Medicare

Medicare is a federal health insurance program primarily for people aged 65 and older, though it also covers certain younger individuals with disabilities and those with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). It consists of different parts, each covering specific healthcare services:

The Four Parts of Medicare

1. Medicare Part A (Hospital Insurance)

• Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

• Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes while working.

2. Medicare Part B (Medical Insurance)

• Covers outpatient services, doctor visits, preventive care, durable medical equipment, and some home health services.

• Requires a monthly premium, which is income-based.

3. Medicare Part C (Medicare Advantage)

• Offered by private insurance companies approved by Medicare.

• Combines Part A and Part B coverage and often includes prescription drug coverage (Part D), vision, dental, and other benefits.

• Typically has a network (HMOs or PPOs).

4. Medicare Part D (Prescription Drug Coverage)

• Helps cover the cost of prescription medications.

• Offered through private insurance companies as a standalone plan or included in Medicare Advantage.

Medicare Supplement (Medigap) Insurance

• Private insurance policies that help cover out-of-pocket costs like deductibles, copayments, and coinsurance for Original Medicare (Parts A & B).

• Available only to those enrolled in Original Medicare (not Medicare Advantage).

Enrollment & Costs:

• Initial Enrollment Period (IEP): Begins three months before turning 65 and ends three months after.

• General Enrollment Period: January 1 – March 31 each year if you missed your IEP.

• Special Enrollment Periods (SEP): Available in specific situations, such as losing employer coverage.

• Costs vary based on income, coverage choices, and additional plans selected.