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Watch our four-part video series for a full understanding of what you need to know about Medicare health insurance.
The Wealth Training Academy believes that the more educated you are about Medicare, the easier it becomes to choose the plan that best fits your unique needs. We are committed to helping you make confident, informed decisions about your Medicare coverage.
Medicare is a health insurance program for:
Part A Hospital Insurance
Most people don’t pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.
Part B Medical Insurance
Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors’ services and outpatient care. It also covers some other medical services that Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.
Prescription Drug Coverage
Most people will pay a monthly premium for this coverage. On January 1, 2006, Medicare prescription drug coverage became available to everyone with Medicare. This coverage is to help you lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. If a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.
Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. Here are some simple guidelines. You can get Part A at age 65 without having to pay premiums if:
If you are under 65, you can get Part A without having to pay premiums if:
While you don’t have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it. It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t get any of the above payments, Medicare sends you a bill for your Part B premium every 3 months.
Medicare Advantage Plans, sometimes called Medicare Part C, are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through the Medicare Advantage Plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include:
When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, there generally are extra benefits and lower co-payments than in the Original Medicare Plan*. Most Medicare Advantage Plans are managed care plans, usually a health maintenance organization (HMO) or a preferred provider organization (PPO) and you may have to see doctors that belong to the plan or go to certain hospitals to get services.
Health Maintenance Organization (HMO) Plan
In most HMO Plans, you can only go to doctors, other health care providers, or hospitals on the plan’s list except in an emergency, for out-of-area urgent care or for temporary out-of-area dialysis. You may also need to get a referral from your primary care doctor to see other doctors or specialists. Find and compare HMO Plans in your area.
Preferred Provider Organization (PPO) Plans
A Medicare PPO Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. In a PPO Plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You pay more if you use doctors, hospitals, and providers outside of the network.
Private Fee-for-Service (PFFS) Plans
A Medicare PFFS Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PFFS plans aren’t the same as Original Medicare or Medicare supplement. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
Medicare Special Needs (SNP) Plans
Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics, and tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.
Keep in mind that Medicare limits when you can join, switch, or drop a Medicare Advantage Plan. You can join a plan when you first become eligible for Medicare. This is anytime beginning three months before the month you turn 65 and ends three months after the month you turned 65. For example, if you turn 65 on May 5, your eligibility period starts on February 1 and ends on August 31.
If you are disabled and have Social Security Disability Insurance, you can join an advantage plan three months before to three months after month 25 of your disability.
You can switch or drop your Medicare Advantage during an enrollment period between October 15 and December 7 of each year.
