How Medicare Works
Medicare is the federal health insurance program for people over 65 years of age and people with certain disabilities or End-Stage Renal Disease (permanent kidney failure).
There Are Four Parts to Medicare:
- Part A – Hospital Insurance
- Part B – Optional Medical Insurance
- Part C – Optional Medicare Advantage Insurance
- Part D – Optional Prescription Drug Insurance
Medicare Part A
Helps pay for care in hospitals, some skilled nursing facilities, hospice, and some health care. For most people, Part A is premium-free because they paid Medicare taxes.
Optional Medicare Part B
Optional coverage to help pay for doctors, outpatient hospital care, and some other medical services not covered by Part A. Part B monthly premium amounts are based on income and change each year. There may be a late-enrollment penalty.
Part C Optional Medicare Advantage Plan Monthly
An alternative to traditional Medicare, Part C is another way to get Medicare benefits. It combines Part A, Part B, and, sometimes, Part D (prescription drug) coverage. Medicare Advantage Plans are managed by private insurance companies approved by Medicare. These plans must cover medically-necessary services. However, plans can charge different copayments, coinsurance, or deductibles for these services.
Part D Optional Medicare Prescription Drug Plan
This optional coverage may help lower an individual’s prescription drug costs and help protect against higher costs in the future.
Medicare Advantage & PDP
The Annual Election Period is October 15 through December 7. We’re here to help with your preparation and answer your questions.
Medicare Advantage Open Enrollment Period
The new Medicare Advantage Open Enrollment Period (OEP) is January 1 through March 31. It allows individuals enrolled in an MA plan to elect a one-time switch to another MA plan (with or without Part D coverage) or to return to Original Medicare. Those using this OEP to make a change may make a coordinating change to add or drop Part D coverage. Those who enroll in a Medicare Advantage plan during their initial election period are also afforded an open enrollment period in the first three months they have Medicare.
We’re here to help and answer your questions.
The following examples are for those who enrolled in an MA plan during an Initial Election Period or Special Election Period.
Example: Someone New to Medicare
A beneficiary’s 65th birthday is on June 20, 2019; she is eligible for Part A and Part B on June 1, 2019.
Her Initial Coverage Election Period (ICEP) is 3 months before, the month of, and 3 months following the month of entitlement: March 1 through September 30, 2019.
She enrolls in a Medicare Advantage plan effective June 1.
MA OEP for her begins the month of entitlement to both Part A and Part B (June) and continues through the last day of the 3rd month from the month of entitlement (August). In other words, her MA OEP runs from June 1 through August 31.
Example: Someone Who Continues to Work
A beneficiary’s 65th birthday is April 20, 2018; she is eligible for both Part A and Part B beginning April 1, 2018. She continues working and doesn’t enroll in Part B until she retires. She uses the Part B Special Election Period (SEP) to in enroll in Part B on May 1, 2019.
Her ICEP is 3 months before her Part B effective date: February 1 through April 30, 2019.
She enrolls in a Medicare plan effective May 1, 2019.
MA OEP for her begins the month of entitlement to both Part A and Part B (May) and continues through the last day of the 3rd month from the month of entitlement to both Part A and Part B (July). In other words, her MA OEP runs from May 1 through July 31.
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