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Medicare: The Basics

By Abby Henry Singh November 30, 2016Pearls of Wisdom Blog

What is Medicare?

Medicare is an insurance program run by the United States government. Medicare is for people who

  • 65 years or older
  • Under 65 but have received Social Security Disability Insurance (SSDI) for 24 months
  • Have end-stage renal disease or Amyotrophic Lateral Sclerosis (ALS)

Medicare has 4 types of possible coverage.

Part A (Hospital Insurance): Part A covers inpatient care such as hospital care, nursing home care, and hospice. It’s free for most Medicare recipients. You cannot apply for Part B without Part A.

Part B (Medical Insurance): Part B overs medically necessary services, meaning services to diagnose and treat medical condition (like cancer). Part B also covers preventative services such as annual exams and cancer screenings.

Part A and Part B make up what is known as “Original Medicare.” You can see any doctor that accepts Medicare. You are not required to have a primary care doctor. You do not need a referral to see a specialist.

Part C (Medicare Advantage Plans): Medicare Advantage plans includes the coverage of Part A and Part B, but they are provided by private insurance companies approved by Medicare. These plans vary depending on your location. Since Part C plans are through private insurance companies, they set their own restrictions, premiums, deductibles, and co-pays. For your coverage to apply, you may be required to see doctors in the plan’s network.

Part D: Part D covers prescription drugs. Original Medicare does not cover prescription drugs. Part C plans may cover prescriptions drugs, depending on the insurance company. All Part D plans are provided by private insurance companies approved by Medicare.

What does Medicare cost?

With Original Medicare, you have a deductible and coinsurance. You do not pay a premium for Part A. The standard Part B premium amount is $121.80. It can be higher depending on your income. Learn more about the cost of Part B here. With Original Medicare, you can also use Medicare Supplement Insurance (Medigap) policies to help with the cost of coinsurance and deductibles.

For Part C and Part D coverage, since they are offered by private insurance companies, costs will vary.

How do you enroll in Medicare?

Some people may be enrolled in Medicare automatically.

  • If you are already drawing benefits from Social Security or the Railroad Retirement Board (RRB), in most cases, you will automatically be enrolled starting the first day of the month you turn 65. You should receive your card by mail three months before you turn 65.
  • If you have drawn SSDI for 24 month, you will be enrolled in Part A and Part B automatically. You will receive you card by mail three months before your 25th month of SSDI benefits.
  • If you have ALS, you will receive Medicare automatically when your disability benefits begin.

If any of the above apply to you and you do not receive your Medicare card, call the Social Security Administration.

Some people may have to enroll in Medicare on their own.

  • If you are not drawing Social Security or RRB benefits, you will need to enroll yourself in Medicare.
  • If you have end-stage renal disease, you will have to enroll yourself in Medicare.
  • If you live in Puerto Rico, you will have to enroll yourself in Medicare.

You can enroll in Medicare by applying through the Social Security Administration online, at your local office, or by phone at 1-800-772-1213.

When can I enroll?

For people turning 65, you will have a 7 month initial enrollment period. This period begins three months before the month of your 65th birthday, and it ends three months after the month of your 65th birthday. Warning: If you choose not to enroll in Medicare Part B when you are first eligible, you may pay a late enrollment penalty if you decide to enroll later. Your premium will be higher for as long as you have Part B coverage.

Medicare also has a general enrollment period once a year from October 15 to December 7. During this time you can enroll in Medicare health plans and prescription drug coverage.

If you are already enrolled in Medicare, you can review any changes to your plan during this time. Medicare health and drug plans may make changes each year to cost, coverage, and the providers in their networks. If your plan changes or your needs change, you can enroll in a different plan that better fits your needs during the general enrollment period.

Where can I learn more about Medicare? The Official U.S. Government Site for Medicare

Medicare Interactive

Social Security Administration

Abby Henry Singh

Author Abby Henry Singh

Manger Content, Outreach, and Outcomes Abby Henry Singh is a native of Sevierville, Tennessee, and a graduate of Belmont University with a bachelor’s degree in English and history. She has been a member of PearlPoint Cancer Support for over 5 years. Previously, Singh was the Program and Outreach Manger for the Lupus Foundation of America, Mid-South Chapter where she worked to raise disease awareness and support those diagnosed with the disease through educational programs. She is a member of Alpha Gamma Delta sorority and the Belmont English alumni book club.

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