What Medicare Covers

Are you nearing your 65th birthday? Whether your birthday is just around the corner or a few years away, it’s time to start getting Medicare explained! Tens of thousands of people turn 65 every day, and most of what they know about Medicare is what they’ve seen on TV or gotten in the mail.

It’s no secret that Medicare is a little hard to understand. But if you take the time to read through this page, you’re sure to have a good grasp on what Medicare is and how it works.

Parts of Medicare

Let’s start by taking a quick look at the parts of Medicare. Medicare is littered with alphabet letters and acronyms, which can make it seem more confusing than it is. We’re going to break down each part of Medicare, so you can understand what each part covers and some potential costs.

Medicare Part A

Part A is also known as hospital insurance or inpatient insurance. The easiest way to describe its benefits is to say it covers your room and board expenses if you are ever admitted as an inpatient to a hospital or skilled nursing facility. It also covers hospice services and some home health care services.

Most beneficiaries don’t pay a premium for Part A. As long as you or your spouse have worked and paid Medicare taxes for ten or more years, you won’t pay a premium for Part A. However, there are other out-of-pocket costs like deductibles, copayments, and coinsurance.

Medicare Part B

Part A is also known as medical insurance or outpatient insurance. It covers a variety of services like visits to your doctor, preventive care, surgeries, lab tests, imaging, and durable medical equipment.

Unlike Part A, Part B does have a monthly premium. Each year, the Centers for Medicare and Medicaid Services (CMS) sets a standard premium that most beneficiaries pay. However, individuals and couples with higher incomes could pay a higher premium. This additional amount is called the Income-Related Monthly Adjustment Amount (IRMAA). You will also be responsible for an annual deductible, copays, and coinsurance costs.

Medicare Part C

Part C is more commonly referred to as Medicare Advantage. If you enroll in a Medicare Advantage plan, all of the coverage from Parts A and B will be wrapped into your Part C plan. Instead of the federal Medicare program paying your medical claims, they’ll be paid by the private insurance company that sold you the plan.

Every Part C plan is required to offer at least as many benefits as Parts A and B, but most offer additional coverage. Premiums and coinsurance costs vary by plan, but most Medicare Advantage plans have very low (if not $0) monthly premiums. If you are interested in Medicare Advantage, you’ll need to take the time to learn more about these plans before you enroll.

Medicare Part D

Part D offers prescription drug coverage. You can get this coverage as a separate plan, or you may have it bundled into your Medicare Advantage plan. Like Part C plans, Part D is offered by private insurance companies.

Each Part D plan has its own drug formulary, which is the list of medications it covers. Each plan also has its own premium and cost-sharing amounts. It’s important to find a Part D plan that covers your current prescriptions at the lowest possible cost.

Enrolling in Medicare

Enrolling in Medicare can sometimes feel time-consuming. Really, most of the effort you put in is going to be when you are choosing your plans. The actual enrollment process is pretty simple, especially if you work with a broker like Bobby Brock Insurance!

Most people think Medicare is only for people who are at least 65 years old. While that is true, some younger folks can also be eligible. If you have been on disability for two years, or if you’ve been diagnosed with End-Stage Renal Disease (ESRD) or Lou Gehrig’s disease, you can apply for Medicare even if you aren’t 65 years old.

We’re going to focus on how the majority of people become eligible for Medicare, which is by turning 65.

The very first enrollment period you should be aware of is your Initial Enrollment Period or IEP. It’s a little different for everyone, as it is based on your birthday month. Your IEP begins three full months before your birthday month and ends three full months after your birthday month. So, if your birthday is on July 15, your IEP begins on April 1 and ends on October 31.

During your IEP, you can enroll in Parts A and B, as well as any other additional coverage you’d like. You can enroll through the Social Security Administration online, over the phone, or at your local office. If you are already receiving Social Security benefits, you’ll be automatically enrolled in Parts A and B.

We often get asked if you have to enroll in Medicare when you turn 65. The answer is no. If you have other health insurance that Medicare approves as “creditable,” you can delay your Medicare enrollment as long as you’d like. Be sure to clarify if your coverage is creditable before you decide to postpone Medicare. Otherwise, you’ll be stuck with some late enrollment penalties.

Choosing Additional Medicare Plans

Original Medicare, which consists of Parts A and B, is a given for most people. However, what you do after that is up to you. While Parts A and B offer great coverage, they leave too many out-of-pocket costs. Because of that, beneficiaries choose to enroll in additional coverage.

One option is to enroll in Medicare Advantage. We mentioned these plans earlier, and they can be a great way to wrap all your benefits into one convenient plan. Most Medicare Advantage plans include extra benefits for prescription drugs, dental, vision, and hearing care, and even things like wellness programs and meal delivery.

Beneficiaries who don’t enroll in Medicare Advantage will often choose a Medicare Supplement plan instead. Medicare Supplements are also referred to as Medigap plans because they fill in the “gaps” left by Original Medicare.

Medicare Supplements work quite differently than Medicare Advantage plans. Instead of replacing Parts A and B, they act as a secondary form of insurance. They’ll help pay for the deductible, copays, and coinsurance costs that Parts A and B would otherwise leave for you to pay.

Medigap plans do not offer extra benefits like Medicare Advantage plans do. They only cover the same services that Parts A and B cover. Because of this, you should consider a Part D plan as well as a Dental, Vision, and Hearing (DVH) insurance policy.

First Steps to Medicare Enrollment

Get Help From a Trusted Medicare Advisor

Medicare is not a one-size-fits-all solution. Each person will have their own healthcare needs and budget. What works for your neighbor may not be the right fit for you. That’s where we come in!

Bobby Brock Insurance is a family-owned independent insurance agency. Our roots date back to 1992. Since then, we’ve helped thousands of Medicare beneficiaries all over the United States. We help you pick the best Medicare Supplement, Medicare Advantage plan, or Medicare Part D plan – whatever you need! Our advisors will make your transition to Medicare seamless and stress-free.

Our founders have been published many times in major reputable publications like Forbes, Newsweek, and Yahoo Finance. We know Medicare!

Call us today or submit a request for a free consultation.




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