part C, also known as a Medicare Advantage plan, includes Part A and Part B coverage through a private insurance company. Monthly premiums vary based on which plan you join. The amount can change each year. Medicare Advantage plans often include Part D coverage for prescription drugs and extra benefits like dental, hearing, and vision coverage, and more. You must continue to pay your Part B premium to stay in a Medicare Advantage plan.
Part D covers your prescription drugs. Part D usually comes with Medicare Advantage plans, but not with Original Medicare. If you don’t sign up for Part D, you may have to pay a penalty. Part D monthly premiums and deductibles depend on the plan you choose. Your actual costs vary depending on the medicines you take, if they are on your plan’s list of covered drugs, and which pharmacy you use.
When to enroll?
There are different times during the year when you can sign up for Medicare, join a Medicare Advantage Plan, or switch Medicare Advantage Plans. These include:
- Initial Enrollment: If you are about to turn 65 and are signing up for Medicare for the first time, initial enrollment begins three months before your 65th birthday and goes through three months after your 65th birthday.
- Open Enrollment: During this annual enrollment period, from October 15 – December 7, you can:
- Join, drop, or change to another Medicare Advantage Plan.
- Switch your coverage from Original Medicare to a Medicare Advantage Plan, like a Community First Medicare Advantage Plan.
Did You Know? There are important differences between Original Medicare and Medicare Advantage Plans. Take a look at our comparison chart here: Original Medicare vs. Medicare Advantage
How to sign up?
- Medicare beneficiaries can enroll in a Medicare Advantage plan at Medicare.gov.
- If you have Medicare and Medicaid, you can also enroll in a Dual Eligible Special Needs (DSNP) Medicare Advantage Plan at Medicare.gov.
Community First Health Plans offers Medicare Advantage HMO Plans to residents of Bexar County and surrounding areas with $0 monthly premiums, plus extra benefits like dental, vision, hearing, and even a grocery allowance for individuals with chronic health conditions. Learn more about our plans at CommunityFirstMedicare.com or call 1-833-434-2347 to speak with a licensed broker who can help you enroll.
Remember, your health is your greatest wealth! The Medicare plan you choose should offer you the coverage you need to stay healthy.