Medicare 101:

What do you need to know?

First and foremost… What is Medicare?

Original Medicare is our country’s federal health insurance program for:

  • Those who are 65 years or older.

  • Certain younger people with disabilities.

  • Those with end stage renal disease. (ESRD)

Covers:

  • Inpatient hospital stays

  • Care in a skilled nursing facility

  • Hospice care

  • Some home health care

Part A

Covers:

  • Certain doctor’s services

  • Outpatient care

  • Medical supplies

  • Preventive services

Part B

Part C

“Medicare Advantage”

Covers:

  • Part A

  • Part B

  • Many Medicare Advantage plans include Part D (Prescription Drug Coverage).

  • Often includes other services that Original Medicare does not offer including: Dental, Vision, and more depending on available plans in your area.

  • Offered by private insurance carriers.

COVERS:

  • Helps cover the cost of precription drugs

  • Helps cover the cost of many recommended shots or vaccines.

  • Offered by private insurance carriers.

Part D

(Prescription Drug Plan)

  • Extra insurance you can purchase to help pay your share of costs in Original Medicare, which may Include:

    • Co-payments

    • Co-insurance

    • Deductibles

  • Offered by private insurance carriers

  • Original Medicare Parts A & B are required to purchase a Medigap plan.

Medigap does not cover:

  • Long-term care (Like a nursing home)

  • Vision or Dental care

  • Hearing aids

  • Eyeglasses

  • Private-duty nursing

Medicare Supplement

(Medigap)

  • A type of health insurance plan for people who have both Original Medicare and Medicaid.

  • A plan for people who can use extra help due to income, disabilities, age, and/or their health conditions

  • A Special Needs Plan works together with your Medicaid health plan.

Dual Special Needs Plans

(DSNP)

Covers:

  • Lung disease

  • End stage renal disease (ESRD)

  • Diabetes

  • Congestive heart failure

    *May not be available in your area

Chronic Special Needs Plans*

Initial Enrollment Period

(New to Medicare)

Around your 65th Birthday

You have a 7-month window of time that begins 3 months before your 65th Birthday, includes the month of your birthday, and ends 3 months after your birth month. (For an example of the timeline, please see the chart below)

  • When does coverage begin?

    • This varies depending when the plan receives your enrollment request

    • If you request to join a plan before your Medicare starts, your plan coverage would begin the same day that your Original Medicare starts

    • If you request to join a plan after your Original Medicare starts, the plan selected would begin coverage on the 1st day of the next month after the carrier receives your application..

Medicare Advantage Open Enrollment Period

January 1st - March 31st

  • This election period ONLY applies if you are already enrolled in a Medicare Advantage Plan.

  • During this period you can drop your Advantage Plane and go back to Original Medicare

    • You can join a Medicare Drug Plan if you revert back to Original Medicare during this time.

  • You can switch to another Medicare Advantage plan with or without drug coverage.

  • When does coverage begin?

    • First of the month after the plan receives your enrollment request.

Annual Enrollment Period

(AEP)

October 15th - December 7th

During annual enrollment, you can:

  • Join, drop, or switch to another Medicare Advantage or Prescription Drug Plan.

  • Switch from Original Medicare to a Medicare Advantage Plan.

  • Join a Medicare Drug Plan, if you are enrolled in Original Medicare.

  • Switch from one Medicare Drug Plan to another, if you are enrolled in Original Medicare

  • When does coverage begin?

    • Typically the first of the month after the carriers receive your enrollment request.

Special Enrollment Period

Varies, please see below 

Certain situations that happen in your life may qualify you for a Special Enrollment Period such as:

  • Moving to a new address.

  • Losing or changing your current coverage.

  • Getting Medicaid, etc.

  • When does coverage begin?

    • Typically the first of the month after the carriers receive your enrollment request.