Choosing a Medicare Plan Doesn’t have to be Complicated

WHAT ARE MY MEDICARE COVERAGE OPTIONS? HOW DO I ENROLL?

GET YOUR QUESTIONS ANSWERED.

What is Medicare?

Medicare is a federal health insurance program for people 65 and older. It was signed into law by President Lyndon B. Johnson in July 1965 to help older adults pay their medical expenses. Over the years, Medicare has been expanded to provide coverage for people of all ages with disabilities and for those with End-Stage Renal Disease (ESRD) or Lou Gehrig's disease (ALS).

People with Medicare are called beneficiaries. In general, beneficiaries can go to any doctor, supplier, hospital, or other facility in the United States that accepts Medicare.

MEDICARE IS MADE UP OF FOUR PARTS:

Who is Eligible for Medicare Coverage?

You are eligible if you are at least 65 and:

• You (or your spouse) worked and paid Medicare and Social Security payroll taxes for at least 10 years (40 quarters}, and

• You are a citizen or permanent resident of the United States.

You are eligible if you are under 65 and:

• You have received at least 24 months of Social Security disability benefits, or

• You've been diagnosed with ESRD or ALS, or

• You have been diagnosed with early onset Alzheimer's, esophageal cancer or any one of approximately 100 conditions that qualify you for a compassionate allowance (CAL).

Part A and Part B: Original Medicare

One of the two main ways to get your Medicare coverage is through Original Medicare, also called Traditional Medicare. Original Medicare consists of Part A and Part B. For some people, Original Medicare is their only health insurance. You can also use Parts A and B to complement other insurance you may have through your employer, union, spouse, or former employer.

With Original Medicare, you are responsible for a deductible and either copayments or coinsurance for most services. The deductible is the amount you must pay each year before Medicare begins to pay for services and supplies covered under the program. A copayment or coinsurance is the amount you pay for covered services after you have paid the deductible.

• Coinsurance means you pay a percentage of the cost (normally Medicare pays 80% and you pay 20%).

• A copayment is a set amount that you pay for healthcare services or supplies.

You must also pay a premium for Part B, which is a set amount you pay each month for your Medicare Part B insurance.

The Two Parts of Original Medicare

What Part A and Part B Does not Cover

• Miscellaneous hospital expenses, such as personal care items, private rooms (unless medically necessary), phone and television

• Custodial care, such as assistance with eating, bathing, and getting dressed

• Routine vision care (and eyeglasses), foot care and orthopedic shoes, hearing aids and related exams

• Prescription drugs, syringes, or insulin (unless used with an insulin pump)

• Dental care and dentures

• Long-term care and alternative healthcare (such as acupuncture)

• Any healthcare services while traveling outside the U.S.

Signing up for Original Medicare

Starting the month you turn 65, you will automatically get Medicare Part A and Part B if you are receiving benefits from Social Security or the Railroad Retirement Board (RRB).

If you're under 65 and disabled, you'll automatically get Part A and Part B after you get disability benefits from Social Security or certain disability benefits from the RRB for 24 months.

If you have ALS, you'll get Part A and Part B automatically the month your disability benefits begin.

If you are 65 and not yet receiving retirement benefits because you're still working, you will not get Part A and Part B automatically. Instead, you will need to sign up for this coverage during the following times:

Initial Enrollment Period

If you are not automatically enrolled when you are first eligible for Medicare, you have a 7-month window to sign up for Original Medicare. The Initial Enrollment Period (IEP) begins 3 months before your 65th birthday, includes the month you turn 65, and ends 3 months after you turn 65. For example, if your birthday is May 10, your IEP is February 1 through August 31.

General Enrollment Period

If you miss your Initial Enrollment Period, you can sign up from January 1 through March 31 each year. Your coverage will begin July 1. You may have to pay a higher premium for late enrollment.

Special Enrollment Period

If you or your spouse (or a family member if you are disabled) is covered by a group health plan through an employer or union, you will be eligible for a Special Enrollment Period (SEP). You can sign up anytime you're still covered by the group plan or during the 8-month period that begins after your employment or coverage ends, whichever comes first.