Medicare

Original Medicare

Original medicare covers most, but not all, of the cost for approved health care services and supplies. After you meet your deductible, you pay your share of cost for services and supplies as you receive them. There is no limit on out-of-pocket expenses within a year, unless you have other coverage (Medigap, Medicaid, or employer/union coverage).

With Original Medicare, you can:

Go to any doctor or hospital that takes Medicare, anywhere in the United States.
Join a separate Medicare drug plan (Part D) to get drug coverage.
Buy a Medicare supplement Insurance (Medigap) policy to help lower your share of cost for services.

If you are not lawfully present in the United States, Medicare will not pay for your Part A and Part B claims, and you may not enroll in a Medicare Advantage Plan or a Medicare drug plan.

Medicare Advantage

Medicare Advantage combines your Part A, Part B, and usually Part D coverage into one plan. Plans may offer hearing, vision, and dental services that Original Medicare does not cover. You join a plan offered by Medicare-approved private companies that follow regulations set by Medicare.

Each plan can have different rules for how you get services, like needing referrals to see specialist. Cost for services and monthly premiums vary dependent on the plan you join. Some plans tailor their benefit packages in order to offer additional benefits to treat special conditions. However, plans must cover all emergency and urgent care, and almost all medically necessary services Original Medicare covers.

With Medicare Advantage, you:

Need to use doctors who are in the plan's network, for non-emergency or non-urgent care.
May pay a premium for the plan in addition to the monthly Part B premium. Plans may have a $0 premium or may help pay all or part of your Part B premiums.
May not buy or use separate supplemental coverage, like Medigap.

When can you enroll?

Initial Enrollment Period

Your Initial Enrollment Period (IEP) is 7 months long; It includes your 65th birthday month plus the 3 months before and after. It begins and ends 1 month earlier if your birthday is on the first of the month. You may enroll in Part A, Part B or both. Individuals delaying retirement may at least want to enroll in Medicare Part A when they are first eligible since, for most, the coverage is free. sometimes there may be reasons to take Part B as well.

You may also choose to enroll in a Medicare supplement plan, Medicare Advantage plan (Part C), and/or a prescription drug plan (Part D). Although you are not required to enroll in Part D, there is a penalty of 1% of the average monthly premium for each month you delay enrollment.

Annual Enrollment Period

Annual enrollment period falls between October 15 - December 7

During annual enrollment you can add, drop, or switch your Medicare Advantage or prescription drug coverage.

Open Enrollment Period

Open enrollment period falls between January 1 - March 31

The Open Enrollment Period (OEP) gives people who missed signing up for Medicare during IEP another opportunity to sign up. Keep in mind people who sign up for Medicare during OEP may face late-enrollment penalties for waiting beyond IEP to sign up.

Special Enrollment Period

Depending on certain circumstances, you may be able to enroll in a Medicare plan outside of the initial enrollment or annual enrollment time frames.

Some special enrollment period qualifications are: