Medicare for Beginners

You're finally eligible for Medicare. Here you can learn more about the parts of Original Medicare and how Medicare Supplement plans can help you fill the gaps and lower your out-of-pocket cost.

If you are 65 or older or will soon be turning 65, and you have been paying into Social Security for 10 or more years, then you are eligible for premium-free Medicare Part A. If you have paid into Social Security for fewer than 10 years, you can buy Medicare Part A coverage. Everyone pays a premium for Part B coverage.

How to Enroll in Medicare or Medicare Supplement Plans

Understanding the Parts of Medicare:

Part A – Hospital Insurance: When you apply to Medicare, you are automatically enrolled in Part A, the hospital insurance plan. Part A covers nursing care and hospital fees, although it does not cover doctors' fees. Part A also covers some home health services, skilled nursing care after a hospital stay, and hospice care. Copayments, coinsurance, or deductibles may apply for each service you receive.

Part B – Medical Insurance: Medicare Part B covers certain medically necessary doctors services, outpatient care, home health services, medical supplies, and preventative services. You will need to pay a premium for Medicare Part B, and under Original Medicare, you must reach the deductible amount before Medicare begins to pay its share of the costs. After the deductible is met, you typically pay 20% of the Medicare-approved amount of the service.

*What is not covered by Part A and B?
  • Most dental care
  • Eye exams
  • Hearing aids and exams
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Long term care

Part C – Medicare Advantage: A Medicare Advantage Plan (Part C or MA) is another way to get Medicare coverage. If you join a Medicare Advantage Plan, you will get your Part A and Part B coverage through a private insurance company, not Original Medicare. In all types of MA plans, you are always covered for emergency and urgent care. These plans may also offer additional coverage, like vision, hearing, dental, and other health and wellness programs. Most plans also include Medicare prescription drug coverage (Part D). In addition to your part B premium, you may also pay a monthly premium for the Medicare Advantage plan.

*Types of Medicare Advantage Plans
  • Health Maintenance Organization (HMO) plans: In most HMOs, you can only go to doctors, other health care providers, or hospitals in the plan's network, except in an emergency. You may also need to get a referral from your primary care doctor for tests or to see specialists.
  • Preferred Provider Organization (PPO) plans: In a PPO, you pay less if you use doctors, hospitals, or other health care providers that belong to the plan's network.
  • Private Fee-for-Service (PFFS) plans: PFFS plans are similar to Original Medicare in that you can generally go to any doctor, health care provider, or hospital as long as they agree to treat you. The plan determines how much it will pay doctors, and how much you must pay when you receive care.
  • Special Needs Plans (SNPs): SNPs provide focused and specialized health care for specific groups of people, like those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions.
  • HMO Point-of-Service (HMOPOS) plans: These are HMO plans that may allow you to get some services out-of-network for a higher copayment or coinsurance.
  • Medicare Savings Account (MSA) plans: These plans combine a high-deductible health plan with a bank account. Medicare deposits money into the account, and you can use it to pay for your health care services during the year. MSA plans don't offer Medicare drug coverage.

Part D – Prescription Coverage: In Original Medicare, Prescription Drug Plans (PDPs) are available through private insurance companies approved by Medicare. If you don't join a Medicare PDP when you are first eligible, you may have to pay a late enrollment penalty if you decide to enroll later.

***Medicare Supplement Coverage: Original Medicare pays for many, but certainly not all, health care services and supplies. That is where Medicare Supplement Insurance policies come in. Commonly referred to as Medigap or Med Supp, these plans are sold by private insurance companies and can help pay some of the health care costs that Original Medicare doesn't cover, such as copayments, coinsurance, and deductibles.

Medigap policies are standardized. This means that every policy sold by a private insurance company must follow federal and state laws designed to protect Medicare beneficiaries.

Learn more about all the details of Medicare Supplement Insurance

NOTE: You cannot use (and can't be sold) a Medicare Supplement policy while you are enrolled in a Medicare Advantage plan.