Medicare Basics

Take some time to explore the basics of Medicare before enrollment deadlines so that you feel more confident in selecting a plan that is right for you.

The Medicare enrollment process can be an overwhelming experience. But it doesn’t have to be. Take some time to explore the basics of Medicare before enrollment deadlines so that you feel more confident in selecting a plan that is right for you. Having a trusted resource, like Keen, can also help make the Medicare enrollment process less stressful. 

Understanding the Parts of Medicare

The first step in your enrollment journey is understanding the different Parts of Medicare. There are four different Parts: A, B, C and D. These Parts make up your health care and medication coverage. Here’s a quick overview of what each Part means.

Medicare Part A and Part B are also known as “Original Medicare.” Medicare Part A can be described as hospital insurance. Part A helps cover inpatient hospital care, skilled nursing home facility care, hospice care and some home health care. Most people who qualify won’t need to pay a monthly premium for Part A. If you do not qualify, many people can even buy into the program.

Medicare Part B can be described as medical insurance. It helps cover outpatient care, certain doctor visits, and durable medical equipment, like wheelchairs and walkers. Part B also helps cover preventive services like annual checkups and immunizations, like Flu shots. You’ll need to pay a monthly premium for Part B. And, if you don’t sign up in time, you’ll have to pay a late enrollment penalty which is added to your monthly premium. 

Part C, also known as Medicare Advantage (MA), are private plans that provide additional benefits above Parts A & B. They are Medicare-approved plans that cover the benefits that Original Medicare offers, and most plans cover additional benefits like vision, hearing, and dental care. Benefits like gym memberships, transportation, and allowances for over-the-counter/food items are also offered by some plans. Medicare Advantage plans have annual maximum out-of-pocket limits. This means there is a limit to what members have to pay for covered services. Many plans offer these products with no additional premium, which can be a great benefit too.

You can also purchase a Medicare Advantage plan that includes Part D coverage. Plans that combine Parts A, B, and D are called MAPD plans. 

If you want Original Medicare and only prescription medication coverage, you’ll need to sign up for Part D, also known as a prescription drug plan (PDP). You’ll have to select a Part D plan from a private insurance carrier and pay a monthly premium. If you choose to enroll in a Part D plan, you should enroll at the same time you enroll in a Medicare plan to avoid penalties. 

Also, if you chose to stay on Original Medicare, because a Medicare Advantage (Part C) plan is not for you, there is also additional coverage you can purchase called Medicare Supplement or MediGap plans.  These plans work with Medicare parts A and B offer different levels of coverage that help cover the cost shares that Medicare parts A and B require.  Depending on your age and desired level of coverage, these could also be an affordable option for some, although these plans always have an additional premium attached to them.  But don’t worry, we’ll explain these a little more clearly later in this article.

Understanding Enrollment Deadlines

Once you understand the different parts of Medicare, you’ll need to understand when to enroll. There are specific timelines around your initial enrollment. There is only a seven-month window to enroll in Medicare without incurring a penalty. 

Most people are eligible to enroll three months before turning 65, but certain disabilities or medical conditions can make you eligible for Medicare before then. If you sign up within those three months, Medicare will begin on the first day of your birth month. If you enroll during the month of when you turn 65, Medicare will begin on the first day of the next month after you enroll. If you sign up two or three months after you turn 65, Medicare will begin the first day after enrollment. 

If you miss this timeframe, then you’ll need to wait until the General Enrollment Period which begins on January 1 of the next year for medical coverage.  As mentioned earlier in this article, if you do not enroll into a Part D plan, (either a PDP or a Medicare Advantage plans with Part D) or receive a letter from your employer or other agency stating that you have creditable Part D coverage, you may be responsible for paying the Part D late enrollment penalty. The late enrollment penalty amount is 1% of the “national base beneficiary premium” for each uncovered month that the person didn't have Medicare drug coverage or other creditable coverage. This penalty is applied if you decide later on that you need prescription drug coverage and once you enroll, you have to pay the late enrollment penalty indefinitely.

Understanding these timelines can seem confusing, but it’s important to get familiar with how they work so you can avoid permanent and costly penalties. Learn more about when to enroll in Medicare by visiting www.Medicare.gov.

Medicare Supplemental Insurance (Medigap)

It’s important to keep in mind that for most people, Medicare won’t cover the full cost of one’s health care. You’ll be responsible for paying the balance of cost-sharing of certain things like deductibles, coinsurances, or copayments. The amount you owe can vary depending on the type of coverage you chose for your Medicare plan.

Medigap is a type of supplemental insurance that is sold by private insurance companies. It helps pay for those health care costs that remain after Original Medicare pays first. You’ll have to pay a separate premium for Medigap coverage. 

You’ll need both Part A & B to be eligible to buy a Medigap plan. And, the best time to buy Medigap is when you are 65 (or older) and first enroll in Original Medicare. You’ll have a time frame of 6 months after your Part B coverage starts to buy a Medigap policy. During this time, you can buy any Medigap policy sold in your state, regardless of pre-existing conditions. 

In most cases, Original Medicare only covers care in the United States and its territories. Depending on which Medigap plan you choose, you may also receive coverage for emergency health care outside of the United States. 

Keep in mind, you can only buy supplemental insurance if you have Part A & B. You cannot buy Medigap if you have a Medicare Advantage (Part C) plan.

Medicare Special Needs Plans (SNPs)

SNPs are a type of Medicare Advantage Plan. In order to enroll in a SNP, you must have a qualifying medical condition, be eligible for Medicaid, or reside in an institution.   These plans have specific benefits to help members manage their unique circumstances and access quality health care.

A Dual Eligible Special Needs Plan (DSNP) is a type of SNP in which the eligible member must also be eligible for Medicaid benefits. These plans always have, case managers to all members, to help DSNP members manage their health care needs.

Choosing a Plan That’s Right For You

Still have questions about which plan is right for you? If you’ve tried navigating Medicare enrollment on your own and you are still unsure, it may also be helpful to speak with a licensed Medicare advisor. Keen’s Medicare advisors are specially trained to help you make sense of your Medicare options and will treat you with care, respect, honesty and integrity. 

With a little guidance on your Medicare enrollment journey, you’ll be on the right path to selecting a quality Medicare plan from a trusted insurance carrier.

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