What Is Medicare: Coverage, Cost and Enrollment

If you've recently celebrated your 65th birthday or have one coming up soon, you're likely receiving a lot of mail about your Medicare eligibility.

Understanding Medicare is essential before you sign up to avoid any surprise costs. And if you've been on Medicare for a while, it's a good idea to review your options each year to make sure your plan is still the right fit for you.

This guide covers everything you need to know about Medicare.

### What Is Medicare?

Medicare is a federal health insurance program primarily for those aged 65 and older. It also covers individuals under 65 with certain disabilities, as well as people with end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig's disease).

### Medicare Eligibility and Enrollment

No matter when you plan to retire, you become eligible for Medicare when you turn 65.

#### Medicare Initial Enrollment

You can sign up for Medicare starting three months before your 65th birthday, during your birth month, and up to three months after. This seven-month timeframe is known as the initial enrollment period. If you miss this window, you may face a long-term penalty, even if you're still working.

If you’re already receiving benefits from Social Security or the Railroad Retirement Board four months before your 65th birthday, you’ll be automatically enrolled in Medicare.

#### Medicare Open Enrollment

For those not enrolling for the first time, the fall open enrollment period, also known as the annual election period, runs from October 15 to December 7. During this period, you can review or adjust your Medicare plans or switch between Medicare and Medicare Advantage plans. Changes take effect on January 1 of the next year.

Another enrollment window, the Medicare Advantage open enrollment period, runs from January 1 to March 31. This period is for those already enrolled in a Medicare Advantage plan who want to switch to another Medicare Advantage plan or revert to original Medicare.

#### Medicare General Enrollment

The general enrollment period for Medicare, lasting from January 1 to March 31, is for those who missed the initial enrollment window and don’t qualify for special enrollment. Coverage begins the month after you enroll, but penalties may apply for late enrollment.

#### Medicare Special Enrollment

If you need to enroll or adjust your coverage outside of the regular enrollment windows, you may qualify for a special enrollment period. Some qualifying situations include losing Medicare coverage, experiencing a natural disaster, serving as a volunteer in another country, or being recently incarcerated. Depending on your circumstances, you may have up to six months to enroll in Medicare without facing penalties.

### Medicare Plans and Coverage

Medicare is divided into several parts, each covering different types of healthcare:

- **Part A**: Hospital care, skilled nursing, hospice, and some home health care.
- **Part B**: Doctor visits, preventive care, outpatient care, and some home health care.
- **Part D**: Prescription drugs.

#### Medicare Advantage (Part C)

Medicare Advantage plans are offered by private companies that contract with Medicare to provide all Part A and Part B benefits, often including Part D drug coverage. These plans may also offer additional benefits like dental, vision, hearing, and wellness programs. However, coverage specifics can vary, so it's important to read the fine print.

### Medicare Supplement (Medigap) Plans

For those opting for original Medicare, a Medicare supplement plan (Medigap) can help cover out-of-pocket costs like deductibles, copayments, and coinsurance. Medigap plans are offered by private insurers and can provide additional coverage, including emergency medical costs when abroad.

### Medicare Savings Programs for Low-Income Seniors

Low-income individuals may be eligible for Medicare Savings Programs, which help with premiums and healthcare costs. The primary programs include:

- **Qualified Medicare Beneficiary Program**: Helps pay premiums, deductibles, coinsurance, copayments, and prescription drugs.
- **Specified Low-Income Medicare Beneficiary Program**: Helps pay Medicare Part B premiums and prescription drugs.
- **Qualifying Individual Program**: Helps pay Medicare Part B premiums.
- **Qualified Disabled Working Individual Program**: Helps pay Medicare Part A premiums for those with disabilities who return to work.

These programs have specific income and resource limits, so check your eligibility to see if you qualify.

### Conclusion

Navigating Medicare can seem overwhelming, but understanding the basics of enrollment periods, coverage options, and assistance programs can help you make informed decisions. Whether you're new to Medicare or reassessing your current plan, staying informed ensures you get the coverage you need.