Navigating healthcare options can be a daunting task. For those over 65 years of age, understanding insurance options is complicated, including Medicare and Medicare Advantage - cornerstones of healthcare support for millions of individuals.
Basics of Medicare and Medicare Advantage
Medicare is federal health insurance available for those who are 65 years and older, and individuals with disabilities or who suffer from End-Stage Renal Disease (ESRD). Three parts of Medicare, Part A, B, and C cover specific services.
Part A Medicare: covers hospital insurance
- Inpatient care- in hospitals (such as critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals and skilled nursing facilities)
- Home health- care services performed in a patient’s home environment
- Hospice care-end of life services
Part B Medicare: covers medical insurance
- Physician visits - primary care physician or specialists including coverage for preventative care, like flu shots and mammograms and Annual Health Assessments
- Lab services - costs, such as blood work and X-rays
- Durable medical equipment - coverage for equipment such as wheelchairs, walkers, and canes
- Other medical care - physical therapy, mental health care, ambulance services
Part C (Medicare Advantage): offered by private insurance companies, combines the benefits of Part A and Part B and often include extra coverage like...
- Vision, dental, hearing services
- Health and wellness programs
- Medicare Part D prescription drug coverage
Think of Medicare Advantage as an all-in-one coverage plan.
Part D Medicare: covers prescription drugs insurance
- Helps cover the cost of prescription medications
- Available as a standalone plan or as part of a Medicare Advantage plan (Part C)
Additional Medicare Options include Preferred Provider Organization (PPO) plans, Private fee-for-service (PFFS) plans, and Medicare Savings Account (MSA) plans.
When Is Someone Eligible for Medicare?
You’re first eligible for Medicare 3 months before you turn 65. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease).
Click here for more information on Medicare or call 1-800-MEDICARE.
When to Apply for Medicare
Medicare Part A and Part B are automatic for most people when they turn 65 or after they’ve received disability benefits for 24 months. If you are already getting benefits from Social Security or the Railroad Retirement Board, you’ll also automatically receive Medicare. In this case, you will decide if you would like Part B when you apply for benefits. Both your Medicare card and a welcome package will be mailed three months before your coverage starts.
How to Apply for Medicare
If you are not automatically enrolled in Medicare, you’ll need to apply manually by contacting Social Security. You can do this by:
- Signing up online through the Social Security website.
- Calling Social Security at 1-(800)-772-1213.
- Contacting your local Social Security office.
Here are 3 ways to find out about the unique offerings in your county
- Talk to your Medicare broker. If you don’t have one, we have trusted, licensed, Medicare agents in each of the 12 counties we proudly serve. Call our customer contact center (800)-445-5747
- Visit Medicare.gov
- If you are still working, talk to your Human Resources (HR) representative
