Learn How Medicare Works

Medicare is health insurance for people 65 or older, people under 65 with certain disabilities, and people of any age with End-Stage Renal Disease, also known as ESRD.

The Four Parts of Medicare
  • Medicare Part A
    Original Medicare Part A is known as hospital insurance. Part A helps to cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.
  • Medicare Part B
    Original Medicare Part B is known as medical insurance. Part B helps to cover services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.
  • Medicare Part C
    Medicare Part C is also known as Medicare Advantage Insurance Plans. Part C (Medicare Advantage) includes all benefits and services covered under Original Medicare Part A and Part B. Sometimes these plans include Medicare prescription drug coverage (Part D) as part of the plan. These plans are sold by private insurance companies approved by Medicare. Many Medicare Advantage Insurance plans also include extra benefits and services for an extra cost.
  • Medicare Part D
    Medicare Part D Prescription Drug plans help to cover the cost of prescribed medications. These plans are sold by private iinsurance companies approved by Medicare and may help lower your prescription drug costs and protect you agaisnt higher costs in the future.

How You Can Get Medicare Coverage

When you first enroll in Medicare, you have Original Medicare (Part A and Part B.) However, you can choose different ways to get your medicare coverage.

1. You can stay in Original Medicare. If you want prescription drug coverage, you must join a Medicare Part D Prescription Drug Plan. If you do not join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage (for example, from an employer or union), you may pay a late enrollment penalty if you choose to join later.

2. You can choose to join a Medicare Advantage Insurance plan (like an HMO or PPO) if one’s available in your area. The Medicare Advantage Insurance Plan may include prescription drug coverage that comes with the Medicare health plan if it’s offered. In some types of plans that don’t offer drug coverage, you may be able to join a stand-alone Medicare Part D Prescription Drug Plan.

Before making any decisions, it’s important to learn as much as possible about the types of coverage available to you. It’s important to consider convenience, cost, coverage, providers, prescription coverage, quality of care, and travel. Many individuals choose Original Medicare Part A  & Part B and simply add a Medicare Supplement to cover the additional expenses left behind by Original Medicare. While other beneficiaries choose to switch to a Medicare Advantage Insurance Plan.

Automatic Enrollment

If you’re already getting benefits from Social Security or the Railroad Retirement Board (RRB), you’ll automatically get Original Medicare Part A and Part B starting the first day of the month you turned 65. (If your birthday is on the first day of the month, Part A and Part B will start the first day of the prior month.)

If you’re automatically enrolled, you’ll receive your red, white, and blue Medicare card in the mail 3 months before your 65th birthday or 25th month of disability benefits. If you do nothing, you’ll keep Original Medicare Part B and pay Part B premiums. You can choose not to keep Part B, but you may have to wait to enroll and pay a penalty for as long as you have Part B.

Initial Enrollment Period

You can first sign up for Original Medicare Part A and Part B during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after you turn 65.

If you sign up for Original Medicare Part A and Part B during the first 3 months of your Initial Enrollment Period, in most cases, your coverage begins the first day of your birthday month. However, if your birthday is on the first day of the month, your coverage will start the first day of the prior month.

If you enroll in Original Medicare the month you turn 65 or during the last 3 months of your Initial Enrollment Period, the start date of your Medicare coverage will be delayed.

General Enrollment Period

If you did not sign up for Original Medicare Part A (if you have to buy it) and/or Part B (for which you must pay premiums) during your Initial Enrollment Period, you can sign up between January 1 – March 31 each year. Your coverage will not start until July 1 of that year, and you may have to pay a higher Part A and/or Part B premium for late enrollment.

Questions about Enrolling?

We can help you better understand your enrollment times and Medicare health plan options. Medicare Pathways is happy to assist in the process of helping you select a benefit package that meets your financial and medical needs. Don’t wait and face a penalty! Contact Medicare Pathways to ensure you are enrolled in the right plan at the right time. Call us at 866-466-9118 to speak with a licensed sales agent.

Medicare Supplement vs. Medicare Advantage

With more information, it’s easier to make the tough decision in choosing what option is right for you. Do you have concerns about Medicare Supplements or wish to know more about switching to a Medicare Advantage plan? We can certainly help provide a comprehensive side-by-side look at all of the health care options available in your area.