If you’re a caregiver, helping a loved one enroll in Medicare can be a daunting task. There are several different parts of Medicare and multiple decisions to make. It’s no wonder the process can feel confusing.
But understanding the different types of Medicare coverage can help you make sure the seniors in your life are getting the best care for their health and lifestyle. Here’s a breakdown of what you – and your loved ones – need to know about Medicare.
What Is Medicare?
Medicare is the federal health insurance program for people aged 65 and older. Unlike private health insurance, Medicare doesn’t offer plans for couples or families; it covers only the individual. Spouses can choose different types of Medicare coverage.
Types of Medicare Coverage
There are two main options for Medicare coverage: Original Medicare and Medicare Advantage. Here are the basics of each option.
You can use Original Medicare at any doctor’s office or hospital in the U.S. that takes Medicare. This option can include the following parts:
- Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
- Part B covers doctor’s office visits and services, outpatient care, medical supplies, and preventive services.
- Part D is a supplemental prescription drug plan. You must be enrolled in Parts A and B to be eligible for Part D. You should also check with your local pharmacy to make sure they participate in your Medicare plan.
- Medicare Supplemental Insurance (Medigap) is extra insurance you can buy from a private company. In most states, Medigap plans are named by letters, like Plan G or Plan K. Medigap can help you pay out-of-pocket expenses, such as co-payments.
Medicare Advantage (Medicare Part C)
Medicare Advantage is a Medicare-approved plan from a private company. It’s also called Medicare Part C.
Medicare Advantage is a bundled plan that includes Medicare Parts A, B, and D. It usually offers extra benefits, like vision, hearing, and dental services. In most cases, you need to use providers in the plan’s network. When choosing a plan, make sure it covers your favorite primary care doctor and pharmacy, as well as any specialists you need to see.
How Can My Loved One Enroll in Medicare?
If they opted to collect Social Security benefits before turning 65, they’ll be automatically enrolled in Medicare Parts A and B when they turn 65. (You’ll still need to sign them up for Medicare Part D.)
If your loved one isn’t receiving Social Security benefits by age 65, you can help them enroll in Medicare online. They can sign up for Medicare Parts A and B by going to the Social Security Administration website or calling 1-800-772-1213.
You can buy a Medigap policy from any licensed health insurance company in your state.
You can sign up for Medicare Advantage and Medicare Part D on the Medicare website.
When Should My Loved One Sign Up for Medicare?
They can sign up for Medicare beginning three months before they turn 65 and up to three months after they turn 65. If your loved one doesn’t sign up for Medicare in that time frame, they may end up paying penalties in the form of higher premiums later.
If your loved one is working past the age of 65 or has health insurance coverage through a spouse, they may opt to delay Medicare.
They can also add, switch, or drop a Medicare Advantage plan or Medicare Part D during the Medicare Annual Enrollment Period. Enrollment is open every year from October 15 through December 7.
What Does Medicare Cost?
Costs for Medicare vary depending on what plan you choose.
- Part A: Most people don’t pay a monthly premium for Part A because they paid taxes into the system.
- Part B: In 2023, most people pay $164.90 per month. (Higher-income individuals may pay more.) Once you’re collecting Social Security benefits, the Medicare premium will be deducted from your monthly Social Security check.
- Medicare Supplemental Insurance: Monthly premiums vary depending on which plan you choose.
- Plan C: Monthly premiums vary depending on which plan you choose.
- Part D: Monthly premiums for supplemental drug coverage vary depending on which plan you choose.
For More Information About Medicare
Navigating the Medicare system can feel confusing. But help is available by phone or online.
For general questions about Medicare, call 1-800-633-4227 or go to www.medicare.gov.
For questions about enrolling in Part A and/or Part B, call the Social Security Administration at 1-800-772-1213.
The State Health Insurance Assistance Program (SHIP) offers online help with Medicare counseling and assistance in your area. You can also reach them at 1-877-839-2675.