Medicare 101 Just the Facts to Support Informed Decisions
May 01, 2018
Medicare is the federal health insurance program for people who are 65 or older, people younger with disabilities, and people with end stage renal disease (permanent kidney failure that requires dialysis or a transplant). This article covers the different parts of Medicare, enrollment and enrollment periods, insurance cards and a few useful tips. For complete information, visit Medicare.gov or MedicareMadeClear.com.
There are four parts to Medicare: Plan A, B, C, and D:
- Medicare Part A is hospital coverage. It covers inpatient or skilled nursing care.
- Medicare Part B is medical coverage. It includes doctor visits, clinical services, and care received as an outpatient. Medicare Part A and Part B are considered Original Medicare.
- Medicare Part C is Medicare Advantage. These plans combine the coverage of Parts A and B into one plan and are offered by private insurance companies approved by Medicare. They sometimes include prescription drug coverage, too. You must be enrolled in Plan A and Plan B to join a Medicare Advantage plan. Medicare Advantage plan costs vary by insurer. One important note: Medicare Advantage (Part C) plans are required by law to put a cap on out-of-pocket spending for plan members.
- Medicare Part D is prescription drug coverage. Plans cover many medications that are prescribed by a doctor or other qualified health practitioner.
Initial Enrollment Period (IEP). Generally, enrollment begins at age 65, which is the Initial Enrollment Period or IEP. Seniors can enroll three months prior or three months after their 65th birthday. It is encouraged to enroll early to avoid gaps in coverage and late enrollment penalties.
Some may be eligible to enroll in Medicare before age 65 with a qualifying disability. Eligibility usually starts after receiving disability for 24 months. Here are few important facts:
- Automatic enrollment includes Original Medicare Parts A and B. Medicare cards will arrive via the U.S. Postal Service a few weeks before the eligibility date.
- Coverage starts the first day of the month that the 25th disability check is received.
- There is still an IEP where decisions are made about Medicare coverage.
- The IEP is seven months long and starts three months prior to the 25th month of disability and three months after.
General Enrollment Period (GEP). Medicare provides a General Enrollment Period or GEP every year for people who missed signing up when they were first eligible. It’s considered a make-up for Medicare enrollment. Here are a few key facts:
- GEP runs from January 1 through March 31every year.
- Enrollment includes Part A, Part B, or both.
- Coverage begins July 1 of the same year.
- There may be a late enrollment penalty.
- Enrollees may be eligible to join a Medicare Advantage (Part C) or prescription drug (Part D) plan April 1 – June 30 of the same year.
Annual Election Period (AEP) . Changes to Medicare plans are generally made during the Annual Election Period or AEP, which runs from October 15 through December 7 every year. During AEP, here is what usually happens:
- Switch from Original Medicare to a Medicare Advantage Plan.
- Switch from a Medicare Advantage Plan back to Original Medicare.
- Switch from a Medicare Advantage plan to a different Medicare Advantage plan.
- Switch from a Medicare Advantage plan that doesn’t include prescription drug (Part D) coverage to one that does, and vice versa.
- Enroll in a stand-alone Medicare Part D prescription drug plan.
- Switch from one stand-alone Medicare Part D prescription drug plan to another one.
- Drop prescription drug coverage.
Special Enrollment Periods (SEPs) . Changes to Medicare Advantage and Medicare prescription drug coverage can be made when certain events happen, like moving or losing insurance coverage. These changes can be made during Special Enrollment Periods or SEPs. Here are a few specific instances where SEPs apply:
- Moving to a new address changes plan’s service area.
- The new location comes with new plan options.
- Relocating back to the U.S.
- Moving in or out of a skilled nursing facility.
- Release from jail.
- Losing Medicaid coverage.
- Losing or gaining coverage from an employer or union.
- Loss of credible drug coverage (coverage as good as Medicare).
- Becoming eligible for both Medicare and Medicaid.
- Qualifying for extra help paying for Medicare prescription drug coverage.
- Qualifying for Medicare Chronic Care Special Needs Plan due to a severe or disabling condition.
- Misinformation that resulted in joining a plan that doesn’t suit current needs.
This is not an exhaustive list. For complete details, visit Medicare.gov, MedicareMadeSimple.com, or call 1.800.633.4227. TTY users call 1.877.486.2048.
New Medicare Insurance Cards
Anyone enrolled in Medicare will receive new insurance cards. One notable change with these new cards is that every person will be assigned a unique Medicare number to be used instead of a social security number. The purpose is to mitigate identify theft and fraud. Here are a few important facts:
- The new card will arrive automatically. No action is needed. If you need to update your address, call the Social Security Administration Office at 1.800.772.1213 or visit your local field office.
- The new card will have a unique number that is different from the social security number.
- Medicare benefits and coverage stay the same.
- The card may arrive on a different day than friends or neighbors.
- The new card is paper, making it easier for providers to use and copy.
- Once the new Medicare card is received, destroy the old one immediately.
- If enrolled in a Medicare Advantage Plan, your Medicare Advantage Plan ID card is your main card for Medicare. Keep and use that card whenever you need care. Also, keep the new Medicare card with you because you may be asked to show it.
- IMPORTANT: ONLY GIVE YOUR MEDICARE NUMBER TO DOCTORS, PHARMACISTS, OTHER HEALTH CARE PROVIDERS, INSURERS, OR PEOPLE YOU TRUST TO WORK WITH MEDICARE ON YOUR BEHALF.
- If you forget your new card, your doctor or other health care provider may be able to look up your Medicare number online.
Medicare will never call you uninvited and ask for personal or private information to get your new Medicaid number and card. Scam artists may try and contact you to about your new card. If someone asks you for your information, for money, or threatens to cancel your health benefits if you don’t share your personal information, hang up and call Medicare at 1.800.633.4227.