Browse by Category

Medicare Basics

Essential information about Medicare eligibility and parts

What is Medicare and who is eligible?

Medicare is a federal health insurance program primarily for people 65 and older. You're generally eligible if you:

Are 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years
Are under 65 with certain disabilities and have received Social Security disability benefits for 24 months
Have End-Stage Renal Disease (ESRD) or ALS at any age

Medicare has different parts that cover different services, and understanding these parts is crucial for making the right healthcare decisions.

What are the different parts of Medicare?

Part A - Hospital Insurance

Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

Part B - Medical Insurance

Covers doctor visits, outpatient care, medical supplies, and preventive services.

Part C - Medicare Advantage

Private insurance plans that include Part A and B, often with additional benefits like prescription drugs.

Part D - Prescription Drugs

Covers prescription medications through private insurance companies approved by Medicare.

Do I need Medicare if I have employer insurance?

This depends on several factors:

If your employer has 20+ employees:

Your employer insurance is primary, and you can delay Medicare Part B without penalty. However, you should still enroll in Part A if it's premium-free.

If your employer has fewer than 20 employees:

Medicare becomes primary, and you should enroll to avoid gaps in coverage and potential penalties.

Always consult with your HR department and a Medicare specialist to make the best decision for your situation.

Costs & Coverage

Understanding Medicare premiums, deductibles, and out-of-pocket costs

How much does Medicare cost?

Medicare costs vary depending on the parts you choose and your income level:

Part A (2024)

• Premium: $0 (most people)
• Deductible: $1,632 per benefit period
• Coinsurance applies after day 61

Part B (2024)

• Premium: $174.70/month (standard)
• Deductible: $257 per year
• Coinsurance: 20% of Medicare-approved amount

Important Notes:

• High-income earners pay additional premiums (IRMAA)
• Part C and D costs vary by plan
• Medigap policies can help cover gaps

What is a Medicare Supplement (Medigap) plan?

Medicare Supplement insurance, also called Medigap, helps fill "gaps" in Original Medicare coverage. These private insurance policies can help pay for:

Copayments and coinsurance
Deductibles
Emergency care when traveling abroad
Excess charges from doctors who don't accept Medicare assignment

Key Benefits:

• Predictable healthcare costs
• Freedom to see any doctor who accepts Medicare
• No network restrictions
• Guaranteed renewable

Are there penalties for late enrollment?

Yes, Medicare has several penalty scenarios:

Part B Late Enrollment Penalty

10% increase in monthly premium for each full 12-month period you delayed enrollment, unless you had qualifying coverage.

Part D Late Enrollment Penalty

1% of the national base premium multiplied by the number of months you were without creditable coverage.

How to Avoid Penalties

• Enroll during your Initial Enrollment Period
• Maintain creditable coverage if delaying
• Work with a Medicare specialist to understand your options

Enrollment Periods

When and how to enroll in Medicare plans

When can I enroll in Medicare?

There are several enrollment periods for Medicare:

Initial Enrollment Period (IEP)

7-month period that begins 3 months before your 65th birthday month

• Best time to enroll
• Avoid late penalties
• Guaranteed issue rights for Medigap

General Enrollment Period

January 1 - March 31 each year

• Coverage starts July 1
• May include late penalties
• Limited Medigap rights

Annual Open Enrollment

October 15 - December 7 each year

• Change Part C or Part D plans
• Switch between Original Medicare and Medicare Advantage
• Coverage starts January 1

Special Enrollment Periods

Qualifying life events allow enrollment outside normal periods

• Losing employer coverage
• Moving to new area
• Qualifying for extra help

How do I apply for Medicare?

You can apply for Medicare in several ways:

Online

Visit ssa.gov to apply for Medicare Parts A and B

By Phone

Call Social Security at 1-800-772-1213

In Person

Visit your local Social Security office

Important:

• If you're receiving Social Security benefits, you'll be automatically enrolled in Parts A and B
• For Part C (Medicare Advantage) or Part D, contact the insurance company directly
• Consider working with a licensed Medicare agent for personalized guidance