Medicare Basics
Get to know the basics of Medicare, what Medicare covers, and important dates.
What is Medicare?
Medicare is federally-provided health care for individuals 65 and older, individuals who may be under 65 but have been receiving Social Security Disability Insurance (SSDI) for a certain amount of time, or who are under 65 and have End-Stage Renal Disease (ESRD).
Original Medicare offers hospital and medical coverage with an option to add prescription drug coverage.
Medicare Advantage plans combine hospital and medical coverage (parts A and B) and usually prescription drug coverage, often with additional benefits such as vision, hearing, or dental.
What Does Medicare Cover?
Original Medicare covers medical services and supplies in hospitals, doctors’ offices, and other health care settings. You also have the option to join a separate plan for prescription drug coverage. You may also get Medicare Supplement Insurance (Medigap) coverage for additional needs.
Medicare Advantage is required to cover all the services that Original Medicare covers and typically includes prescription drug coverage. Some Medicare Advantage plans will also offer extra benefits that Original Medicare doesn’t include, such as vision, dental, and hearing. Some Medicare Advantage plans also come with lower out-of-pocket expenses.
Important Medicare Dates
Initial Enrollment Period
You can first sign up for Part A and/or Part B during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
If you sign up for Part A and/or Part B during the first 3 months of your Initial Enrollment Period, in most cases, your coverage starts the first day of your birthday month. However, if your birthday is on the first day of the month, your coverage will start the first day of the prior month.
If you enroll in Part A and/or Part B the month you turn 65 or during the last 3 months of your Initial Enrollment Period, the start date for your Medicare coverage will be delayed.
Special Enrollment Period
After your Initial Enrollment Period is over, you may have a chance to sign up for Medicare during a Special Enrollment Period. If you didn’t sign up for Part B (or Part A if you have to buy it) when you were first eligible because you’re covered under a group health plan based on current employment (your own, a spouse’s, or a family member’s (if you have a disability)), you can sign up for Part A and/or Part B:
- Anytime you’re still covered by the group health plan
- During the 8-month period that begins the month after the employment ends or the coverage ends, whichever happens first.
Usually, you don’t pay a late enrollment penalty if you sign up during a Special Enrollment Period. This Special Enrollment Period doesn’t apply to people who are eligible for Medicare based on End-Stage Renal Disease (ESRD). It also doesn’t apply if you’re still in your Initial Enrollment Period.
Note: If you have a disability, and the group health plan coverage is based on the current employment of a family member, the employer offering the group health plan must have 100 or more employees for you to get a Special Enrollment Period.
Open Enrollment Period
January 1st – March 31st – Changes may be made to your Medicare plan. You may change from a Medicare Advantage plan to an Original Medicare plan or change Medicare Advantage plans. You may only make ONE change during this period (contact our independent licensed agent to make the right decision for YOU). Any changes you make will be effective on the first of the month after the plan receives your request.
Annual Election Period
October 15th – December 7th – Switch to Original Medicare or Medicare Advantage plan, change Medicare Advantage or Medicare Part D prescription drug plans, and add or subtract prescription drug coverage (may incur late enrollment penalty to enroll for Part D prescription drug plans if not previously enrolled). Coverage begins January 1st.
January 1st – New coverage begins.
Which Medicare Plan is Right for Me?
Explore the differences between Original Medicare and Medicare Advantage here, RSVP for a Medicare meeting near you, or schedule a free consultation with a licensed independent insurance agent.
Contact Us
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