What is Medicare & When Can I Sign Up?

You are approaching your 65^th birthday and you will need to make important decisions regarding your health coverage. By now, you have more than likely heard the word Medicare quite a few times. With so much information coming from every direction, it is easy to get confused and feel unsure as to what actions to take. You most likely will have questions such as, “What is Medicare? Am I even eligible? When can I sign up for Medicare?” Vantage Health Plan is available to help answer questions and clear any confusion.

The following guide will explain the four parts of Medicare, eligibility requirements, and when you can sign up.

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What is Medicare?

Medicare helps more than 50 million Americans receive much needed healthcare. Medicare is a health insurance program offered by the U.S. government to citizens and legal residents 65 years of age and older, those who qualify due to disability, or people with end-stage renal failure. Do not confuse Medicare with Medicaid, as these are two separate health programs. Medicaid is only available to eligible low-income residents and residents with certain disabilities.

How Do I Qualify for Medicare?

To qualify for Medicare, you must meet at least one of the following criteria:

You must be at least 65 years old or have a qualifying health condition or disability
You must be a U.S. citizen or a permanent legal resident for 5 years
You or your spouse must have worked legally in the U.S. for at least 10 years while paying Medicare taxes

4 Parts of Medicare

Medicare Part A

Medicare Part A consists of hospital coverage that helps with costs for skilled nursing facilities, hospice, inpatient hospital care, and some home health care services. Required coverage in Medicare Part A is determined by Federal and State laws, while local coverage decisions are made by the companies that process claims in each state.

Medicare Part B

Medicare Part B is the second part of Original Medicare and helps with costs for doctor visits, outpatient care, preventive care (shots, scans, colonoscopies, mammograms, etc.), some home health, and some physical and occupational therapy. Certain hospital services such as radiation, chemotherapy, surgeries, durable medical equipment, and dialysis are included in Part A, as well as clinical drugs like insulin pump fills, osteoporosis injections, and infused drugs. Basically, if the service you are needing is deemed medically necessary, it will usually be covered under Part B.

It is important to note that there are several specific items and services that Part B does NOT cover. These include:

Hospital expenses covered by Part A
Cosmetic procedures
Dental care
Hearing aids
Routine vision
Routine hearing
Routine foot care
Orthopedic shoes
Over-the-Counter Medications
International healthcare

Some Medicare Advantage plans may cover these items as part of their supplemental benefits.

Medicare Part C

Commonly referred to as a Medicare Advantage plan, most Medicare Part C plans cover Parts A, B, and D while also including supplementary benefits that are not covered under Original Medicare. For example, a Medicare Advantage plan may include vision, dental, hearing, routine foot care, and transportation to medical appointments.

Medicare Advantage plans are offered through private companies that by law are required to offer the same basic benefits and coverage as Original Medicare. Most who enroll in Medicare Advantage plans appreciate the added benefits and welcome the convenience of having all their coverage under the same plan.

Medicare Part D

Medicare Part D is coverage for prescription drugs and these plans are commonly called Prescription Drug Plans. Most prescription drugs are not covered by Original Medicare, so adding a Medicare Part D plan to your coverage is required. You may purchase a standalone Medicare Prescription Drug Plan (which adds drug coverage to Original Medicare), or you can sign up for a Medicare Advantage plan that offers prescription drug coverage.

Although coverage and costs vary from plan to plan, all Medicare drug plans must provide a standard level of coverage that is defined by Medicare. When comparing prescription drug plans, there are important factors to consider. Asking the following questions will help find the plan that works best for you.

What is your prescription drug needs?
Are your prescription drugs covered in the plan’s formulary?
What will your drugs cost under the plan?
Will you have to pay a co-payment, coinsurance, or deductible?
Will any of your drugs be subject to prior authorization or quantity limits?

When Can I Sign Up for Medicare?

When you first become eligible for Medicare, there is a period when you can sign up for Medicare Part A and Part B. For example, if you are eligible for Medicare when you turn 65, your Initial Coverage Election Period is 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 are already 65 or older, you can sign up or change plans during the Annual Enrollment Period that occurs yearly starting October 15^th and ends December 7th. The plan you select during the Annual Enrollment Period will take effect on January 1^st.