Getting ready to pick Medicare?

Medicare is a Federal health insurance program for people 65 and older or those with certain illnesses like End-Stage Renal Disease (ESRD) or Lou Gehrig’s Disease (ALS). Over 67 million people are enrolled in Medicare.

Medicare and Medicaid sound alike but are different. Medicare is a Federal program for people 65 and older or with specific disabilities. Medicaid is a joint Federal and State program for people with limited income. Each State runs its own Medicaid program with its own rules.

You usually become eligible for Medicare at age 65. There are other criteria too for those under 65 because of disabilities or certain health conditions. 

Most people can get Medicare at age 65. If not, you might qualify based on your spouse or ex-spouse’s work record. Special rules apply for divorced or widowed people. Also, about 15% of Medicare recipients are under 65 due to disabilities or specific health conditions.

There are two ways to enroll in Medicare: automatic enrollment and self-enrollment.

1. Automatic Enrollment

If you’re already getting Social Security benefits, you’ll be automatically enrolled in Medicare at 65. Your Medicare card will arrive about 100 days before your 65th birthday.

2. Self-Enrolling in Medicare

If you’re not getting Social Security benefits, you will have to sign up yourself. The Initial Enrollment Period (IEP) lasts seven months, starting three months before your 65th birthday and ending three months after.

You don’t have to enroll at 65 if you have health insurance that offers a prescription that matches or exceeds the value of Medicare Prescription Drug Coverage. There’s a Special Enrollment Period (SEP) for those who delay enrollment because of employer coverage, ensuring you don’t have gaps in coverage or penalties.

Your Medicare number is on your red, white, and blue Medicare card. Always carry your card with you unless you have a Medicare Advantage plan, then use that card instead.

Medicare has different parts, each covering specific healthcare services:

• MEDICARE PART A: Covers hospital stays. The deductible is $1,632 per benefit period
• MEDICARE PART B: Covers outpatient services. The deductible is $240 per year, and Medicare covers 80% of costs after that.
• MEDICARE PART C (Medicare Advantage): Private insurance plans offering all benefits of Part A and B, plus extra coverage like prescription drugs, dental, vision or hearing coverage.
• MEDICARE PART D: Covers prescription drugs, with premiums from $10 to $70 per month.

Medicare costs include premiums, deductibles, copays, and coinsurance.

• MEDICARE PART A: Free for most people with 10 years of Medicare taxes.
• MEDICARE PART B: Standard premium is $174.90 per month

Original Medicare has costs that you need to pay out-of-pocket, but there are ways to cover these gaps.

• MEDIGAP PLANS: Help pay for costs not covered by Original Medicare.
• MEDICARE ADVANTAGE PLANS: Provide extra benefits, often with lower premiums but may require using in-network providers. 

Medicare Part D plans cover prescription drugs. Choose a plan that covers your medications and fits your needs.

Original Medicare usually doesn’t cover vision or dental care unless medically necessary. Consider buying a separate vision or dental insurance or a Medicare Advantage plan with these benefits.

Medicare can be hard to understand. You can get help from licensed Medicare agents or brokers.