Understanding Medicare: Your Guide to Federal Health Insurance
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD). At InnQuote, we're here to help you understand how Medicare works and find the coverage that's right for you.
Who is Eligible for Medicare?
- Age 65 or older: Most people become eligible for Medicare when they turn 65
- Under 65 with disabilities: People who have been receiving Social Security disability benefits for 24 months
- End-Stage Renal Disease (ESRD): People with permanent kidney failure requiring dialysis or a kidney transplant
- Lou Gehrig's disease (ALS): People with ALS become eligible for Medicare immediately
The Four Parts of Medicare
Medicare Part A - Hospital Insurance
Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
What's Covered:
- Inpatient hospital care
- Skilled nursing facility care
- Hospice care
- Home health care
- Lab tests and surgery
Cost: Most people don't pay a premium for Part A if they or their spouse paid Medicare taxes while working.
Medicare Part B - Medical Insurance
Part B covers outpatient care, medical services, and some preventive services.
What's Covered:
- Doctor visits
- Outpatient care
- Medical supplies
- Preventive services
- Some medical equipment
Cost: Most people pay a monthly premium for Part B, which is typically deducted from your Social Security benefit.
Medicare Part C - Medicare Advantage
Part C plans are offered by private insurance companies approved by Medicare.
What's Covered:
- All Part A and Part B benefits
- Additional benefits like dental, vision, hearing
- Prescription drug coverage
- Fitness programs
- Transportation to medical appointments
Cost: You still pay your Part B premium, plus any additional premium the plan may charge.
Medicare Part D - Prescription Drug Coverage
Part D helps cover the cost of prescription drugs and may lower your costs and protect against higher costs.
What's Covered:
- Prescription drugs
- Some vaccines
- Cost-sharing assistance
- Catastrophic coverage
- Formulary management
Cost: You pay a monthly premium, annual deductible, and copayments or coinsurance for your prescriptions.
Medicare Supplement (Medigap) Plans
Medigap policies are sold by private insurance companies and help pay some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles.
Key Benefits of Medigap Plans:
- Predictable out-of-pocket costs
- Freedom to see any doctor who accepts Medicare
- Coverage that travels with you anywhere in the U.S.
- Guaranteed renewable coverage
- Standardized benefits across all insurance companies
Enrollment Periods
Understanding Medicare enrollment periods is crucial for avoiding penalties and ensuring continuous coverage:
Initial Enrollment Period (IEP)
This is a 7-month period that begins 3 months before you turn 65, includes the month you turn 65, and ends 3 months after you turn 65. If you don't enroll during this period, you may face late enrollment penalties.
Annual Enrollment Period (AEP)
October 15 - December 7 each year. During this time, you can change your Medicare Advantage or Part D plan for the following year.
Special Enrollment Periods (SEP)
Special circumstances that allow you to enroll outside of regular periods, such as losing employer coverage, moving to a new area, or qualifying for Extra Help.
Medicare Costs
Understanding Medicare costs is essential for budgeting your healthcare expenses:
Premiums
Monthly payments you make to Medicare or your insurance company for coverage.
Deductibles
Amount you must pay for covered services before Medicare begins to pay.
Copayments
Fixed amounts you pay for covered services, like $20 for a doctor visit.
Coinsurance
Percentage of the cost you pay for covered services, like 20% of the Medicare-approved amount.
How InnQuote Can Help
Navigating Medicare can be complex, but you don't have to do it alone. Our team at InnQuote specializes in Medicare and can help you:
- Understand your Medicare options and eligibility
- Compare different plans and their costs
- Find plans that cover your specific healthcare needs
- Enroll in the plan that's right for you
- Get ongoing support and assistance
- Resolve billing issues and claims problems
Ready to Learn More?
Contact our Medicare experts today for a free consultation and personalized guidance.
Get Your Free Quote Contact Us