What is Medicare and who is eligible?

On July 30, 1965, President Lyndon B. Johnson signed the bill that led to the formation of Medicare. The original Medicare program included Part A (Hospital Insurance) and Part B (Medical Insurance), also known as “Original Medicare.” Over the years, Congress has made changes to Medicare benefits and to include many groups of eligibles.

Medicare is a national health insurance for people 65 or older, certain people under 65 with disabilities, and people of any age with End-Stage Renal Disease. Medicare has many moving parts and it is important to understand how they fit together for you.

What are the Parts of Medicare?

Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital stays, skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance)
Part B covers certain doctor services like a specialist visit, outpatient services, durable medical supplies, and preventive services.

Medicare Part C (Medicare Advantage)
These plans are an alternative to Original Medicare (Part A and B). They include Part A, Part B, and usually Part D. Most plans offer benefits that Original Medicare does not cover like routine vision and dental. Because of their contract with Medicare, thus being allowed to call themselves “Part C”, the plans must minimally cover what Original Medicare covers and follow Medicare’s coverage rules.

Medicare Part D (prescription drug coverage)
Helps cover the cost of prescription drugs. You can receive these benefits through a Medicare Advantage plan with drug coverage or standalone Medicare drug plan.

When to Enroll

When to enroll depends on your specific situation. If you are already retired (woohoo!), in most cases you want to enroll in Medicare within the 3 months before your 65th birthday, so that your Medicare coverage begins on the 1st of your birthday month. Your Initial Enrollment Period is the seven month window around your 65th birthday. You can enroll into Medicare at any time within the seven months without penalty, however if you enroll in your birthday month or the three months after, the Part B coverage will start the month after your enrollment (You cannot choose the month).

Automatic Enrollment

If you are already receiving Social Security or Railroad Retirement Benefits, you will be automatically enrolled in Medicare. You’ll get your red, white, and blue Medicare card in the mail about 3 months before your 65th birthday or before your 25th month of receiving disability benefits. If you are fast approaching your birthday month and don’t have your card, call the Social Security Administration to check on the status.

Manual Enrollment

Those eligibles not already receiving Social Security or RR Benefits may enroll in Medicare through Social Security one of three ways:

  1. Setting up a phone appointment
  2. Enroll on the Social Security website (in about 15 minutes or less) after you create an account
  3. Make an appointment or walk into your local Social Security office

After you apply, it will take usually 2 to 4 weeks for your card to arrive, so you should plan to apply several weeks before you need the coverage to begin. And remember, this will enroll you in Medicare Part A and B. If you want to enroll in a Medicare Advantage Plan, Prescription Drug Plan, or Medicare Supplement you can work with a licensed agent (like me!) to help navigate options in your area.

Now what?

Let’s say you have enrolled into Medicare and have your red, white, and blue card in your hand. What is the next step? Learn more about Medicare Advantage and Medigap plans to see which type of plan may be a good fit for your needs.