Medicare
Basics

Learn the basics of Medicare so you can get the confidence you need to choose the right Medicare plan.

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At Healthpilot, we empower confidence so you can make the right Medicare decision that fits your specific needs. Our plan recommendations include estimated health care cost savings based on how people like you utilize healthcare.

In order to build that confidence you need to make the right Medicare plan choice, let’s start by learning a little bit about how Medicare works. When you’re ready to compare plans, Healthpilot is here to help you navigate your options.

What is Medicare?

Medicare is the health insurance program run by the federal government for adults aged 65 and older and for people under 65 with disabilities or certain health conditions. The Medicare program helps people pay for hospital care, doctor visits, and prescription drugs. Today, more than 60 million Americans receive Medicare healthcare coverage.

What do the different Medicare options cover?

As you shop for a Medicare plan, you’ll see many references to Medicare “Parts.” These building blocks of Medicare offer different coverage options.

What are Medicare Part A and Part B?

Medicare Part A (Hospital insurance) covers hospital care and services. This includes coverage for in-patient hospital stays, care received in a skilled nursing facility or rehabilitation center and more.

Medicare Part B (Medical insurance) covers physician services and other outpatient treatments such as x-rays, lab tests, and medical equipment like wheelchairs and walkers. Part B also covers preventive services, which is healthcare to prevent illness or detect it in an early state.

Together, Medicare Part A and Part B are often referred to as “Original Medicare.”

When should I enroll in Medicare Part A and Part B?

The Medicare Initial Enrollment Period: Most people get Medicare Part A and Part B during this period. It starts 3 months before you turn 65 and ends 3 months after the month you turn 65. You are automatically enrolled in Original Medicare if you already receive Social Security or Railroad Retirement Board benefits. If you’re not already collecting Social Security benefits before your Initial Enrollment Period starts, you’ll need to sign up for Medicare online at www.ssa.gov or call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You can sign up just for Medicare and wait to apply for your retirement or spousal benefits later.

To get the most from your Medicare and avoid the Part B late enrollment penalty, complete your Medicare enrollment during this enrollment period. This lifetime penalty gets added to your monthly Part B premium, and it goes up the longer you wait to sign up.

IIn order to enroll in a Medicare Advantage plan (Part C) or a Medicare Supplement Insurance policy (Medigap), you must be enrolled in Medicare Parts A and B. You can accomplish this by enrolling in a Medicare Advantage Plan or Medigap policy when you first enroll in Medicare. At that time, you can also add a Part D prescription drug plan.

What is Medicare Part C?

Medicare Part C, also called Medicare Advantage, is an “all in one” alternative to Original Medicare coverage. With Medicare Advantage, you get coverage from Medicare-approved private insurance companies.

When enrolling in a Medicare Advantage Plan, you still have Medicare. These bundled plans include all the services covered under Medicare Part A and Medicare Part B, and often also include Medicare Part D prescription drug coverage.

Additionally, Medicare Advantage plans often include extra benefits — such as routine dental, vision, and hearing exams that Original Medicare does not cover.

What is Medicare Part D?

Medicare Part D helps pay for prescription drugs. Even if you don’t take prescription drugs now, you should consider getting Medicare drug coverage. Medicare drug coverage is optional and is offered to everyone with Medicare. If you decide not to get it when you’re first eligible, and you don’t have other creditable prescription drug coverage (like drug coverage from an employer or union), you’ll likely pay a late enrollment penalty if you join a plan later.

You can get Medicare Part D prescription drug coverage from a Medicare-approved private insurer in one of two ways:

  1. You can enroll in a standalone Medicare Part D Prescription Drug Plan as long as you have Medicare Part A or B.
  2. You can enroll in a Medicare Advantage plan that includes prescription drug coverage.

When can I enroll in a Medicare Advantage plan and Medicare Part D?

Medicare Annual Enrollment Period: Medicare Annual Enrollment runs from October 15 to December 7, each year. During that time you can decide if you want to make any changes to your current Medicare coverage. For example, if you signed up for Original Medicare when you turned 65, you may decide you want to try a Medicare Advantage plan instead, or vice versa.

You can also enroll in a Medicare Advantage Plan and/or Part D prescription drug plan during your Initial Enrollment Period.

If you qualify for a Special Enrollment Period, you do not have to wait for Medicare Annual Enrollment to make changes to your Medicare Advantage or prescription drug coverage.

What is Medigap?

Medicare Supplement Insurance, also known as Medigap, helps people pay their portion of medical expenses. These plans are offered by private insurance companies to supplement Original Medicare coverage.

Medigap plans work alongside Medicare Part A and Part B, often paying the Medicare Part A deductible and Part B coinsurance as well as some other costs for covered services.

Some Medigap plans also cover services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, here's what happens:

  • Medicare will pay its share of the Medicare-approved amount for covered health care costs.
  • Then, your Medigap plan pays its share.

When can I enroll in a Medigap plan?

Medigap Open Enrollment: The Medigap Open Enrollment is a 6-month period when you can buy any Medicare Supplement policy sold in your state, even if you have pre-existing health conditions. This period automatically starts on the first day of the month that you meet both of the following 2 criteria:

  • You're 65 (or older) AND
  • You’re enrolled in Medicare Part B (Medical Insurance)

Note: In some states, you can enroll in Medigap before age 65.
Check your state’s Department of Insurance website to learn if Medigap is available to those under 65.

You can apply for a Medicare Supplement policy any time during the year, however during your Open Enrollment period, you are guaranteed Medicare Supplement coverage. When applying outside of your Open Enrollment period, you may be subject to restrictions based on your previous health history or current medical conditions, and you could also be denied acceptance.

Summary

Medicare is not a one-size-fits-all program — you have choices in how you get your Medicare coverage. While it seems challenging, Healthpilot is here to make sure you do not hit any turbulence during your Medicare journey.

Finding a plan that fits you depends on exactly that — YOU. There are many considerations that can make one Medicare plan better for you than another. It used to be complicated and confusing to compare plans but Healthpilot is here to change that experience.

The Healthpilot online plan comparison tool sifts through your Medicare options in seconds, reviewing your needs with plan costs and benefits to give you a recommendation. Then, you can easily compare plans to decide which best meets your health needs and budget. Finally, once you have selected the right plan, simply enroll online.

When you use Healthpilot to enroll in a Medicare plan, we monitor and alert you to any important plan changes. With the right information at the right time, you can make informed coverage decisions easily, every year.

Let’s move onward together in your Medicare journey by clicking the button below.