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What is Medicare?

Published January 20, 2022

What is Medicare and who is eligible?

If you have come to this page, it is likely that you or a family member are either 65 years of age or close to it, and you want to know more about Medicare. Medicare is the federal government health insurance program for people over 65, are disabled or have End Stage Renal Disease (kidney disease). With a very few exceptions, when you are 65 or are a few months away from your birthday, you will be automatically eligible for the hospital coverage part of Medicare (Part A) and most people will pay NO monthly premium for that coverage.

Medicare has four parts which we describe in more detail here. The parts of Medicare are labelled A, B, C, and D. Parts A and B are often referred to as Original Medicare. You can start enrolling without any penalties three months before your 65th birthday and three months after.

Original Medicare includes Medicare Part A and Part B. Medicare Part A is the coverage for the care you receive in a hospital, and it also covers limited services in a nursing home (Skilled Nursing Facility or SNF), some home health services and Hospice (end of life) services. Once you determine your eligibility for Medicare Part A, it’s time to think about Part B.

Medicare Part B covers services provided by physicians, services outside an acute care hospital, ambulance services, equipment like wheelchairs, mental health services and some categories of prescription drugs. Part B is voluntary, but if you turn it down, there is a financial penalty that increases the longer you wait to enroll. There is a monthly premium for Part B which is income-based. The longer you wait to sign up, the higher your premium will be.

Medicare Part C is a different kind of Medicare plan. Part C is the managed care program. You may have heard it referred to as Medicare Advantage. It combines Parts A, B, and D -- hospital, physician services, and prescription drugs all rolled into one program. Often Part C also covers some dental, vision and hearing aid services too that are not covered by Original Medicare. If you decide you want to enroll in a Part C plan, you generally do not need to enroll in a separate prescription drug plan (Part D). There are some restrictions to a Part C plan which we explain here.

Medicare Part D is the prescription drug benefit that was added to Medicare in 2006. You must be enrolled in Parts A and B to receive prescription drugs through a Part D plan. Other than a few types of drugs that are covered by Part B (like injectable drugs or drugs given to you in a hospital), you will likely want to sign up for a Part D prescription drug plan. Private companies offer the drug benefit and there are many options. The monthly premium prices vary, as do the individual drugs that are covered in each plan. All of this information is available on the Medicare website and we can help you sort through your choices (call 844-913-1177). Like with Part B, there is a late penalty if you do not choose a Part D plan when you first have the opportunity to do so.

By the way, if you will still be working after the age of 65, you can still have Medicare, but if you have an employer who provides you with health insurance, the process for enrolling is different.

As with every insurance program, there is always fine print. You may be overwhelmed by the information online, but not all of it is unbiased. We direct you to official Medicare sites or our advisors to answer your questions directly. We are not financially affiliated with any of the insurance plans that offer Medicare coverage.

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