About Medicare

How does Medicare work?

All Medicare eligible individuals begin with Original Medicare, which consists of Part A and Part B.

Most individuals who are approaching age 65 must enroll in some form of Medicare coverage in order to avoid incurring significant out-of-pocket expenses.

Individuals who are receiving Social Security Disability (SSDI) benefits will be automatically enrolled in Original Medicare.

When considering which Medicare plan will meet your unique needs, it’s important to understand the different Parts of Medicare and how each Part works together.

Original Medicare options

Medicare Part A
known as “hospital insurance”

What’s covered:

  • Inpatient care in a hospital
  • Skilled nursing facility care
  • Hospice care
  • Home healthcare

Medicare Part B
known as “medical insurance”

What’s covered:

  • Doctor visits
  • Medically necessary services
  • Outpatient services
  • Preventive care

It is important to note that Original Medicare – Parts A and B – has no limits on out-of-pocket expenses, however, by enrolling in a Medicare Advantage Plan (Part C) you may be able to limit your maximum out-of-pocket expenses.

Additional plans offered through private insurers

Medicare Advantage Plan
known as “Part C” or “MA Plans”
An alternative to Original Medicare which combines Medicare Part A, Part B, and often Part D, and which also includes additional benefits such as routine dental, vision, or hearing coverage.
Medicare Part D
known as “Medicare drug coverage”
Provides prescription medications and drug cost coverage.
Medicare Supplemental Plan
known as “Medigap”
Medigap is insurance designed to work with Original Medicare. Original Medicare does not cover all of the costs associated with covered healthcare services and supplies. Medigap can cover some of the remaining healthcare costs, such as coinsurance, deductibles, and copayments.

Get a free consultation with an experienced licensed agent to discuss
which Medicare plan meets your individual needs.

Get a free consultation with an experienced licensed agent to discuss which Medicare plan meets your individual needs.

How do I enroll?

If you are not already receiving SSDI benefits, you will need to take one of the following actions to enroll in Original Medicare:

If you are currently enrolled in Part A and want to enroll in Part B, you will need to complete an Application for Enrollment in Medicare Part B form (CMS-40B). Download the form here.

Contact us to discuss your options and enroll
in additional plans beyond Original Medicare.

Contact us to discuss your options and enroll in additional plans beyond Original Medicare.

Frequently asked questions

When do I enroll in Medicare?

Upon approaching eligibility for Medicare at age 65, you can enroll in a Medicare Plan three months before, the month of, or three months after your Medicare entitlement date. For Supplement Plans, the enrollment period lasts five months after your entitlement date.

Upon becoming eligible for Medicare because you have received 24 months of SSDI benefits, you will be automatically enrolled in Part A and Part B.

What happens if I miss my enrollment period?

If you do not fully understand your Medicare enrollment options and you choose the wrong plan or do not enroll during the allotted enrollment period, you may find yourself incurring significant out-of-pocket expenses. If you enroll late in certain Parts of Medicare, you will have to pay a penalty each time you pay your premiums, for as long as you are enrolled.

I already have health insurance. Do I have to sign up for Medicare?

It depends. Medicare rules allow you to delay enrollment in Medicare Part B and Medicare Part D without penalty if you are covered by an employer group health plan that covers 20 or more employees – so long as that health coverage is based on your or your spouse’s current, active employment. If your other health insurance coverage is NOT based on the current, active employment of yourself or a family member, it is likely that you will need to enroll in Medicare. We recommend that you follow up with your current health insurance provider to see if it is required that you enroll in Medicare Part B when you become entitled.

I am on a fixed monthly income. Can I get help paying for Medicare?

It’s possible. The Low-Income Subsidy (LIS) program, also known as “Extra Help,” is available to help pay a portion of Part D prescription drug costs, including premiums, copayments, and deductibles, for certain people with low income and minimal assets. Depending on your income and assets, the Extra Help program may provide a full or partial subsidy. Some people are automatically enrolled in the Extra Help program, while others must apply for the subsidy.

What is the difference between Medicare and Medicaid?

Medicare is a federal health insurance program for people age 65 and older, people under age 65 who receive SSDI benefits, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). Your income does not affect your eligibility for Medicare. Medicaid, on the other hand, is a joint federal and state program that helps with medical costs. To qualify for Medicaid, you must have low income and limited resources.

Can my spouse and family also receive Medicare coverage?

No, Medicare is not offered as a family or dependent benefit. People must qualify on an individual basis. For example, a person under age 65 does not receive Medicare automatically because their spouse turns 65 and enrolls in the Medicare program.

What is the difference between Medicare Advantage and Medigap?

While there are several types of Medicare coverage, two of the most common are Medicare Advantage and Medicare Supplement – also known as Medigap – plans. While both pay for expenses not covered by Original (“Governmental”) Medicare, you cannot be enrolled in both Medicare Advantage and Medigap coverage simultaneously, as they each serve different functions. There are also several important distinctions between Medicare Advantage and Medigap that you should know if you are looking to enroll in Medicare.

Learn more: What is the difference between Medicare Advantage and Medigap?

Is Medicare expensive?

While Medicare costs can add up fast depending on an individual’s needs and coverage selections, it is a myth that Medicare is unaffordable or that it is always more expensive than other forms of healthcare coverage. In fact, many people are surprised to discover that Medicare can lower their medical expenses. There are customizable options available for individuals considering Medicare, and these are worth exploring with the guidance of an experienced Licensed Insurance Agent to better understand all the Medicare available options and their associated costs.

Learn more: Is Medicare expensive?

Get your free consultation with an experienced licensed insurance agent.