Since 1966, the government’s Medicare program, also known as Medicare Part A and Part B, has helped millions of Americans obtain health care. It includes basic hospital coverage (known as Medicare Part A) and basic medical coverage (known as Medicare Part B).
Unfortunately, Medicare Part A and Part B can become expensive. When going to the doctor, you must pay for 20% of your care out-of-pocket. And, there is no maximum cap on these fees, meaning the more care you need, the more you may have to pay. Medicare Part A and Part B also do not cover prescription drugs, meaning you do not get any help paying for medication at the pharmacy or by mail. Add to that the fact that there is usually no coverage for dental, vision, or long term care, and Medicare Part A and Part B can have gaps in coverage that may not be enough for your needs.
Fortunately, the government has authorized certain health insurance companies to offer Private Medicare plans (also known as Medicare Part C) that provide the same coverage as Parts A and B and often include additional benefits. It is important to note that Medicare Part C replaces Medicare Part A and Part B, and cannot be used in conjunction with Part A and Part B plans. However, Private Medicare plans may be a great way to help lower your out-of-pocket costs and get additional benefits.
MedicareUS.org has access to many Medicare health insurance companies offering Private Medicare plan options with one simple to use website. Helping you make sense of your enrollment options has never been easier with MedicareUS.org.
Learn more about MedicareUS.org and some common Medicare questions here.
What Is It? Medicare Part A and Part B is the health insurance coverage provided by the government. Part A is for inpatient or hospital coverage and Part B is for outpatient or doctor's office coverage.
Who Is Eligible? To be eligible, you must be 65 years old, and you or your spouse have paid federal taxes for at least 10 of your working years, or under 65 years old with certain disabilities.
When Can I Enroll? You can enroll in Medicare Part A and Part B during the Initial Enrollment Period. The Initial Enrollment Period is the 7 months surrounding your 65th birthday (3 months before the month you turn 65 years old, the month you turn 65 years old, and 3 months after the month you turn 65 years old).
If you miss the Initial Enrollment Period, you can sign up during the General Enrollment Period, which is between January 1 and March 31. Unfortunately, you have to wait until July 1 for your coverage to begin. Additionally, you could incur late-enrollment penalties and/or pay higher premiums when you purchase supplemental coverage from a private insurer.
If you or your spouse are currently over 65 and have health coverage through your employer, you may be eligible to get Medicare Part A and Part B during the Special Enrollment Period. The Special Enrollment Period will begin once your employer-based coverage expires.
How to Enroll in Medicare Part A and Part B? You can apply online at https://www.ssa.gov/medicare/ or visit your local Social Security office. You can learn more at medicare.gov.
Learn more about Medicare Part A and Part B here.
What Is Medigap? Medigap, also known as Medicare Supplement Insurance, is offered by private insurance companies. They help fill the coverage "gaps" left open by Medicare Part A and Part B. There are 10 types of Medigap plans. They are Plans A, B, C, D, F, G, K, L, M and N. Not every insurer offers all 10 plans, and prices can vary, but the amount of coverage is the same across companies.
Do I Need Medigap Insurance? Many can find Medicare Part A and Part B to have too many "gaps" in coverage. Supplementing your coverage with a Medigap plan may help to reduce the amount you pay out-of-pocket when using medical services. Multiple or extended hospitalizations (60 days or more) could potentially cost a lot of money out of pocket. So could just one or two outpatient procedures. That is why it may be more cost effective to purchase a Medigap plan, even when factoring in the monthly premium.
Some Medigap plans may also provide you with additional coverage, such as emergency health care when you are traveling internationally, and care at a nursing facility. Be sure to talk with the insurance company offering the plan to fully understand what the plan covers before you sign up.
Who Is Eligible? To be eligible, you must be enrolled in Medicare Part A and Part B.
When Can I Enroll? You must enroll during the Medigap Enrollment Period, which begins 6 months after you turn 65. Those under 65 may be able to enroll if they have a qualifying disability. Remember, you must have Medicare Part A and Part B to qualify for enrollment.
If you miss the Medigap Enrollment Period, you may still be able to enroll in a plan. However, insurers are not required by law to accept your enrollment, and can deny you coverage based on pre-existing conditions. Insurers can charge you a higher premium if you enroll during this time.
How to Enroll in Medigap? You can compare leading Medigap options here on MedicareUS.org. After you choose a plan, the enrollment process is simple. To begin, just enter your zip code and tell us about yourself.
Learn more about Medigap here.
What Is It? Medicare Advantage Plans (also known as Medicare Part C) provide your Medicare Part A and Part B benefits (Parts A & B), along with additional medical coverage, all in one convenient private insurance plan. The additional coverage helps limit medical expenses.
Unlike Medicare Part A and Part B, many Medicare Advantage plans may also include coverage for prescription drugs (also known as Part D). Medicare Advantage plans may also include dental, vision, and other benefits. Since every plan varies, it is important to understand what your plan covers before signing up.
