Medicare is a regular part of the American healthcare system, however, there are many nuances to the health insurance policies that you should be aware of, such as their changing yearly prices and dates.
Each year social security sets out rules for Medicare and although this seven-letter word appears small, there’s a lot to unpack and understand about the insurance policy. It can be exhausting for you to sift through all the information about Medicare, so to make it simple we’ve prepared this guide to Medicare that will take you through all the important information you’ll need to successfully apply for the parts of Medicare. By the end you should be familiar with the following:
Medicare Open Enrollment
The Four Parts of Medicare (including Original Medicare)
Medicare Supplement Open Enrollment
Medicare Advantage Plan (Part C)
Medicare might seem to have confusing rules, but don’t worry we’ll make sure you feel comfortable applying and understanding the Medicare ins and outs.
In the United States, Medicare is for citizens 65 and over (or in special cases under 65) and people with disabilities (such as permanent kidney failure) can enroll in a federally funded health care program. Medicare is split into four parts, which we’ll discuss in detail below. There are also portions of Medicare, such as the Medicare Supplement which is only open for a once-in-a-lifetime bracket making it essential not to miss.
Medicare is not an all-encompassing insurance plan and there are particular fees that aren’t covered and other parts that work hand-in-hand with Medigap/Medicare Supplement Insurance. You can also choose to opt-in or out of particular plans based on what you would like covered or not covered, and there are particular dates for enrollment, switching, and leaving. Portions of Medicare, outside of Original Medicare, are also privatized and can be enrolled through other insurance companies.
As mentioned before, Medicare is split into four categories each having its own set of coverages and policies. The parts labelled as “Part A” and “Part B” are Original Medicare, Part C is Medicare Advantage Plan and Part D is for drug coverage.
Original Medicare (Parts A and B) are government-run and set by Social Security, whereas Part C and supplementary coverage is run by private insurance companies that follow the rules set out by Medicare. Below are each Medicare part and its coverages.
Part A: Medicare Part A covers hospital insurance, including all care done within the hospital (in-patient care). If after your hospital stay you’re asked to spend time in a nursing facility then that’ll also be covered in Part A Insurance.
Many people who are over the age of 65 are eligible for free Part A if they have paid Medicare taxes for a prolonged period.
For the exact age,
“If you’re eligible at age 65, your initial enrollment period begins three months before your 65th birthday including the month you turn age 65, and ends three months after that birthday.”
Part B: Medicare Part B covers medical insurance. Unlike Part A, which covers inpatient care at the hospital, Part B covers actions taken outside of the hospital that pertain to the injury sustained. Outpatient care includes home health care, medical equipment and services from doctors
Part A includes free enrollment, whereas Part B requires paid premiums in monthly installments. The price for these premiums will differ based on one’s home income bracket. Usually, the higher the income bracket, the higher the premium the individual will pay.
Together, Part A and Part B make up what is known as Original Medicare. The two are controlled and regulated by a federal level, and cannot be accessed through a private company to provide the benefits.
Signing up for Part B: Since Part A and B make up Original Medicare you can choose to opt-out of part b, as to not pay monthly installments. If you opt-out but decide later on that you want to opt back in then you may be subjected to higher premiums and it will delay the overall enrollment of your benefits.
Remember, each year you get a chance to re-enroll so if you don’t sign up this year for Part B you can always sign up the next year.
The window for General Enrollment is from January 1st, 2022 to March 31st, 2022, and the coverage starts July 1st, 2022.
Alongside General Enrollment there is also a Special Enrollment Period (SEP), To qualify for SEP you must have health plan coverage from you or your spouse’s insurance.
According to Medicare Benefits, having a group plan from the employer may qualify you to sign up for part B at different times:
“Any month you remain covered under the group health plan and you or your spouse's employment continues.
The eight-month period that begins with the month after your group health plan coverage or the employment it is based on ends, whichever comes first.”
Before moving onto Parts C and D, we’ll delve into Medigap, commonly referred to as Medicare supplement. This supplemental insurance is essential to Part B and for those who are turning 65.
The name Medigap/Medicare Supplemental Insurance comes from this insurance’s purpose of filling in the gaps of coverage that Original Medicare does not cover. It is a supplement to the already provided benefits of Original Medicare.
Supplement Insurance is not operated by Social Security but by private companies. Some of the supplemental coverages offered by Medigap are copayments, coinsurance and deductibles. It also covers medical care outside of the U.S for traveling.
Medicare Supplement can only be taken for those who have Original Medicare (from Parts A and B). The supplement insurance is not the same as the Medicare Advantage Plan (which we’ll discuss more later on in the article).
Where Medigap is an addition to the preexisting benefits from Original Medicare, the Medicare Advantage Plan offers more benefits. In other words, one has more benefits while the other supplements the preexisting benefits offered from original medicare.
