How Does Medicare Work?

Medicare is a health insurance program that is run and funded by the federal government. It provides healthcare coverage to American citizens aged 65 and older, as well as younger citizens who have a qualifying disability or disease. Because it’s a federal program, making sure you get the coverage you need can be more complicated than you might think. Let’s go over some of the basics you need to know about how Medicare works before you enroll or make changes:

What Do I Have to Do to Qualify for Medicare?

As we mentioned above, Medicare covers every American citizen as soon as they reach the age of 65. If you’re a permanent resident who has lived in the country for at least five years, you are also eligible for Medicare. If you are not yet 65, but you have a disability or disease that prevents you from working to earn an income, you might qualify for Medicare coverage.

How Do I Enroll in Medicare?

Most people are automatically enrolled in Medicare Part A (free for most) and Part B (not free for most) around the time they turn 65. In some cases you may need to go to the Social Security website to manually enroll. If you need Medicare coverage before the age of 65 due to a qualifying disability or disease, you’ll need to manually apply for coverage. If you find that you need coverage in addition to Medicare Part A and Part B, you will need to apply and/or talk to your health insurance agent about coverage to supplement your Medicare coverage.

What Does Medicare Cover?

Medicare Part A covers hospital visits, while Medicare Part B covers doctor visits.

Medicare Part C (also known as Medicare Advantage) is an option that allows you to get your Medicare Part A and Part B coverage through a private insurance company instead of directly from the federal government. Medicare Advantage may also provide additional benefits not normally provided by Medicare Part A and Part B, such as dental and vision coverage. Most Medicare Advantage plans also include coverage for prescription drug costs, allowing you to get all the coverage you need under one plan. Just remember that, even with a Medicare Advantage plan, you still need to pay your Medicare Part B premiums, in addition to your Medicare Advantage premiums.

If you can’t get a Medicare Advantage plan with prescription drug coverage, you can purchase a standalone Medicare Part D plan. Medicare Part D helps cover the cost of prescription drugs and is offered through private insurance companies that have been approved by Medicare.

You can also buy a Medicare Supplement insurance plan, also known as a Medigap plan. Medigap plans are offered by private insurance companies, and as the name implies, it helps cover some of the gaps in your Medicare coverage, including copayments, coinsurance, and deductible costs.

Keep in mind that the costs of Medicare Advantage and supplemental policies varies widely depending on the insurance company and your location. Reach out now if you need help making sure you have the right Medicare coverage for you.