medicare

If you are just turning age 65 or recently became disabled, you have options beyond marketplace health plans.

What is Medicare?

Medicare is the Federal health insurance program for individuals who are age 65 and older and for younger individuals who are disabled.

Medicare eligibility does not take into consideration an individual’s income. However, individuals may pay higher premiums based on income, and low-income individuals may be eligible for additional assistance.

Receiving care: Individuals can receive their Medicare medical coverage directly from the Federal Government on a fee-for-service basis (this program is known as “Original Medicare” or “Fee-for-Service Medicare”) or through a private health plan.

Prescription drug coverage: Individuals can attain prescription drug coverage by attaining a Medicare Part D outpatient drug plan through a private health plan.

Ways to get Medicare:

Original Medicare Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. You can seek services from doctors or hospitals that takes Medicare throughout the United States. You will receive basic coverage and you will be responsible to pay on the average 20% of your medical costs. Original Medicare does not cover prescription drugs so you will need to purchase a drug plan separately. Medicare Supplement (Medigap) Medicare Supplement which is also known as Medigap is additional coverage you can purchase through private health insurance providers to help supplement the gams that Original Medicare does not cover. However, most supplement plans do not provide prescription drug coverage so you would need to purchase a separate Medicare Part D coverage. Prescription Drug Plans (PDP) In most cases, you will need to purchase a separate prescription drug plan since Original Medicare and Medigap polices do not cover prescription drugs. You can purchase a prescription drug plan from private insurance carriers. Medicare Advantage (MAPD) Medicare Advantage plans (also known as Part C) is a Medicare-approved plan offered through health insurance providers that offers an alternative to Original Medicare for your health and drug coverage. Advantage plans offers you the convenience of “bundled” plans which includes coverage for Original Medicare Part A and Part B as well as features of Medicare Supplement plans. Most Advantage plans offers a prescription drug plan. In most cases, you can only use doctors who are in the plan’s network. In many cases, you may need to get approval from your plan before it covers certain drugs or services. The advantages of an Advantage plans are they offer lower out-of-pocket costs than Original Medicare. They may offer some extra benefits that Original Medicare doesn’t cover—like vision, hearing, and dental services.

To join a Medicare Advantage plan, you must enroll in both Original Medicare Part A and part B

If you have employer health coverage, you have the option of waiving Medicare Part B coverage and you can avoid paying a late enrollment penalty.

When can I join, switch, or drop a plan?

You can join, switch, or drop a Medicare drug plan or a Medicare Advantage Plan with drug coverage during these times:

Initial Enrollment Period
When you first become eligible for Medicare, you can join a plan. The initial enrollment period starts 3 months prior to the month you turn age 65 and ends 3 months after the month you turn age 65.

Annual Open Enrollment Period
From October 15 – December 7 of each year, you can join, switch, or drop a plan. Your coverage will begin on January 1 as long as the plan gets your request by December 7.

Medicare Advantage Open Enrollment Period
From January 1 – March 31 of each year, if you’re in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time.

If you have to pay a premium for Part A and sign up for Part B for the first time during the General Enrollment Period, you can also join a plan from April 1 – June 30. Your coverage will start on July 1.

Special Enrollment Periods
Generally, you must stay in your plan for the entire year. But when certain events happen in your life, like if you move or lose other insurance coverage, you may qualify for a Special Enrollment Period. You may be able make changes to your plan mid-year if you qualify. Check with your plan for more information.

Date	Description
October 1, 2024	Start comparing your current coverage with other options. You may be able to save money or get extra benefits. Visit Medicare.gov/plan-compare
October 15 to December 7, 2024	Change your Medicare health or drug coverage for 2023, if you decide to. You can join, switch or drop a Medicare Advantage Plan or Medicare drug plan during this Open Enrollment Period each year.
January 1, 2024	New coverage begins if you made a change. If you kept your existing coverage and your plan's cost or benefits changed, those changes also start on this date.
January 1 to March 31, 2024	If you're in a Medicare Advantage Plan, you can change to a different Medicare Advantage Plan or switch to Original Medicare (and join a seperate Medicare drug plan) once during this time. Any changes you make will be effective the first of the month after the plan gets your request. See page 63.

You will need to pay for Medicare Part B to join a MAPD program.

Dollars

Average Part B Premium

Medicare

What is Medicare?

Ways to get Medicare:

To join a Medicare Advantage plan, you must enroll in both Original Medicare Part A and part B

When can I join, switch, or drop a plan?

You will need to pay for Medicare Part B to join a MAPD program.

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