Medicare enrollment involves a selection of Medicare plans. Individuals who qualify at age 65 usually get Part A coverage with no premium requirement if they are already getting benefits from Social Security or the Railroad Retirement Board. Individuals who have not filed for such benefits, but are still eligible to receive them are also eligible for Medicare-related benefits. The same applies to a spouse who meets the same conditions. Individuals under the age of 65 may still receive Part A without premiums if they have been receiving Social Security or Railroad Retirement Board benefits for 24 months or have certain qualifying medical conditions such as end-stage renal disease.
Medicare plans provide the same basic coverage with some noted differences. Part C is also referred to as Medicare Advantage Plans (MA) . Medicare Advantage plans are offered by private companies that are Medicare-approved. MA plans include all Part A and Part B coverage. This includes hospital and medical coverage. Some emergency and urgent care are also covered. MA plans are required to cover all Medicare-related services except hospice care. Those who get Medicare-direct benefits (meaning not through an MA plan) will have hospice care even when enrolled in an MA plan. MA plans typically offer extra coverage such as hearing, dental, and vision and wellness programs and includes prescription drug coverage.
Medicare Advantage plans must follow Medicare-established rules. However, there are no guidelines for out-of-pocket expenses, meaning each plan can have different fees with conditions and rules. Typically this includes when a participant may see a specialist and approved medical and pharmaceutical suppliers. Participants usually pay two premiums, one for the MA plan and the other for Part B coverage. Contact Medicare directly for additional information.
Medicare provides enrollees with four choices:
Medicare Part A
Medicare part A is the only choice where you do not have to pay. It is basic coverage that provides:
Inpatient care in hospitals, inpatient rehabilitation, and long-term care.
Inpatient care in a skilled nursing facility.
Home health care services.
Hospice care services.
Inpatient care is only qualified if the Doctor formally admits you to the facility. You should always ask if you are considered an inpatient or an outpatient.
Medicare Part B
Medicare Part B is the part of Medicare where you will need to pay a monthly premium. Most people pay a standard premium amount.
Part B covers the following:
Medically necessary services like outpatient care, doctors' services, and other medical services that are needed to treat your condition.
Preventive care services such as annual flu shots, or services that can detect early-stage illness.
You should enroll in Medicare Part B within ninety days before you turn 65 to avoid any delays (This is referred to as your initial enrollment period).
Medicare Part C
Medicare Part C is also referred to as a "Medicare Advantage Plan." Medicare Part C acts more like an HMO, or PPO. Medicare Advantage is operated by private insurers approved by the government. All Medicare Advantage plans by law need to include what is in Medicare Part A and B.
Because of the higher monthly premium in Medicare Part C, your coverage may also include dental and vision, and wellness programs. Not all policies are the same, so you may be able to tailor a policy that fits your affordability and needs.
Medicare Part D
Medicare Part D is the part of Medicare that covers prescription drug coverage. It is run by government-approved private insurers. Medicare Part D can be a stand-alone policy or can be included in a Medicare Advantage Policy.
Like Medicare Advantage, Medicare Part D can be designed to fit your needs and affordability.