Medicare is available for people age 65 or older, as well as younger people with disabilities and certain illnesses. Original Medicare has two primary parts: Part A, which is hospital insurance, and Part B, which covers doctor’s visits and outpatient services. Most people do not pay monthly premiums for Part A, but everyone pays monthly premiums for Part B.
If you receive Social Security or Railroad Retirement benefits when you become eligible for Medicare, you will be automatically enrolled. Otherwise, your Initial Enrollment Period begins three months before you become eligible and lasts for seven months.
What Is Original Medicare?
Original Medicare includes Parts A and B. Part A covers inpatient hospital care, skilled nursing facility care, home health care, and hospice care. Medicare does not pay the entire costs of these services, however. You are generally responsible for parts of the cost-sharing, including deductibles, coinsurances, and copayments.
Medicare Part B covers outpatient services and medical coverage, such as doctor’s visits, X-rays, lab tests, home health services, emergency ambulance services, mental health services, and some preventive services and screenings.
Original Medicare has a number of exclusions, including alternative medicine, cosmetic surgery, dental care, vision care, certain preventive services, and various other services.
Prescription Drugs and Other Coverage
In addition to Original Medicare (Parts A and B), you may also want to enroll in Part C (Medicare Advantage), Part D (prescription drug coverage), or Medigap (Medicare Supplement). Medicare Part D adds prescription drug coverage to Original Medicare. These drug plans are offered by insurance companies that are approved by Medicare. Medicare.gov offers a list of prescription drugs covered by Part D plans and other information about prescription drug coverage.
Medigap policies cover costs not addressed by Original Medicaid such as deductibles and copayments. They do not cover dental care, vision care, prescription drugs, and other similar services. Premiums and benefits vary by company. You can find Medigap policy information from your state’s department of insurance.
The Advantages of Medicare Advantage Plans
As an alternative to Original Medicare, you may enroll in Medicare Advantage (Part C). These Medicare-approved plans are provided by private companies, such as Aetna, and are legally required to include everything that Original Medicare covers. They also offer additional benefits, have limited out-of-pocket spending, and sometimes $0 copays. While Medicare sets the premiums, deductibles, and coinsurance for Original Medicare, each individual plan sets its own costs with Medicare Advantage. These plans may include vision care, dental care, hearing aids, prescription drug coverage, wellness programs, gym memberships, cancer screenings, educational programs, and other services. These benefits vary by plan; therefore, you need to compare the benefits and costs of various plans to find the right one for you.
When to Enroll or Switch Plans
After the Initial Enrollment Period comes to a close, you can enroll in Medicare during a special enrollment period only under certain circumstances; the Open Enrollment Period runs from October 15 through December 7 each year. If you want to change your plan, this is the time to do it. During Open Enrollment, anyone with Medicare Parts A and B can switch to a Medicare Advantage (Part C) plan, or if you have a Part C plan, you can switch back to Parts A and B.
Also during this time frame, anyone with a Medicare Advantage plan can switch to a different Medicare Advantage plan. Additionally, anyone with Parts A and B can join, drop, or switch a Part D (prescription drug) plan.
If you are ready to enroll in Medicare or want to switch your plan, do you research to find out what are the best options available to you. Talk to your medical providers or call 1-800-MEDICARE with questions. Most importantly, choose the plan that is both cost-effective and includes all the benefits you will need.
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