Medicare can be a very confusing process. Unlike health insurance, there are many requirements and options for coverage due to management by the government for Parts A and B. When you are eligible at the age of 65, it is difficult to navigate the options and figure out what is needed to get the coverage you need. To help you out, here are the ABC’s of how to apply for Medicare coverage.
A is for Part A
Medicare Part A is provided by the government through Social Security payments. With Part A, you receive:
- Certain Blood Transfusions
- Hospice Care
- Inpatient Hospital Stays
- Inpatient Mental Health
- Skilled Nursing Services
There are limits to this coverage, such as copay for outpatient prescription drugs in hospice care and for hospital stay longer than 60 days. You can see more of the limits of Part A on our Medicare page.
B is for Part B
Like Medicare Part A, Medicare Part B is provided by the government through Social Security. Part B expands what Part A provides, including:
- Dental, vision, and hearing in certain limited situations
- Durable medical equipment including wheelchairs, oxygen tanks, etc.
- Laboratory services
- Necessary doctor visits and services
- Outpatient hospital visits, mental health, physical therapy, occupational therapy, speech-language therapy
- Some preventive care, diagnostic screenings, and skilled nursing
Part B is not fully covered and requires a monthly premium based on annual income. There are other costs associated with Medicare Part B which you can further explore on our Medicare page.
C is for Part C
Medicare Advantage, also known as Medicare Part C, takes Parts A and B for Medicare and supercharges it with additional benefits and more prescription drug coverage. Some of the things that Part C covers includes:
- Doctor Visits
- Hospital Costs
- Medical Services
- Prescription Drug Costs
- Routine Vision, Hearing, Dental, and Wellness
- And More! Learn more on our Medicare Advantage page.
D is for Part D
Medicare Part D is the insurance plan that helps cover the cost of prescription drugs that are not covered in Parts A and B. In order to receive Part D Medicare, you must be paying for Part B. Often people who choose a Part C/Medicare Advantage plan do not need Part D coverage. You can learn more about coverage and costs on our Medicare Part D page.
E is for Eligibility
Medicare eligibility begins when you are 65. There are certain requirements, such as having to be a US citizen for at least five years in a row, as well as certain exceptions where you can become eligible even earlier. Medicare enrollment is available the three months before your 65th birthday, the month of your birthday, and the three months after your 65th birthday. Not signing up for Advantage, Part D, or Supplement during the eligibility period will also cause the cost of your premium to rise.
F is for Fully Licensed Insurance Brokers
When it comes to buying Medicare Part C, Part D, or Supplement insurance, it is important to go through a fully licensed insurance broker who specializes in Medicare. Like we said, it is a complicated service and brokers who specialized in other types of insurance may not know all the details and nuances between the different Medicare offerings and plans. A licensed Medicare insurance broker will provide consultation and personalized service to find the perfect plan for your needs and budget without you having to learn a new industry.
G is for Gap Insurance, or Medicare Supplement
Medicare Supplement, also known as Medigap insurance, can help cover a large portion or all of the costs that are not covered by Medicare Parts A and B. One of the biggest benefits of Medicare Supplemental insurance is that the plan is the only one to cover people of any age who suffer from end-stage renal disease (ERSD). Depending on your budget and coverage needs, you can choose from 10 different plans including A, B, C, D, F, G, K, L, M, and N. Learn more about Medigap insurance options on our Medicare Supplement page.
H is for How to Apply for Medicare
For Parts A and B, you will be automatically enrolled in Medicare and receive a card in the mail three months before your 65th birthday. Manual enrollment is required if you are eligible for Medicare but are not 65 yet and fall into one of the special circumstances categories. You will also need to manually enroll if you are in Puerto Rico and you want Medicare Part B. Visiting your local Social Security office will answer those questions you have about Parts A and B. Regarding additional Medicare insurance coverage with Part C, Part D, or Supplement, you will need to go through an insurance broker to find a plan with an independent insurance company who offers those additional Medicare plans. It is important to do this in the seven month enrollment period around your 65th birthday to avoid higher premiums.