Most Medicare Advantage Plans tend to be either HMOs or PPOs. HMOs involve using a set of in-network doctors, specialists and hospitals. They typically require you to coordinate your care through a primary care physician, who can refer you to specialists when needed. PPOs tend to have larger networks and do not typically require referrals for specialists. Since Medicare Advantage HMOs and PPOs provide most of your health coverage in a single plan, they can seem similar to the insurance you may have had through an employer.
Why Get It? Medicare Advantage plans may help to reduce the amount you pay out-of-pocket for health care. Medicare Part A and Part B requires you pay for 20% of medical costs when needing outpatient care. It also requires you to pay a set fee per day when hospitalized for 60 days or more. Further, there is no cap on your out-of-pocket costs. There also is no coverage for prescription drugs, meaning you pay for 100% of costs at the pharmacy or for prescriptions obtained by mail.
Medicare Advantage plans may help with paying for these out-of-pocket costs, with many plans including prescription drug coverage. They also place a "worst-case" maximum limit on your out-of-pocket costs. These limits vary from plan to plan. Medicare Advantage maximum out-of-pocket limits can keep your costs both affordable and predictable.
Some people may prefer Medicare Advantage over Medigap because they enjoy the convenience of having one plan. Medigap plans work on top of, or in addition to, Medicare Part A and Part B. Medicare Advantage plans replace Medicare Part A and Part B, and often include additional benefits.
Who Is Eligible? You must have Original Medicare to be eligible for Medicare Advantage. To be eligible for Medicare Part A and Part B, you must be 65 years or older. Those under 65 may be eligible if they have a qualified disability.
How Much Does It Cost? Monthly premiums for Medicare Advantage plans greatly vary based on the plan you choose and the state you live in.
How to Enroll? You can compare multiple Medicare Advantage plan options here on MedicareUS.org! After you choose a plan for your needs, it is easy to apply.
Learn more about Medicare Advantage here.
What Is It? Medicare Part A and Part B does not include coverage for prescription drugs at the pharmacy or in the mail. Fortunately, the government has allowed certain private insurers to offer Medicare Prescription Drug plans (also known as Medicare Part D).
There are two types of Part D plans. The first type is Medicare Advantage Prescription Drug Plans (MAPDPs). This type of coverage is included as part of a Medicare Advantage plan, so you will only be able to access this plan’s coverage if you enroll in a Medicare Advantage plan (also known as Medicare Part C), that includes Prescription Drug (Part D) coverage.
The other type is standalone Prescription Drug Plans (SPDPs). This is the type of coverage you get separately along with Medicare Part A and Part B. So, you have two choices for drug coverage: Medicare Part A, Part B, and a standalone prescription drug plan (Medicare Part D), or Medicare Advantage with a Medicare Advantage Prescription Drug Plan. If you have Original Medicare and a Part D standalone prescription drug plan, you may also have a Medicare Supplement plan.
Why Get It? Paying for prescription drugs out-of-pocket can be very expensive. If you are currently taking medication, or think you may need to, it is highly recommended to get a Medicare Prescription Drug Plan.
Who Is Eligible? You must have Medicare Part A and/or Part B to get a Medicare Prescription Drug plan.
When Can I Enroll? Both Medicare Advantage Prescription Drug Plans and Standalone Prescription Drug Plans are best purchased during the Initial Enrollment Period or the Open Enrollment Period.
The Initial Enrollment Period is the 7-month period surrounding your 65th birthday -- 3 months before the month you turn 65, the month you turn 65, and 3 months after the month you turn 65.
After the Initial Enrollment Period, the next time you can enroll in a prescription drug plan is the Open Enrollment Period, which begins on October 15 and ends on December 7. You may also switch Prescription Drug plans during the Open Enrollment period if you are already enrolled in one and would like to change plans.
It may be possible to enroll in a Prescription Drug plan during the Special Enrollment Period. It is important to remember that the Special Enrollment Period is only open to those who recently had a major life change, such as a move or a loss of health coverage.
Since Special Enrollment is limited, it is important that you do not miss the Initial or Open Enrollment Periods.
Finally, there are two additional opportunities to change plans if you are already enrolled.
If you are enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan, or switch to Original Medicare (and join a separate Medicare drug plan) one time from January 1 through March 31 each year. And if you have to pay a premium for Part A and enroll in Part B during the General Enrollment Period, you can also join a Prescription Drug Plan from April 1 through June 30.
How Much Does It Cost? Monthly premiums for Medicare Prescription Drug Plans vary by carrier, plan, the state you live in, and the prescription drugs you require.
When shopping for a plan, it is important to compare plans side by side, and by formulary. The formulary is the exact drugs that the plan covers, and different formularies have different costs.
How to Enroll? You can compare Medicare Prescription Drug options here on MedicareUS.org! You can apply once you find the right plan for your needs. To begin, just enter your zip code and tell us about yourself.
Learn more about Medicare Prescription Drug Plans here.