How Medicare Works
Ashford Insurance
Medicare Insurance Made Easy
More than 60 million Americans get their health care coverage through this federal insurance program for older Americans.
At 65, you become eligible for the program — which means you will need to set aside time around that milestone birthday to sift through many options so you can sign up for the coverage that meets your health needs and budget.
It’s up to you to get ready. No letter will arrive in the mail announcing it’s time to start making these decisions. What’s more, the timetable is specific — and important. You can start signing up three months before you turn 65, and you’ll have until three months after your birthday month to enroll. If you miss that deadline, you may end up paying higher premiums. If you are still working and have employer-sponsored health coverage, you can probably wait to sign up — but more about that later.
Original Medicare is health coverage managed by the federal government. Generally, there is a cost for each service. In most cases, you can go to any doctor, other health care provider, hospital, or another facility that is enrolled in Medicare and is accepting new Medicare patients. With a few exceptions, most prescriptions are not covered in Original Medicare. However, you can add drug coverage by joining a Medicare Prescription Drug Plan (Part D). With Original Medicare, you do not need to choose a primary care doctor. In most cases, with Original Medicare, you don’t need a referral to see a specialist, but the specialist must be enrolled in Medicare. You may already have employer or union coverage that may pay costs that Original Medicare does not. If not, you may want to buy a Medicare Supplement Insurance (Medigap) policy. Alternatively, you may wish to get a Medicare Part C, or, Medicare Advantage Plan.
Medicare has four basic forms of coverage:
• Part A: Pays for hospitalization costs
• Part B: Pays for physician services, lab and x-ray services, durable medical equipment, and outpatient and other services
• Part C: Medicare Advantage Plan (like an HMO or PPO) offered by private companies approved by Medicare
• Part D: Assists with the cost of prescription drugs
Medicare enrollees who have limited income and resources may get Extra Help paying for their premiums and out-of-pocket medical expenses from Medicaid (e.g. MSPs, QMBs, SLBs, and QIs).
You’ll need to do some homework before you start assessing options and picking plans. Make a list of your doctors and decide how important it is to you that you can continue seeing them once you are on Medicare. Also, make a list of any medications you take so you can make sure any prescription drug plan you select will meet your needs.
Think about your lifestyle. Are you a homebody and never travel outside the U.S.? Or are you an adventurer who goes abroad frequently? Do you split your time between residences and need medical care in different states? All these factors are likely to figure into the decisions you make.
Your financial situation also is important. You’ll learn through this guide that Medicare helps pay for medical care for older Americans and people with disabilities. But it’s not free. You’ll want to choose an option you can afford and build the array of out-of-pocket costs into your annual budget. And take time to review the ways the federal government can help you pay Medicare’s costs if you can’t afford them.
Next, learn: How to Enroll in Medicare