Original Medicare covers a lot, but it doesn’t pay for all the health care you may need. If you only have Part A and Part B coverage, you’ll pay the full cost for services Original Medicare doesn’t cover, including:
If you choose Original Medicare, you can buy extra coverage from private insurance companies to help pay for things that Medicare Part A and Part B don’t cover. Medigap plans, also known as Medicare Supplement plans cover things like coinsurance and copays, deductibles, your share of extended hospital stays, blood transfusions, and foreign travel emergencies. Medicare Supplement plans do not include Medicare Part D outpatient prescription drug coverage.
Part C is also known as Medicare Advantage. These are private plans that cover everything Original Medicare does plus many include prescription drugs coverage and other extras.
You can purchase Medicare Part D coverage from private health care companies to help cover the cost of your prescriptions. There are two ways to get Part D:
You don’t have to get a Part D plan when you enroll in Medicare. But if you don’t sign up when you first become eligible, you may pay a late enrollment penalty if you decide to sign up later. You’ll pay the penalty for as long as you have Part D coverage. To learn more about penalties related to Part D enrollment, visit the Medicare website.
Part D coverage is broken into a few phases:
Most people are eligible for Medicare at age 65. If you’re already receiving Social Security benefits, you’ll be enrolled automatically.
If you’re not receiving Social Security benefits, you’ll need to sign up for Medicare. You have seven months to sign up for Medicare – three months before your 65th birthday, the month of your 65th birthday, and three months after your 65th birthday.
Check with your employer if you need to enroll in Medicare first because there is the option to wait to enroll. If you or your spouse plan to keep working and have active employer group coverage with a large employer you can wait to enroll.
You can sign up for Medicare three ways:
Once you’re enrolled in Original Medicare, you can decide to enroll in a Part C (Medicare Advantage), Medicare Part D (Prescription drug coverage), or Medigap plan from a private insurance company.
There are three election periods where you can enroll in or change your plan choice:
This is when you first become eligible for Medicare. During this time, you can enroll in Medigap and a Part D plan (if you choose Original Medicare) or a Medicare Advantage Plan for the current year.
After your initial enrollment, you can make changes to your plan choices for the following year during the Annual Election Period (AEP) from October 15 to December 7.
From January 1 to March 31 every year or if you are newly eligible to Medicare, within the first three months. During this time, if you are enrolled in a Medicare Advantage plan, you change plans once during this election. You can enroll in another Medicare Advantage plan or disenroll from your plan and return to Original Medicare.
In addition to these election periods, there are special circumstances in which you can enroll or make changes called Special Election Periods (SEP). For example, if you were covered by your employer’s plan and didn’t enroll during the initial enrollment period or you moved to a new area with different plan options.
For all of the details on enrollment guidelines and requirements, visit www.Medicare.gov (external link).