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What Is Medicare?

Most people have at least heard of Medicare but may not understand how it works or exactly what type of coverage it offers. Medicare is a federal health insurance program serving people 65 and older. Medicare also provides insurance coverage for younger people with disabilities and those with end-stage renal conditions.

What Are the Parts of Medicare? 

There are four parts to Medicare, each covering specific medical services. The following are the four types and what each covers. 

- Part A covers inpatient hospital stays. 

- Part B covers outpatient medical care. 

- Part C offers alternate coverage. 

- Part D covers prescription drugs.

What Is Original Medicare? 

Most people receive Parts A and B through original Medicare, a fee-for-service federal insurance program. This type of Medicare is offered directly through the federal government, and the government pays for your medical coverage. Original Medicare allows you to visit a doctor or hospital without prior approval. Beneficiaries pay a premium for their Medicare Part B, and some pay premiums for Part A, depending on their coverage. When you visit the doctor, you will owe a coinsurance payment, also called a co-pay. Doctors and hospitals are limited on what they can charge you for services if you have original Medicare. Original Medicare does not include prescription drug coverage. If you want Medicare Part D, you must choose a PDP plan, which is a stand-alone private Medicare plan. If you are eligible, federal programs can help you with the cost of your prescription drugs. There is an alternative to original Medicare, called Part C. You can only get Part C from a Medicare Advantage Plan. This coverage is also called a Medicare Private Health Plan. If you enroll in a Medicare Advantage Plan, you must still pay your Part B premiums. Although Medicare Advantage Plans must offer the coverage of Part A and Part B Medicare, they can do so at different rates and with further restrictions and coverage rules than original Medicare. 

How Do You Sign Up For Medicare? 

Some people will automatically receive Medicare Part A and B, but some must sign up for their federal insurance coverage. The fastest approach to enrolling in Medicare is online. Your first enrollment period will begin three months before your 65th birthday. If you begin receiving Social Security between 62 and 65, you will automatically receive Medicare without enrolling. If you are still working at 65 and do not want to receive Social Security, you can sign up for Medicare only.

What Is the SEP (Special Enrollment Period) & How Do You Qualify? 

You can only enroll or change plans in Medicare during the open enrollment period, which is November 1st through January 15th. Under specific circumstances, you may qualify to sign up for Medicare or change plans outside of open enrollment during the special enrollment period. You must meet the following qualifications to enroll during SEP. 

- You got married within the last 60 days. 

- You had a baby, adopted a child, or became a foster parent within the last 60 days. 

- You got divorced within the last 60 days and lost your healthcare coverage. 

- Someone on your Marketplace plan died within the last 60 days. 

- You moved to a new home with a new zip code or in a new county. 

- You moved to the United States from a foreign country. 

- You lost healthcare coverage through a job or Medicaid. 

- You gained membership in a federally recognized tribe. 

- You got out of jail within the last 60 days. 

- You became a United States citizen within the last 60 days. 

Understanding the Benefits of Enrolling in Original Medicare 

The main benefit of enrolling in original Medicare is the savings. You will pay low monthly premiums. Part A is usually free for most seniors, while Part B premiums. Start at $240 a month, based on your income. Another benefit of enrolling in original Medicare is that it is broadly accepted. Medicare gives you flexibility in selecting your provider. Most doctors, hospitals, and treatment clinics accept original Medicare. The main drawback of original Medicare is that there is no prescription drug coverage and no vision, dental, or hearing benefits. If you need this coverage, you can purchase an additional private plan.

Medicare Gives You the Medical Coverage You Need 

If you are 65 or older, you can qualify for Original Medicare and receive Part A and Part B coverage. You are allowed to enroll within three months of turning 65. You can change your plan or purchase additional coverage during open enrollment periods. You may enroll in Medicare by visiting the Centers for Medicare and Medicaid Services website or get help through an agent if you want to sign up for a Medicare Advantage Plan. This coverage will give you peace of mind in knowing your medical needs will be covered.

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