Medicare Overview
What is Medicare?
Medicare is a federal health insurance program that provides coverage for Americans aged 65 and older, as well as certain younger individuals with disabilities or specific health conditions. Understanding Medicare’s components and enrollment process is essential for making informed healthcare decisions as you approach eligibility or experience qualifying life changes.
Keep reading or jump to our Highlights and Frequently Asked Questions.
What is Medicare and Who Qualifies?
Medicare is a government-run health insurance program established in 1965 to provide healthcare coverage for older Americans and specific groups with disabilities. The program serves as the primary health insurance for over 65 million beneficiaries across the United States.
Eligibility Requirements
You qualify for Medicare if you meet any of these criteria:
- You’re 65 years or older and a U.S. citizen or legal resident who has lived in the country for at least five consecutive years
- You’re under 65 with a qualifying disability and have received Social Security Disability Insurance (SSDI) for 24 months
- You have End-Stage Renal Disease (ESRD) requiring dialysis or a kidney transplant
- You have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease
The Four Parts of Medicare Explained
Medicare Part A (Hospital Insurance)
Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Most people receive Part A premium-free if they or their spouse paid Medicare taxes while working. However, you’ll still pay deductibles and coinsurance for covered services.
Medicare Part B (Medical Insurance)
Medicare Part B covers outpatient medical services, including doctor visits, preventive care, medical equipment, and some home health services. Unlike Part A, Part B requires a monthly premium that varies based on your income level. Standard monthly premiums for 2024 start at $174.70.
Medicare Part C (Medicare Advantage)
Medicare Advantage plans are private insurance alternatives that combine Parts A and B coverage, often including prescription drug coverage (Part D) and additional benefits like dental, vision, or wellness programs. These plans may have different costs and coverage rules than Original Medicare.
Medicare Part D (Prescription Drug Coverage)
Part D provides prescription drug coverage through private insurance companies. You can add Part D to Original Medicare or choose a Medicare Advantage plan that includes drug coverage. Monthly premiums vary by plan and income level.
When and How to Enroll
Initial Enrollment Period
Your Initial Enrollment Period begins three months before your 65th birthday month and extends three months after. During this seven-month window, you can enroll in Medicare Parts A and B without penalty.
Special Enrollment Periods
If you have qualifying employer coverage when you turn 65, you may be eligible for a Special Enrollment Period that allows you to delay Medicare enrollment without penalties. This period typically lasts eight months after your employer coverage ends.
Annual Open Enrollment
From October 15 to December 7 each year, you can make changes to your Medicare coverage, including switching between Original Medicare and Medicare Advantage plans or changing prescription drug plans.
For complete coverage of Medicare basics, you can visit the official U.S. government site for Medicare at Medicare.gov.
Medicare Can Be Confusing
We understand. That's why we wrote a simple guide to help you decipher the terms, makes sense of the options and gain enough insight to make an informed decision.
If you're not ready to reach out to Bob and the Insurance Connection team, please grab your free copy of The ABC’s & D of Medicare. Learn More
New to Medicare
Frequently Asked Questions
What happens if I miss my Initial Enrollment Period?
If you miss your Initial Enrollment Period and don’t have qualifying employer coverage, you may face late enrollment penalties. For Part B, the penalty is 10% of the standard premium for each 12-month period you were eligible but didn’t enroll. Part D penalties are calculated differently but can also result in permanently higher premiums.
Can I keep my current doctor with Medicare?
Whether you can keep your current doctor depends on your Medicare plan choice. With Original Medicare (Parts A and B), you can see any doctor who accepts Medicare. With Medicare Advantage plans, you’ll typically need to use doctors within the plan’s network, though emergency care is covered anywhere.
How much does Medicare cost?
Medicare costs vary based on the parts you choose and your income level. Part A is premium-free for most people, while Part B has standard monthly premiums starting at $174.70 in 2024. Medicare Advantage and Part D plan costs vary by provider and coverage level, with some plans having $0 monthly premiums but different deductibles and copayments.
Insurance Connection USA is a division of Garrison Enterprises a licensed Insurance agency and not connected with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Medicare has neither reviewed nor endorsed this information. Not connected with or endorsed by the United States government or the federal Medicare program.
Important Highlights
Medicare provides essential health insurance coverage for Americans 65 and older, plus certain individuals with disabilities or specific health conditions.
Enrolling during your Initial Enrollment Period helps you avoid late enrollment penalties and ensures continuous healthcare coverage.
Contact Medicare Support
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9:00am – 5:00pm CST
Click to Call:
940-382-4700