If you’re approaching age 65, you may be wondering how Medicare works and what steps you need to take to enroll. The Horton Group hosts Medicare 101 webinars on the third Thursday of each month, where we provide an educational overview of Medicare. Anyone who is interested is welcome to join. We’ve compiled main points from the webinar here, as an additional resource for attendees and those who may be interested in future webinars.
To put it simply, Medicare is health insurance supplied by the federal government. Eligibility is determined by key factors, such as age and citizenship status, which we have highlighted in more detail below.
You qualify for Medicare if you are a US citizen or legal resident for five or more consecutive years and one of the following:
- Age 65 or older
- Under 65 with a qualifying disability
- Have been diagnosed with end-stage renal disease or ALS.
There are multiple parts to Medicare that you should consider when enrolling. Each part plays a different role in your coverage.
- Original Medicare (Parts A and B)
- Part A: This covers hospital insurance, such as inpatient hospital care. Part A is premium free for those who paid in to Medicare for 40 quarters.
- Part B: Covers doctor and outpatient visits, such as physician and lab services. Part B requires premium for anyone enrolled.
- Part D: Helps cover the cost of prescription drugs. Part D is only offered through private insurance and contains a list of the drugs (known as a formulary) that are covered by this plan.
- Medicare drug plans have four stages, whose amounts reset on January 1st.
|Stage 1||Stage 2||Stage 3||Stage 4|
|Annual Deductible||Initial Coverage||Coverage Gaps (formerly known as Donut Hole)||Catastrophic Coverage|
- Part C (also known as Medicare Advantage): Encapsulates Parts A and B, and can include Part D. You must be enrolled in Parts A and B and live in this plan’s service area to be eligible.
- Medicare Supplement: This helps cover any gaps in Medicare Part A and Part B. Like Part C, you must be enrolled in Parts A and B to qualify and live in the state in which you’re applying for coverage. In some states you may be eligible if you’re under 65.
There are two main steps to take when choosing which Medicare plan is best for you or your loved one.
- Enroll in Medicare Part A and Part B – done through social security.
- Decide between these coverage options:
- Medicare supplement with standalone Part D that covers prescription drugs.
- Medicare Advantage Part C – if you need prescription drug coverage you must select a plan that includes Part D.
When You Can Enroll
You can enroll in Medicare Part A and Part B during your Medicare Initial Enrollment Period. The enrollment period includes the month of your 65th birthday, as well as three months before or three months after. If your birthday falls on the first day of the calendar month, you may enroll four months before or two months after.
If you are working past the age of 65, you may still enroll in Medicare Part A and Part B. Looking to delay enrollment without penalty? Confirm with your HR department if you meet the following criteria:
- Your employer providing the coverage must have a minimum of 20 employees.
- Your prescription drug coverage is deemed creditable by Medicare.
We Can Help You
At the Horton Group, our Medicare team is equipped with the knowledge and tools needed to help get you covered. Want to learn more about Medicare? Email our team at firstname.lastname@example.org or follow the button below for more information.
Material posted on this website is for informational purposes only and does not constitute a legal opinion or medical advice. Contact your legal representative or medical professional for information specific to your legal or medical needs.