Medicare Coverage Plans

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Medicare Insurance Explained

Medicare is a program coordinated through the United States federal government that provides health insurance to certain populations. The program covers people who are 65 years old or older, people under 65 with certain disabilities, and people of all ages who have kidney failure (end stage renal disease or ESRD) or other approved medical conditions or permanent disabilities. 

Some people will qualify for different services depending on the type of plan they have. Overall, there are four main parts to the program: hospital (Part A), medical (Part B), third party supplemental coverage (Part C), and prescription coverage (Part D). 

Part A is for hospital insurance. It covers inpatient hospital stays (when you have to be admitted to the hospital overnight). It also covers medical care in skilled nursing facilities and hospice, and some home care services. Part A covers services like tests, surgical procedures, and visits to the doctor’s office. It also covers medical supplies that acre considered necessary to treat a medical condition, like wheelchairs.

Part B is for medical services and supplies that are used to treat medical conditions. This can include outpatient hospital care (like an ambulance, doctor appointments, lab tests or x-rays for which you don’t have to be admitted to the hospital). It also covers preventative services (like the flu shot) and rehabilitation services (like physical therapy). 

Part C includes certain approved third party private health insurance plans for people enrolled in Part A or Part B. This provides the option for additional coverage like dental, vision, and hearing on top of standard Part A or Part B benefits. Part C plans could be a Health Maintenance Organization (HMO), a Preferred Provider Organization (PPO), a Private Fee-for-Service (PFFS), a Special Needs Plans (SNPs), an HMO Point-of-Service (HMOPOS), or a Medical Savings Account (MSA). Eligible individuals live in the service area covered by the private provider, have program coverage, and do not have end-stage renal disease.

Part D is the prescription drug benefit of the program. This helps cover part or all of prescription drugs for the treatment of health conditions. 

Medicare Eligibility: Who Is It for?

Which types of coverage you apply for will depend upon your age, whether you have an existing health insurance plan, and any medical conditions you currently have. There are several qualification criteria for people to enroll. Generally, the plans provide health insurance coverage to US citizens who: 

  • Are age 65 years or older
  • Are under 65 years with certain permanent disabilities
  • Are any age with kidney failure
  • Are any age with approved medical conditions

If you’re not sure whether or not you qualify for coverage, talk to your doctor or visit your local Social Security office to discuss eligibility.

How Do You Apply?

In general, people can apply when they become eligible by default once they turn 65. If you’re already receiving retirement benefits then you may be automatically enrolled in Part A and Part B. 

When you turn 65 there is a 7-month open enrollment window to enroll (3 months before your 65th birthday month, your 65th birthday month, and 3 months after your 65th birthday month). Otherwise, there is an annual open enrollment period for Part A and Part B from January 1 - March 31. There are also special enrollment periods for conditions like employer insurance expiration. 

Enrollment is also linked with disability benefits. People who receive disability benefits will be automatically enrolled after 24 months of disability benefits. People who are under 65 and have a qualifying condition like end stage renal disease or Lou Gehrig's disease (ALS) may also apply for Part A and Part B, or be automatically enrolled when applying for disability benefits. 

If you are under 65 and think you may be eligible for coverage, of if you are 65 or older and want to enroll, you can find Medicare information and apply through your local Social Security office, at the Social Security office online at, or by calling Social Security

There are specific times when a person should enroll in Medicare; otherwise, he or she may be forced to pay the penalty or have a gap in coverage. Depending on circumstances, some people will get Medicare automatically, but others will have to apply. In particular, if an individual is not receiving social security or railroad retirement benefits, or any disability benefits, one can enroll during three periods.

Understanding Medicare Enrollment

As people age, there are many questions about retirement benefits that people are most concerned about trying to understand. Two of the most sought-after inquiries for people reaching retirement age is how and when to sign up for Social Security and Medicare. While the process may seem complicated, it is relatively easy once it is understood.

People who seek to enroll in Social Security can do so as early as age 62. By contrast, people who are looking to receive Medicare health insurance must wait until they reach 65 to be eligible unless they are on Social Security Benefits before they turn 62 years of age. Medicare enrollment is not done automatically and is not an automatic benefit and must be signed up for in order to receive this insurance. Additionally, applicants can only sign up during open enrollment time periods and Medicare enrollment online is an easy way to accomplish this.

Medicare is the most widely used insurance for people aged 65 or older in the country. While people who turn 65 are automatically eligible, people who are on Social Security Disability have different eligibility requirements. People who are approved for Social Security Disability do not become eligible for almost two years after they are approved for their disability payments.

How To Change Your Medicare Plan

You can add Medicare supplement insurance or a Medicare advantage plan at anytime, but both cannot be used together. Either one can help with some of the costs that Medicare doesn't cover. In some states, if you do not purchase a Medicare supplement insurance plan within the 6 month period of you turning 65, you may not be able to purchase one later.

If they do accept you, they'll probably charge you more money. If you want to change your drug plan or Medicare Advantage to another, all you have to do is sign up for the plan. Once you're approved, your other coverage is automatically dropped. You can always still contact them just to be sure.

Things To Consider 

When you add or change your Medicare plan, there are some things you need to consider first such as are all the services you need going to be covered under the new plan. You will want to figure out whether or not, you're eligible for other coverage, especially those that involve prescription coverage.

You need to be aware of the deductibles, premiums, copays, what you pay out of pocket yearly, if you have a choice of doctors and hospitals, prescription drugs, if the offices are conveniently located, if they provide transportation when needed, and most importantly, if you get quality care.