What is Medicare?
Medicare is a federal health insurance program for people age 65 and older, and for some younger individuals with disabilities or certain health conditions. It is not the same as Medicaid – Medicaid is a joint federal and state program that provides health coverage for certain low‑income people, families and children, pregnant women, seniors and people 】. Some people qualify for both Medicare and Medicaid.
Parts of Medicare
- Part A (Hospital Insurance): Covers inpatient hospital care, skilled nursing facility care, hospice care and home health care.
- Part B (Medical Insurance): Covers services from doctors and other health care providers, outpatient care, home health care, durable medical equipment like wheelchairs, and many preventive services.
- Part D (Drug coverage): Helps cover the cost of prescription drugs, including many recommended shots or vaccines. You get Part D through a standalone drug plan or as part of a Medicare Advantage Plan.
- Medicare Supplement Insurance (Medigap): Extra insurance from private companies that helps pay your share of costs in Original Medicare. Policies are standardized, typically named by letters like Plan G or Plan K.
Original Medicare vs. Medicare Advantage
Original Medicare is the traditional program run by the federal government. It includes Part A (hospital) and Part B (medical) coverage, and allows you to see any doctor or hospital that accepts Medicare. You pay deductibles and co‑insurance, but you can purchase a separate Medicare Supplement (Medigap) policy to help cover those out‑of‑pocket costs. Prescription drug coverage (Part D) is also obtained separately.
Medicare Advantage (Part C) plans are offered by private insurance companies that contract with Medicare. They bundle Part A and Part B (and usually Part D) into a single plan, and may include extra benefits like vision, dental, hearing, or wellness programs. These plans often have provider networks and may require referrals or prior authorizations. Out‑of‑pocket costs va
Enrollment Periods
Out-of-pocket costs vary by plan, and you generally cannot use a Medigap policy with Medicare Advantage.
Enrollment Periods
There are specific times when you can enroll in Medicare. Your Initial Enrollment Period (IEP) is a 7‑month window that begins three months before the month you turn 65, includes your birthday month, and continues for three months after. Signing up on time helps you avoid late penalties.
If you miss your IEP, you can sign up for Part A and/or Part B during the General Enrollment Period from January 1 through March 31 each year; coverage will start July 1 and you may pay a late‑enrollment penalty. Special Enrollment Periods (SEPs) are available if you have certain life events, such as losing employer coverage, moving, or qualifying for Extra Help. These let you make changes without penalty.
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