Medicare 101: Understanding Your Coverage Options

What Is Medicare?

Medicare is a federal health insurance program for individuals aged 65 and older and certain younger individuals with disabilities or qualifying medical conditions. Understanding how Medicare works and choosing the right coverage can be overwhelming—but we're here to make it simple for you.

The Four Parts of Medicare

Medicare is divided into four main parts, each covering different aspects of healthcare:

✅ Medicare Part A – Hospital Insurance

Covers:

Inpatient hospital stays

Skilled nursing facility care

Hospice care

Some home health care

📌 Cost: Most people get Part A premium-free if they or their spouse worked and paid Medicare taxes for at least 10 years.

✅ Medicare Part B – Medical Insurance

Covers:

Doctor visits

Outpatient services

Preventive care (screenings, vaccines, etc.)

Durable medical equipment (wheelchairs, oxygen, etc.)

📌 Cost: The standard Part B premium in 2024 is $174.70/month, though it may be higher based on income.

✅ Medicare Part C – Medicare Advantage

A private insurance alternative to Original Medicare

Combines Part A, Part B, and often Part D (prescription drug coverage)

May offer additional benefits like dental, vision, hearing, and wellness programs

📌 Cost: Varies by plan and provider but often includes low or $0 monthly premiums.

✅ Medicare Part D – Prescription Drug Coverage

Covers prescription medications

Available as a standalone plan or included in some Medicare Advantage plans

Each plan has a formulary (list of covered drugs)

When Can You Enroll in Medicare?



🔹 Initial Enrollment Period (IEP)

Your first opportunity to enroll in Medicare:

Starts 3 months before your 65th birthday

Includes your birthday month

Ends 3 months after your 65th birthday

🔹 Special Enrollment Period (SEP)

If you delay Medicare Part B because you have employer-sponsored coverage, you get a Special Enrollment Period when you leave your job or lose coverage.

🔹 General Enrollment Period (GEP)

If you miss your initial enrollment, you can sign up from January 1 – March 31 each year (coverage starts July 1). Late enrollment penalties may apply.

🔹 Annual Enrollment Period (AEP) – Medicare Advantage & Part D

If you already have Medicare and want to change plans, you can do so from October 15 to December 7 each year.