Medicare is a federal health insurance program designed for people aged 65 and older, although certain younger individuals with disabilities or specific medical conditions can also be covered. Medicare is the primary insurance coverage option for most people 65+. 

 

Overview of Medicare Coverage

With different insurance providers, budgets, and coverage choices available, choosing a health insurance plan can be overwhelming. To keep it simple, there are four basic components that comprise Medicare, outlined below.

 

1. Medicare Part A – Hospital Insurance

• Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services.
• Usually you do not pay a premium if you or your spouse paid Medicare taxes while working.

 

2. Medicare Part B – Medical Insurance

• Covers doctor visits, outpatient care, preventive services (like screenings and vaccines), and medical equipment.
• Requires a monthly premium, with your cost varying based on your income.

 

3. Medicare Part C – Medicare Advantage

• Offered by private insurance companies approved by Medicare.
• These plans must cover all services that are covered by Medicare Part A and B, and often include prescription drug coverage (Part D) and additional benefits like vision and dental.
• Plans may have different costs and rules for how you get services, such as whether specialist referrals are needed.

 

4. Medicare Part D – Prescription Drug Coverage

• Available to everyone with Medicare, regardless of income and resources, to help cover the cost of prescription drugs.
• Offered by private insurance companies approved by Medicare.

 

Enrollment and Options

 

Initial Enrollment Period: Generally begins three months before you turn 65, includes your birthday month, and ends three months after your birthday month. So, if your birthday is in July, you can enroll in April, May, June, July, August, September, and October.

 

Special Enrollment Periods: Available for those who qualify due to specific circumstances, like working past 65 and having employer coverage.

 

Annual Enrollment Period: Occurs each year from October 15 to December 7, allowing individuals to review and change their Medicare coverage options.

 

Other Important Things to Know:

 

• Medicare Supplement Insurance (Medigap) may be an option for you: Helps pay for some of the healthcare costs that aren’t covered by Original Medicare, such as copayments, coinsurance, and deductibles [link to resource].
• Income-Related Monthly Adjustment Amount (IRMAA) may apply: Higher-income beneficiaries may pay an additional premium for Part B and Part D coverage.
• Medicare Savings Programs may be available to you: Offered by states to help people with limited income and resources pay Medicare premiums and other costs.

 

Understanding Medicare involves considering your healthcare needs, budget, and preferences to choose the coverage options that best suit you. Each part of Medicare provides different benefits and costs. KC Medicare Simplified will answer your questions and let you decide which option is the best for you and your family [contact link].