Medicare

You are eligible for Medicare if you are:

• 65 and older
• Under 65 with qualifying disabilities
• Any age with End-Stage Renal Disease

To receive Medicare, you must be a citizen or legal resident of the United States, and have spent at least 5 consecutive years in the country.

Medicare is made up of different parts - Part A, Part B, Part D and Medigap (or Medicare Supplement Plans). You may have heard people refer to Part C as well. Part C can also be known as Medicare Advantage.
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Part A (Hospital Insurance)
• This covers in-patient hospital care, as well as care in skilled nursing facilities, hospice care, and some healthcare. This includes room costs, meals, nursing services, equipment and supplies used in care, and OR services. Part A covers all the providers in the US.
• Part A is premium free. You earn it by working at least 10 years and paying into Medicare throughout your professional life. If you have worked less than 10 years, you may have to pay a premium.
• Part A does have a deductible, as well as copays and/or coinsurance. You only pay while receiving Part A services.

Part B (Medical Insurance)
• Part B covers outpatient services, provider visits and services, durable medical equipment (DME), and some home health care, This includes ER services, ambulance services, and preventative care. Part B covers all providers in the US.
• Part B does have a premium. This will usually be deducted from your Social Security check, but may be paid to Medicare directly if you’re not receiving Social Security.
• Other costs of Part B will generally include some copay, a deductible, and some coinsurance. Most services are covered up to 80% - which means Medicare will pay 80% of the cost and you are responsible for the remaining 20%.

Part D (Prescription Drug Plan)
• Part D plans are offered by Medicare-approved private carriers and help cover the cost of your prescription drugs. Each plan must cover all classes of medications, but individual drug coverage can be found in your plan’s formulary.
• Costs will vary from plan to plan. Generally, you can expect to pay a monthly premium, as well as a copay when filing a prescription.
• Most Part D plans will have a pharmacy network. Using an in-network pharmacy will result in the lowest copay.

Medigap (AKA Medicare Supplement)
• Medigap plans fill the gap between the total cost of a required service and what Medicare will pay, hence the name! These plans are offered by Medicare-approved carriers and are standardized across carriers. A Plan G with Regence will offer the same type of coverage as a Plan G with Premera, and so on.

Part C (Medicare Advantage)
• Medicare Advantage plans are managed care plans offered by Medicare-approved carriers that include all benefits covered under Part A and Part B. Many will also include Part D benefits as well as other fringe benefits such as vision, dental, and hearing. These plans will often have specific provider networks for covered services.
• Medicare Advantage plans may have a premium, copay, or coinsurance depending on the carrier. All Medicare Advantage plans are required by medicare to have an out of pocket maximum as built-in financial protection to subscribers.

The Initial Enrollment Period (IEP) for Medicare typically spans seven months, beginning three months before your 65th birthday month and continuing for three months afterward. If you are still actively employed, you may not want to drop your employer’s coverage and hold off signing up for Medicare. This is allowable as long as it's not COBRA.