New to Medicare?

What is Medicare?

Medicare is a federally funded program coordinated through the Center for Medicare Services (CMS) and Social Security that offers healthcare coverage to American citizens and legal residents over the age of 65 or with certain qualifying disabilities.

This program is often referred to as Original Medicare, with two main components:

• Part A: Inpatient & Hospital Coverage
• Part B: Outpatient & Medical Coverage

Once eligible to receive Medicare coverage, beneficiaries can choose how to obtain their coverage:

• Through Original Medicare (Parts A & B) provided by the federal government
• Through a Medicare Advantage plan (Part C), which is an alternative to Original Medicare and  provided by private insurance companies contracted through Medicare

Learn More About Medicare Basics 

At age 65, you become eligible for Original Medicare if:
• You’re a U.S. citizen OR a legal permanent resident living in the U.S. for the past five years
You can also qualify for Medicare if:
• You’re younger than 65 with a qualifying disability
• You’re any age with a diagnosis of end-stage renal disease or ALS

Note: If you qualify for Original Medicare, once enrolled you’re also eligible for additional Medicare coverage options.

The answer can vary. Several factors that will determine your actual Medicare costs, such as where you live, your income, the specific plan you select, and the out-of-pocket expenses relating to your plan.

Understanding your coverage costs is an important step in your Medicare education and plan selection process. It’s crucial to choose the plan that fits your budget. At a basic level, the costs associated with Medicare plans include: premiums, deductibles and coinsurance/ copayments.

If you don’t sign up for Parts A, B and D during the appropriate enrollment period when you’re first eligible, you assume the risk of incurring a separate late enrollment penalty (LEP) for each of these Medicare parts. These LEPs can be added to your monthly premium and can be costly.

What many beneficiaries also don’t realize is that LEPs can last for as long as you keep your Medicare coverage, which, for most, is your lifetime! It’s important to make sure you understand your enrollment periods and how to comply.

Knowing when to enroll in Medicare is equally as important as choosing your Medicare benefits.  Specific enrollment periods were created to accommodate various life events and changes.  First, let’s identify the different enrollment period scenarios to determine which best applies to you and your situation.

Here are five key categories that guide when you enroll:

• You’re turning 65
• You’re working past 65
• You have a qualifying life event or change
• You missed your Initial Enrollment Period
• You need a plan and prescription review

Enrollment is not automatic for everyone, and it’s important to know which enrollment period best applies to your situation.  If you miss your deadline to enroll, you risk incurring late enrollment fees, which is why it’s crucial to enroll on time.