Turning 65 - Medicare 101

Turning 65 is a significant milestone, and one of the crucial aspects of this age is becoming eligible for Medicare. Understanding the basics of Medicare will help you make informed decisions about your healthcare coverage. Here's a simplified guide to help you navigate this essential program.

​What is Medicare?

​Medicare is a federal health insurance program in the United States primarily for people aged 65 and older. It also covers certain younger people with disabilities and individuals with End-Stage Renal Disease.

​Parts of Medicare

​Medicare is comprised of several parts, each offering different types of coverage:

1. Part A (Hospital Insurance): Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
2. Part B (Medical Insurance): Covers certain doctors' services, outpatient care, medical supplies, and preventive services.
3. Part C (Medicare Advantage Plans): A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Most Medicare Advantage Plans also offer prescription drug coverage.
4. Part D (Prescription Drug Coverage): Adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans.

Enrollment Periods

Understanding the enrollment periods is crucial to ensure you don't miss out on coverage or incur penalties:

• Initial Enrollment Period (IEP): A 7-month period that begins 3 months before the month you turn 65, includes your birth month, and ends 3 months after that month.
• General Enrollment Period: Runs from January 1 to March 31 each year if you didn’t sign up when first eligible and you aren’t eligible for a Special Enrollment Period. Coverage begins July 1.
• Special Enrollment Period (SEP): If you or your spouse is still working and you’re covered by a group health plan through that employment, you can sign up for Part A and/or Part B during a Special Enrollment Period.

Costs Associated with Medicare

​While Medicare helps cover many health care costs, it is not free. Here's a brief overview of potential costs:

• Premiums: Most people don't pay a premium for Part A if they or their spouse paid Medicare taxes while working. Part B, however, usually requires a monthly premium.
• Deductibles and Coinsurance: With Original Medicare, you typically pay a deductible and coinsurance. The amounts can vary depending on the services.

Additional Coverage Options

• Medigap (Medicare Supplement Insurance): Helps fill "gaps" in Original Medicare and is sold by private companies. Medigap policies help pay some of the health care costs that Original Medicare doesn't cover.
• Medicare Savings Programs: Available for individuals with limited income and resources to help cover some Medicare costs.

Resources for Assistance

There are various resources available to assist you with Medicare decisions:

• Medicare.gov: The official U.S. government site for Medicare.
• State Health Insurance Assistance Programs (SHIPs): Offer free, personalized counseling and assistance with Medicare.

Understanding Medicare can seem daunting, but breaking it down into these components can help simplify the process. Make sure to explore your options thoroughly to choose the best coverage for your needs.