Medicare coverage varies. It includes four parts, and there’s also an additional option of getting a Medicare Supplement insurance plan. Understanding how coverage works can help you pick the right plan for your healthcare needs. This article will discuss the different parts of Medicare and how Medicare enrollment works.
What are the Different Parts of Medicare?
The four parts of Medicare include: Part A, Part B, Part C, and Part D. Medicare Part A is hospital insurance; Medicare Part B is medical insurance; Medicare Part C is a Medicare Advantage plan, and Medicare Part D is a prescription drug plan to save on medication. Original Medicare includes Part A and Part B. With this coverage, you can go to any doctor or hospital that accepts Medicare patients. Part A hospital insurance covers most basic hospital expenses like:
Hospice careHome health careStays in a semi-private roomCare in skilled nursing care facilitiesBlood transfusions of more than 3 pints of blood
Part B medical insurance provides coverage for:
Doctor visitsLab testingImaging testsPreventative careAmbulance ridesOther services like chemotherapy, radiation, and dialysis
Most people receive Medicare Part A free of charge, but Part B does have a monthly premium that’s based on your adjusted gross income. Although coverage under Original Medicare is sufficient for some people, others require additional benefits and coverage. In this case, there’s the option of signing up for a Medicare Advantage plan, also known as Medicare Part C. Medicare Part C isn’t offered by the federal government. Instead, you’ll buy this coverage from a private health insurance company. Medicare Advantage plans are required to provide the same benefits of Part A and Part B, as well as additional benefits like dental care, hearing, and vision. Some Part C plans also include Medicare Part D prescription drug coverage, but you don’t have to enroll in a Medicare Advantage plan to get prescription drug benefits. Medicare Part D is also available as a standalone policy to accompany Original Medicare.
How to Enroll in Medicare: Understanding Enrollment Periods
Now that you understand the different parts of Medicare: When are you eligible to enroll and receive benefits? It’s important to note that there isn’t one set enrollment date for Medicare. Enrollment periods vary depending on the type of Medicare plan, and when you want to start receiving benefits.
Medicare Initial Enrollment Period
If you’re receiving Social Security benefits prior to the age of 65, you’re automatically enrolled in Original Medicare Part A and Part B on the first day of the month you turn 65. If you don’t receive Social Security benefits, you’re eligible to sign up for Original Medicare during the seven-month window that begins three months before you turn 65, and ends three months after you turn 65. This is your Initial Enrollment Period. During this time you’re eligible to sign up for Original Medicare, a Medicare Advantage plan, and a Medicare prescription drug plan. When enrolling in Original Medicare, you can enroll in both Part A and Part B, or only Part A. You can delay Part B enrollment if you receive health insurance through your employer or your spouse’s employer. You can sign up for Part B at a later time, but you’ll pay a late enrollment penalty.
Original Medicare General Enrollment
If you don’t sign up for Original Medicare Part A and Part B when you’re initially eligible, you can sign up each year during Medicare General Enrollment. This occurs between January 1 and March 31 of every year, with coverage starting July 1.
Medicare Annual Open Enrollment
From October 15 to December 7 of each year, you can switch from Original Medicare to a Medicare Advantage plan or vice versa; or switch from a Medicare Advantage plan with drug coverage to one without drug coverage or vice versa. During Medicare’s Annual Enrollment Period you can also enroll in a Medicare Part D prescription drug plan, drop a plan, modify your coverage, or switch to a new insurer. Changes made to your Medicare coverage during open enrollment take effect January 1.
Medicare Advantage Open Enrollment
Once you’re already enrolled in a Medicare Advantage plan, you can switch to another Medicare Advantage plan, or switch back to Original Medicare during the Medicare Advantage Open Enrollment period from January 1 to March 31 of each year. Coverage starts on the first day of the following month.
Medicare Special Enrollment
Keep in mind there’s also special enrollment for Medicare. Not everyone is eligible for these enrollment periods, though. This allows you to make changes to your Medicare Advantage plan or Medicare Part D prescription drug plan under certain circumstances. Depending on the situation, you might be able to enroll in, switch, or drop a plan outside of normal enrollment periods. Special enrollment can apply if you move outside of your plan’s service area, or if you lose medical insurance or prescription drug coverage through your employer.
How to Apply for a Medicare Supplement Insurance Plan
Original Medicare won’t cover all of your hospital and doctor expenses. So depending on your health—and how often you’ll need care—you might look into buying a Medicare Supplement insurance plan, also known as Medigap. These plans cover costs that Original Medicare doesn’t. This can include your out-of-pocket expense for deductibles, copayments, and coinsurance. Similar to Medicare Part A, Part B, Part C, and Part D, Medicare Supplement insurance plans or Medigap also have an enrollment period. This is the six-month window starting the first day of the month you turn 65. You don’t have to purchase a supplement program at this time. But if you don’t enroll when you’re first eligible, you might be unable to get a supplement plan later on. Your ability to get Medicare Supplement insurance after your Initial Enrollment Period will be subject to medical underwriting. Be mindful that you can only enroll in a Medicare Supplement program if you have Original Medicare. This plan is not available if you have a Medicare Part C Advantage plan. Understanding how Medicare enrollment works before you’re eligible can help simplify and speed up the enrollment process. To apply for Medicare, call 1-800-772-1213, or sign up online (www.ssa.gov) or in-person at your local Social Security office. The best time to sign up for Medicare is when you’re first eligible, especially if you’ll need Medicare Part B and a Medicare Supplement plan. Delaying enrollment, in either case, could result in a late enrollment penalty or higher premiums. Next up, here’show to be a good caregiver and take good care of yourself, too. Each Medicare plan and insurance product we feature has been independently selected and reviewed by the Medicare Expert USA team. If you make a purchase using the links included, Parade.com may be compensated.
