What is Medicare?

Medicare is a federal health insurance program designed primarily for individuals aged 65 and older, as well as certain younger individuals with disabilities or specific medical conditions. It helps cover hospital stays, doctor visits, prescription drugs, and other healthcare services.

Who is eligible for Medicare?

To qualify for Medicare, you must be:

• 65 years or older
• A U.S. citizen or legal resident for at least five years
• Under 65 with a qualifying disability or End-Stage Renal Disease (ESRD)

What are the different parts of Medicare?

Medicare consists of four main parts:

• Medicare Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing care, and hospice care.
• Medicare Part B (Medical Insurance): Covers outpatient care, doctor visits, preventive services, and medical supplies.
• Medicare Part C (Medicare Advantage): Offered by private insurance companies, combining Parts A and B with additional benefits.
• Medicare Part D (Prescription Drug Coverage): Helps cover the cost of prescription medications.

What is the difference between Original Medicare and Medicare Advantage?

• Original Medicare (Part A & Part B): Provides standard hospital and medical coverage but does not include additional benefits like vision, dental, or hearing.
• Medicare Advantage (Part C): A private insurance alternative to Original Medicare that often includes additional coverage, such as dental, vision, and prescription drugs.

How do I enroll in Medicare?

You can enroll in Medicare through the Social Security Administration (SSA):

• Automatic enrollment: If you receive Social Security benefits, you are automatically enrolled in Medicare Part A and Part B at age 65.
• Manual enrollment: If you are not receiving Social Security benefits, you must sign up online at SSA.gov or visit your local SSA office.

When is the best time to enroll in Medicare?

The best time to enroll is during the Medicare Initial Enrollment Period (IEP), which starts three months before your 65th birthday and lasts for seven months.

Does Medicare cover prescription drugs?

Medicare does not automatically cover prescription drugs under Original Medicare. You must enroll in a Medicare Part D plan or choose a Medicare Advantage plan with prescription drug coverage.

What is Medigap, and do I need it?

Medigap (Medicare Supplement Insurance) is private insurance that helps cover out-of-pocket costs like deductibles, copayments, and coinsurance in Original Medicare. If you want more financial protection, a Medigap plan can help reduce unexpected medical expenses.

How much does Medicare cost?

The cost of Medicare depends on the plan and coverage you choose:

• Medicare Part A: Free for most people, but those who haven't worked enough may pay up to $506/month (2023 rate).
• Medicare Part B: Standard premium of $164.90/month (2023), with additional costs based on income.
• Medicare Advantage (Part C): Varies by plan and provider.
• Medicare Part D: Premiums depend on the specific drug plan chosen.

Can I have both Medicare and Medicaid?

Yes! If you qualify for both Medicare and Medicaid, you are considered dual eligible. Medicaid can help pay for Medicare premiums, deductibles, and copayments, reducing your overall healthcare costs.

Does Medicare cover dental, vision, and hearing care?

Original Medicare does not cover routine dental, vision, or hearing services. However, some Medicare Advantage plans offer additional benefits for these services.

How can I find the best Medicare plan for my needs?

To find the best Medicare plan, compare options based on:

• Coverage needs (hospital, doctor visits, prescriptions)
• Budget (premiums, deductibles, out-of-pocket costs)
• Provider network (preferred doctors and hospitals)

Can I change my Medicare plan after I enroll?

Yes! You can switch or update your Medicare plan during:

• Medicare Open Enrollment (October 15 – December 7): Change Medicare Advantage or Part D plans.
• Medicare Advantage Open Enrollment (January 1 – March 31): Switch Medicare Advantage plans or return to Original Medicare.
• Special Enrollment Period (SEP): Available for qualifying life events (e.g., moving, losing employer coverage).

What happens if I work past 65? Do I still need Medicare?

If you have employer-sponsored health insurance, you may delay Medicare Part B without penalty. However, it's important to compare your employer coverage with Medicare benefits to determine the best option.