Medicare eligibility is automatic for almost all Americans. You can apply for Medicare when you reach 65 years of age. However, Medicare enrollment is open when you are younger if you have a qualifying condition, such as a disability or terminal diagnosis. 

Medicare has four parts, each covering a different type of medical service or product. Medicare Part A is free for most people. If you have 40 work credits with the IRS (generally worked consistently for at least 10 years) you typically won’t pay.

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It does not provide comprehensive coverage like insurance plans from private companies. You can enroll in multiple Medicare parts to get broader health care coverage. 

Many call Medicare Part A “hospital insurance” since it covers charges related to inpatient care at hospitals, skilled nursing facilities, and hospice. It also pays for a portion of home health services, laboratory tests, and surgeries.

Medicare does not pay for all of your medical costs. You will be responsible for paying your portion or coinsurance. Some costs for covered services:

·      $1,556 deductible

·      $0 coinsurance for the first 60 days of inpatient care

·      $389 coinsurance a day for inpatient care longer than 60 days and no more than 90

·      $778 coinsurance a day for care after 90 days for up to 60 days

Medicare Part B covers outpatient care and doctors’ services, such as annual wellness visits and flu vaccines. It reduces the cost of preventive and medically necessary services and supplies for treatment. Part B can help you pay for walkers, wheelchairs, and other durable medical equipment.

Medicare Part B costs:

·      $233 deductible

·      20 percent for most doctor and outpatient services

·      $0 for Medicare-approved laboratory services

Medicare is the combination of Part A and B. With Original Medicare enrollment, you can go to any medical professional or facility that accepts Medicare. 

You can enroll in Medicare Part D to help pay for prescription drugs. It also pays for the medication your doctor gives you for treatment, so your visits to your doctor are more affordable. The deductible and coinsurance vary by plan. 

Medicare Part C coverage comes from government-approved private insurance companies. Also known as Medicare Advantage, these plans must cover the same medical care as Original Medicare and Part D. Some of the federally mandatory benefits include:

·      Inpatient and outpatient hospital services

·      Care at nursing facilities, rural health clinics, and licensed freestanding birth centers

·      Early and Periodic Screening, Diagnostic, and Treatment Services (EPSDT)

·      Laboratory and X-ray services

·      Family planning, nurse midwife, and pediatric services

·      Transportation to medical care

States have the option to add mandatory services, and state-approved private companies must include these in their plans for Medicare beneficiaries. In most cases, Medicare Advantage plans pay for additional services like dental and eye care. Medicare Part C plans are similar to insurance coverage you may have had with an employer. 

You can apply for Medicare around your 65th birthday. Your initial enrollment period begins three months before your birthday and ends three months after. For example, if your birthday is June 15, your seven-month enrollment period is March 1 to September 30. 

The government may automatically enroll you in Part A and B when you apply for retirement or disability benefits. Or, your automatic Medicare enrollment could occur after receiving disability benefits for more than 24 months.

You can sign up during the Medicare Open Enrollment period if you want to delay signing up:

·      October 15 to December 7 – You can join Medicare Part A, B, and D.

·      January 1 to March 31 – You can join a Medicare Advantage plan.

The government may charge you a premium increase if you do not meet the late penalty waiver requirements, such as: 

·      Having health insurance from your or spouse’s job and then losing it at retirement.

·      Serving abroad and then coming back to the country.

The private insurance companies set the costs for Medicare Advantage premiums, copayment, coinsurance, and deductible. You can compare costs when you sign up for coverage to find a plan that matches your needs and budget. You are also not stuck with the first plan you pick, as you can switch plans during the annual open enrollment periods.  

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