Introduction to Medicare

Getting Started With Medicare

By Marc Mora, MD
Chief medical officer, Health Plan Specialty Administration, Group Health Physicians

If you’re new to Medicare, all the parts and terms and rules can be confusing and overwhelming. But learning a few basics will give you the information you need to start sorting through your options—and finding the coverage that best meets your needs.

1. Medicare is health insurance you can get at age 65.

This program is administered by the U.S. government through the Centers for Medicare & Medicaid Services (CMS). If you’re a U.S. citizen, you automatically qualify for Medicare once you reach age 65 or have collected disability benefits for a certain amount of time.

2. Medicare Part A is hospital insurance.

It helps pay for inpatient care in hospitals, rehabilitation facilities, and long-term care hospitals. If you’ve worked in the United States and paid Medicare taxes for about 10 years (40 quarters), your Part A coverage is free. If you don’t qualify for free Part A, you can buy this coverage from the government.

3. Medicare Part B is medical insurance.

It covers doctor services and outpatient care, and has a monthly premium. The premium is deducted from your monthly Social Security check or billed quarterly if you’re not yet receiving Social Security benefits. If you’re covered by an employer’s health plan after you turn 65, because you or your spouse are continuing to work, you may want to postpone enrollment in Part B until later. (You can enroll up to eight months after your other coverage ends without penalty.)

Original Medicare is the combination of Parts A and B. If you are already collecting Social Security benefits, you will be automatically enrolled in Medicare Parts A and B and will receive your Medicare card three months prior to your 65th birthday. If you’re still working and not collecting Social Security benefits, you’ll need to sign up.

4. Medicare Advantage and Part C are the same thing.

They combine your benefits from Parts A, B, and sometimes D (prescription drug coverage) in a single plan and are an alternative to Original Medicare. Often, Medicare Advantage plans include vision, hearing, and dental benefits, and health and wellness programs, so the coverage is more robust than what you get through Original Medicare.

These plans are offered by private companies and must be approved by Medicare. To qualify for enrollment, you must be eligible for Part A and enrolled in Part B. You may have to pay a premium for the Medicare Advantage plan, and you must continue to pay your Part B premium.

5. Medicare Part D is prescription drug coverage.

This optional benefit is offered through private companies and has a monthly premium. You can get Part D as a stand-alone drug plan, or as part of a Medicare Advantage plan that includes both your medical and prescription drug coverage—known as an MAPD plan.

You're eligible for Part D if you have Medicare Part A and/or Part B, you live in your chosen plan's service area, and you don't already have prescription drug coverage through your employer or union, COBRA, or other means. If you don't enroll in a Part D plan, you'll be responsible for the full cost of your prescription medications. And if you eventually enroll, you'll pay a permanent surcharge on your Part D premium for every month you were eligible and didn't enroll.

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