The Basics of Medicare
“Parts” & Options
Navigating Medicare information can be complicated. There is a lot of information out there that can become very difficult to sort through and understand. Here, at Horizon Insure of Willow Grove, it’s our goal to help residents of Bucks, Montgomery and Philadelphia Counties find the right Medicare Original and/or Advantage Plan for their needs. This short guide is intended to help you, our neighbor, to gain a general understanding of the different plan types and your options. If you would like more in depth details and professional, knowledgeable guidance while searching for the correct Medicare Plan for you, please contact us through our MediCareful portal.
When Should I Enroll in Medicare?
Most people are eligible starting at the age of 65. As outlined below, in some cases, Medicare will begin automatically, in other cases, you must apply.
Automatic Medicare Enrollment
You will be automatically enrolled in Parts A & B (Original Medicare) if, at the time you will turn 65, you receive any of following:
In the case you are eligible for Automatic Enrollment, you will receive a welcome packet and card approximately 3 months before you turn 65.
Apply for Medicare on Your Own
If you do not collect the above benefits, you must apply for Medicare. You may apply online, by phone, or via paper enrollment 3 months before your 65th birthday. See medicare.gov for more information about enrolling.
Be sure to apply 3 months before your 65th birthday to ensure your benefits begin on the first day of the month your birthday is in.
What are the “Parts” of Medicare?
There are 4 basic parts that, together or individually, help cover your health and medical costs. Your out-of-pocket costs often depend on income-related taxes that have been paid by you or your spouse.
The traditional healthcare plan provided by the Federal Government for individuals over 65, Original Medicare is separated into two parts: Part A and Part B. This is the original program the taxes you paid while working have been applied to and you likely qualify for free coverage under the benefits provided with Medicare Parts A & B.
Medicare Part A
This Part of Medicare Insurance is “Hospital Insurance”. It helps to pay for inpatient hospital stays, skilled-nursing care, home health care and hospice care. Part A is administered by the Social Security Administration.
Most people qualify for “premium-free” Medicare Part A and have zero costs to receive these benefits. If you are 65 or older and do not qualify for “premium-free”, you may still purchase the plan. Determining factors of your associated costs may be legal status in the United States or income history. The Social Security Administration is the determining authority. Typically, if you pay for Part A at your own cost, you must also have Part B.
Medicare Part A starts the first day of the month you turn 65 (see enrollment info above). If you work past the age of 65, you may still enroll in Medicare and use your employer provided benefits as supplemental insurance.
Medicare Part B
Part B of Medicare is “Medical Insurance”. It helps to pay for services and supplies, such as visits to the doctor, surgeries and wheelchairs when considered to be medically necessary or preventative.
A monthly premium is associated with the cost of Medicare Part B. If you receive Social Security, Railroad Retirement Board or Office of Personnel Management benefits, your premium will be automatically deducted from that benefit payment. Otherwise, you will be billed directly.
More about Original Medicare
Enrollment for Medicare Parts A and B is 7 months long and starts 3 months before your 65th birthday. You may also enroll during your birthday month or any of the 3 following months.
In some cases, Original Medicare can be at zero out-of-pocket cost to you as long as you use providers, doctors and suppliers who have accepted “assignment”. Assignment means that a doctor, provider or supplier had agreed (or is required by law) to accept the Medicare-approved amount as full payment for covered services.
If you choose to have an Advantage Plan (below), the rules may be different for you, but the plan you otherwise purchase must provide at least the same coverage as Original Medicare.
Medicare Advantage Plans
Part C and Part D are considered Medicare Advantage Plans (MA Plans) and are intended to “fill in the gaps” that may not otherwise be covered. These plans are provided by private companies approved by Medicare and provide the same coverage as Parts A and B (Original Medicare). However, Advantage Plans often provide extra coverage for vision, hearing and dental as well.
Medicare Part C
When you choose to replace the coverage available in Original Medicare by Advantage Plan private health care provider (like an HMO or PPO), Medicare pays a fixed amount each month to that company. These companies must follow a set of rules.
Your out-of-pocket expenses can vary with each Medicare Part C provider and plan you may choose. Each Plan may have a different set of rules for referrals and doctor choices. However, with a Medicare Advantage Plan, you have more choices when deciding on a health care plan that is best for you. Many Part C Plans include prescription coverage also.
Medicare Part D
If you choose to use Original Medicare, but would like to add prescription drug coverage, Part D is the right Advantage Plan for you. These plans are provided by private providers and sometimes called Prescription Drug Plans (PDPs). The plans plans designed to add pharmacy coverage to Parts A and B (Original Medicare).
Horizon Insure of Willow Grove is proud to be an agent licensed to help you find the Medicare Advantage Plan that is right for you.