Supplement policies are not both for you and your spouse, they must be purchased separately. Supplement insurance does not include prescription drug costs, for drug coverages look into Medicare Advantage plans.
“Medigap policies generally don't cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.”
Enrolling in medicare supplement occurs once in your life. If you are 65 and enrolled in Part B, then Medicare companies must accept your medicare supplement request without asking you any health-related questions. There is an important six-month period for supplement insurance, your Part B and Medigap both start at the same time and continue for the next six months.
There are a few rare exceptions where individuals may qualify for a second Supplement Insurance Open Enrollment. If an individual retires, then works again and in that world joins a group health care plan, then retires again they are eligible to enroll for Part B and Supplement Insurance again. The second exception is if you are under 65 but have a disability and are eligible for Medicare. Once you turn 65, you can enroll in Part B and Supplement insurance again.
Open Enrollment for Supplement Insurance can be done anytime during the year, but it’s best to do it during the six-month period, which starts when you’re both 65 or older and enrolled in Original Medicare. Enrollment during this time ensures that you will not be asked any health-related questions during the application process.
These two next parts can be offered by private insurance companies, however even though these are not federally run, there are strict Medicare guidelines that all these insurance companies must follow, which ensures consistency throughout the entire process.
Medicare Advantage Plan: Previously, Medicare Advantage Plan was known as solely Part C. This section of Medicare has all the benefits associated with Original Medicare (Part A and B) (“prescription drugs and additional benefits such as vision, hearing, and dental”), but all in one plan rather than separated into two parts.
According to the official Medicare website, Medicare Advantage Plan covers:
Health Maintenance Organizations
Preferred Provider Organizations
Private Fee-for-Service Plans
Special Needs Plans
Medicare Medical Savings Account Plans
For Medicare Advantage Health Plan there are three enrollment Periods: Initial, Open and Medicare Advantage Open
The Initial Enrollment Period describes the date you are eligible for Medicare, listed below are the dates in which you are eligible.
If you apply for Medicare during the month you turn 65, then coverage begins “the first day of the month after you ask to join the plan”.
For those joining during the three months before turning 65, when you turn 65 the coverage will start.
Finally, if you join in the three months following your 65th birthday, then “the first day of the month after you ask to join the plan”
The Open enrollment period is from October 15, 2021 to December 7th, 2021. In this period, you are allowed to join a plan, switch to another plan or opt-out of a plan. This coverage, if everything is filled in properly during the time period, will begin on January 1st, 2022. If you do not submit in time, then the start of your coverage may be delayed.
During the Open Enrollment period, you have the option to switch from Original Medicare (Part A and B) and solely have a Medicare Advantage plan, that covers everything Original Medicare and additionally perception drugs (if you choose one that offers drug coverage).
You can also do the opposite, where you opt-out of a Medicare Advantage plan and enroll into Original Medicare. You may also switch portions of the Medicare Advantage plan, for example having a coverage plan for prescription drugs, or switching to a cover that does not have prescription drugs (opting in and out). You may also switch to another plan from another company (same plan different company). And, you can completely opt out of the Medicare Drug coverage.
However, during the enrollment period from January 1st, 2022 to March 31st, 2022. You can still switch between coverage that has prescription drug coverage and ones that don’t, but you cannot switch between Original Medicare and Medicare Advantage plans. Also, if you are signed up with Original Medicare, then you cannot, in this period, add a drug plan.
Part D: commonly referred to as Medicare Drug coverage, and as the name suggests this covers the cost of prescription drugs.
This is an optional part of Medicare as you have the choice to not opt-in to a drug coverage policy. It’s important to keep in mind that although you may not need prescription drugs currently, you may still want to look into Medicare Drug coverage since you may need it in the future and if you enroll in Medicare drug coverage outside the open enrollment period, you may be subject to a late enrollment penalty.
There are two ways to get Medicare prescription drug coverage. The first is through a designated Medicare drug plan. To enroll in one, you must already be enrolled in Original Medicare, and the Medicare drug plan will add coverages from Part A and B.
The second way to get Medicare drug coverage is through a Medicare Advantage plan that offers drug coverage (remember to enroll into an Advantage plan you must have Original Medicare).
Medicare is split into four parts, two of which are federally run while the rest are offered by private insurance companies that follow Medicare rules.
Parts A and B are referred to as Original Medicare while Part C is Medicare Advantage Plan, and Part D is Drug coverage plans. To fill the gaps from Original Medicare, so that you don’t have to pay out-of-pocket, you can apply for Medigap.
Medicare supplement happens in a onetime window, during the 6-month period when you are both: 65 and enrolled in Medicare parts A and B.
If you’re still feeling overwhelmed about which medicare private insurance plans to apply for, head here for a free Medicare Quote.