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Making Sense of Medicare Options

Medicare is the federal program that helps people 65 and older pay for their healthcare and prescription drugs.

If you’re new to Medicare, the following is a basic step-by-step process that you can use to get started.

Find out when you become eligible

Most people will sign up for Medicare when they first become eligible—sometime in the 3 months before they turn 65 or in the 7 months following. People with certain disabilities and serious health concerns, such as end stage renal disease, may sign up earlier. To learn more about when and how to sign up for Medicare, go to the Medicare website.

Review your coverage options

In general, you have 3 choices:

  • Original Medicare. This program is a fee-for-service program run by the federal government. This is the default plan if you don’t choose another option.

  • Original Medicare with supplemental insurance. Original Medicare doesn’t cover all of your medical costs. To have complete coverage, some people purchase additional insurance known as a Medigap plan.

  • Private health insurance. You may choose a private health insurance plan that manages your Medicare coverage, called Medicare Advantage plans. Examine the details of the different plans you are considering to figure out what your monthly costs and co-pays would be.

Consider costs

Medicare does not cover 100% of your costs. Also remember that Medicare is a secondary insurance. That means if you have health insurance from a former employer, Medicare will cover part of the costs that the primary insurance doesn’t cover. Your work history will determine how much you have to pay for Medicare. Some people with low incomes may be able to get government assistance to help pay for healthcare costs.

Pick a healthcare provider

If you have Original Medicare, you can go to most doctors. If you have a private insurance plan, select a primary care manager who is in the network of the insurance carrier you choose. Make sure the provider is accepting Medicare patients.

Get your “Welcome to Medicare” exam

You are entitled to a free comprehensive wellness check to get started as a Medicare recipient. After that, you can have a free wellness check every 12 months.

Know what Medicare covers

Medicare has several basic parts:

  • Part A. This part covers all hospital-related care. It’s free if you have worked and paid taxes for at least 10 years. If you have worked less than that, you will have to pay for the coverage.

  • Part B. This part covers all of your basic healthcare needs. This means medically necessary services and some preventive services. You will pay a fee for this coverage. How much you pay is based on your income and the health insurance you choose or have already.

  • Part C. This part allows private health insurance companies to offer Medicare Advantage plans. These provide for all of the same services Medicare covers, but they are administered under a private health insurance model. The government reimburses the managing companies.

  • Part D. This part covers prescription drug costs. You will need a plan paired with your Medicare coverage. Enrolling in a prescription drug plan is optional, but if you enroll after a certain initial enrollment period, you may have to pay a late fee.

Know what is not covered

Unfortunately, certain services are not covered by Medicare. These include:

  • Most vision services

  • Most dental services

  • Hearing aids

  • Cosmetic surgeries

  • Assistance with housekeeping

  • Some preventive services

  • Alternative medicines

  • Most nonemergency transportation

  • Care received in another country

Check on enrollment periods

You can sign up for or change your plans, but only during annual enrollment periods. Of course, you can do your research at any time of year.