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Medicare Considerations imageMedicare can be an increasingly difficult subject to grasp. There are several legal and political forces that make Medicare a topic of controversy and confusion. In order to ensure that you are aware of how Medicare will affect you and your family, it is important to remember these considerations

1. Medicare Is Divided into Four Parts

Medicare coverage is divided into four parts labeled alphabetically as Medicare Part A, B, C, and D. Part A is considered hospital insurance because it covers visits to hospitals, typically for individuals who are over 65 and also eligible for Social Security benefits. Part B is considered medical insurance and anyone who qualifies for Part A is also eligible for Part B.

Coverage includes both necessary and preventative services. Part C is commonly known as Medicare Advantage and allows for supplemental insurance policies purchased through Medicare-approved private insurers. Medicare Part D includes prescription drug coverage. Anyone covered by Parts A, B, or C is eligible for Part D coverage

2. Medicare Does Not Cover All Expenses

Medicare is a supplemental policy to insure people of retirement age. However, it does not cover all services or procedures. Many procedures may need to be paid for out of pocket and even then, may not be fully reimbursed. Supplemental insurance plans such as Medicare Part C can help offset some of the costs. It is important to speak with your insurance agent regarding what is covered and how much you will owe for services and procedures

3. Open Enrollment Periods

Medicare can only be claimed during certain enrollment periods each year. Many people who are approaching 65 are encouraged to apply before they turn 65 in order to maximize their coverage. While everyone of retirement age is automatically enrolled in Medicare Part A, eligible persons seeking other coverage may only enroll during one time window each year. The Open Enrollment Period for Medicare Part B is 7 months after eligibility for Part A.

4. Special Enrollment Periods

Special Enrollment Periods also exist depending on the circumstances surrounding missing the Open Enrollment Period. Failure to enroll during the initial enrollment period may result in higher premiums.

Special enrollment eligibility criteria may include:

  • Working for the government and being injured before retirement age
  • Permanent kidney failure
  • Had Medicare but dropped coverage
  • Working for the railroad industry
  • Disabled widows/widowers already receiving some sort of benefits

5. Coverage Does Not Begin Immediately

While Medicare Part A enrollment begins automatically, enrollment terms for Part B can be slightly confusing. If you enroll in Part B, coverage will begin depending upon the date that you enrolled. For example, if you enroll before you turn 65, your coverage will begin the month you turn 65.

If you enroll during the month you turn 65, coverage begins the month after you turn 65. If you wait until a month after you turn 65, the coverage will begin the next month. If you enroll 2-3 months after you turn 65, coverage will begin 2-3 months after you enroll.