A Comprehensive Guide to Medicare

Medicare Guide Information

Find your way through the complex choices and options of Medicare, with our simple and useful guide on how coverage works.

Medicare is a program that helps millions of Americans get the healthcare they need. It can help you tremendously because it offers you choices on how you can obtain your benefits. However, sometimes finding the solution you need is tricky. So make sure you spend time exploring your options, because, in the end, you can find a solution that’s right for you. Our comprehensive guide to Medicare introduces you to the choices that are available and will explain the important differences.

This guide will help you construct a rock-solid plan for understanding what’s important when it comes to your Medicare. Healthcare costs are a big part of your finances. It’s something we all have to acknowledge now— even when it comes with a big price tag. Medicare offers helping hand with these costs. Making the right choice for you will take some thoughtful and extensive planning, so let’s get started!

Understanding Medicare from Medicare World on Vimeo.

What is Medicare?

You paid taxes on Medicare most of your life. This is why people 65 or older are eligible for Medicare. Medicare is also health insurance for people under 65 with certain disabilities. People of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant) are also eligible for Medicare. You must be a U.S. citizen or a legal resident who has lived in the country for at least five consecutive years.

What are my coverage choices?

There are two main ways to get your Medicare coverage—Original Medicare (Part A and Part B provided by the federal government) or a Medicare Advantage Plan (Part C offered through private insurance). Explore your options to help you decide which way to get your coverage.

What are the different parts of Medicare?

Medicare Part A (Hospital Insurance) helps cover:

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Original Medicare doesn’t pay for everything. You still pay a share of the cost in monthly premiums and copays
  • Home health care

Part B (Medical Insurance) helps cover:

  • Services from doctors and other health care providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
  • Original Medicare, parts A & B are the same across the United States

Medicare Part C (Medicare Advantage):

  • Includes all benefits and services covered under Part A and Part B
  • Run by Medicare-approved private insurance companies
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • May include extra benefits and services for an extra cost

Medicare Part D (Medicare prescription drug coverage):

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies

May help lower your prescription drug costs and help protect against higher costs in the future

When to ENROLL 

The Initial Enrollment Period (IEP) is your first chance to enroll in Medicare. It’s the three months before your 65th birthday month, the month of your birthday, and the three months after your birthday month.

  • If you enroll before the month you turn 65, coverage starts on the first day of your birthday month
  • If you enroll during your birthday month or later, coverage starts on the first day of the month following the date you enroll

Tip: If you don’t sign up for Part D coverage when you enroll in Medicare, you may pay a penalty if you enroll later unless you qualify for an exception.

Evaluate your choices once a year

After you choose your Medicare coverage, it’s important to know that you can make changes to your coverage during the Medicare Open Enrollment Period (OEP), Oct 15th– Dec 7th. Make sure you review your coverage thoroughly so you can find something that’s suits you best.

Special Election Period (SEP)

In some cases you can enroll or switch plans outside of IEP and OEP. This includes changes to your life situation which include:

  • You’re in retirement and choose a healthcare plan through your employer or union.
  • You move out of your healthcare plan’s service area.

How do I get started?

You must begin the enrollment process with Social Security. Go online or call/visit your local Social Security office to get started with your Medicare coverage. The Social Security Administration takes care of the paperwork for joining Medicare. The first letter you get in the mail about Medicare will come from Social Security. If you’re drawing Social Security benefits when you turn 65, Social Security should automatically enroll you in Medicare Part A and Part B, but check with your local Social Security office if you suspect there is a problem. Social Security can also help you find out if you’re eligible for Extra Help with the cost of Medicare coverage.

Who’s eligible for assistance?

It depends on your income. Your income includes money you get from retirement benefits or other money that you report for tax purposes. It also includes your assets (for example, property other than your house). The income eligibility levels vary by state and program. The income eligibility limit for 2020 is $19,140 a year for an individual or $25,860 for a couple. Go online, call or visit your local Social Security office to determine if you are eligible for extra help.

What Medicare DOES NOT cover

Here are some things Medicare doesn’t cover.

  • Custodial care (help with bathing, dressing, eating, etc.)
  • Most chiropractic services
  • Routine foot care
  • Acupuncture
  • Cosmetic surgery
  • Long-term care
  • Most care while traveling outside the United States
  • Routine hearing tests
  • Routine eye care
  • Most dental care
  • Diabetes testing
  • Lab Testing

Assess your current coverage

If you have coverage from your current job, or insurance from the job you retired from, you’ll want to find all the information you can and how it works with your Medicare plan. Always remember that help is available, even financial help. For additional information and resources, make sure you visit us at medicareworld.com.

Additional Medicare information

Visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. Representatives are available 24 hours a day, seven days a week.

Call your local State Health Insurance Assistance Program (SHIP) to see if you qualify for any financial assistance

  • Medicaid: helps pay for health care costs not covered by Medicare for people and families with limited incomes. It may also offer extra benefits that Medicare doesn’t cover, but each state creates its own program, so contact your state office for more information.
  • Medicare Savings Program helps you pay your Part A and B premiums, deductibles and coinsurance.
  • Program of All-Inclusive Care for the Elderly (PACE) combines medical, social and long-term care services for frail elderly people who live in the community, not a nursing home. It’s not available in all states.
  • Other programs may be available in your state.

Related links

A Glossary of Medicare Terms

Medicare Parts Explained

Medicare Education: Services NOT Covered by Medicare

Medicare Part A and B Won’t Cover These Services

What Does Medicare Cover?

Get Money Back from Medicare

Alarming Facts About Medicare Seniors Should Know

How to Change Medicare Plans

10 Things to Acknowledge When Considering Medicare Plans

8 Essentials to Understanding Medicare

6 Useful Tips to Avoid Medicare Mistakes

5 Medicare Rules You Should Know Inside Out

5 Medicare Mistakes That Cost You Big Money

5 Services Seniors Need that Medicare Doesn’t Cover

4 Puzzling Medicare and Medicaid Stats You Should Know

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