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Medicare Basics
Welcome Guide

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Get the Basics About Medicare

Making the right decisions about your Medicare options is easier when you have all the facts. From understanding the parts of Medicare, to the differences between Medicare Advantage and Medicare Supplement plans, to figuring out when to enroll — we can help.

Who Qualifies and When to Enroll in Original Medicare

You should enroll in Medicare when you first become eligible. For most people this is when they:

  • Turn 65;
  • Retire (if they work past their 65th birthday);
  • Or before they turn 65 due to a disability.

When to enroll

Your initial enrollment period (IEP)

You have a seven-month window in which to enroll in Medicare. It starts three months before the month you become eligible and ends three months after the month you became eligible.

If you sign up for Part A and/or Part B during the first 3 months of your Initial Enrollment Period, in most cases, your coverage starts 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 Part A and/or Part B the month you turn 65 or during the last 3 months of your Initial Enrollment Period, the start date for your Medicare coverage will be delayed.

When to enroll chart

Mark your calendar for three months before the month of your 65th birthday to remind yourself to get started. By starting early, you can make sure that all your coverage is in place exactly when it should be.

If you miss your IEP, there are other opportunities during the year when you can enroll, including:

  • Special Enrollment Period (SEP): Anytime during the year
    You can change your coverage when certain events happen in your life, like you move out of your plan's service area, you enroll in Medicaid, or you start to receive Extra Help for your prescription drugs. For more information about Special Enrollment Period, call us!
  • General Enrollment Period (GEP): January 1 – March 31
    This is when you can sign up for Parts A and B, if you didn't sign up when you were first eligible, during your Initial Enrollment Period, you may sign up for Medicare Parts A and/or B during the General Enrollment Period. Your coverage will begin July 1 of that year.
    If you enroll during the General Enrollment Period, your Part A and B costs may be higher due to an assessed late enrollment penalty.
  • Annual Enrollment Period (AEP): October 15 — December 7
    This is when you can join or switch Part C (Medicare Advantage), Medicare Supplement (Medigap), or Part D (prescription drug) plans. You can also change from a plan that includes Part D to one that does not. Your new plan benefits will begin January 1 of the following year.
    Important dates to remember:
    • October 1st you can start reviewing your coverage against other plans.
    • October 15th — December 7th you may change your Medicare health or prescription drug coverage.
    • January 1st is when your new coverage will begin.
  • Medicare Advantage Disenrollment Period (MADP): January 1 — February 14
    This is when you can disenroll from a Medicare Advantage plan and return to Original Medicare, but you cannot join or switch to another MA plan. During this time you will have a Special Enrollment Period to join a stand-alone Medicare Part D plan. Your new stand-alone Medicare Part D plan will begin the first day of the month following. You may also elect to join a Medicare Supplement (Medigap) plan. For more information about the Medicare Advantage Disenrollment Period, call us!

You must meet certain requirements to qualify for Medicare. If you are unsure if you qualify, you can refer to the Medicare Eligibility Calculator.

What is Medicare and How It Works

Medicare is confusing. But understanding how all the parts work together is the key to finding the coverage that fits your needs, lifestyle, and budget.

Medicare is a federally managed health insurance program that began in 1965. It provides coverage for people age 65 and older or younger individuals who qualify under special circumstances (such as disability).

There are four main parts to Medicare: Part A, B, C, and D. Each part covers different health care costs. Let's take a look at what each one covers so you can decide which one, or ones, are right for you.

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Original Medicare provided by the federal government

Part A

Part B

What is it? Hospital insurance

What does it cover?

  • Hospital stays
  • Skilled nursing care
  • Home health visits

What does Part A cost?

You usually don't pay a monthly premium for Medicare Part A coverage, if you or your spouse paid Medicare taxes while working and you worked for a total of 10 years.

If you need to buy Part A, you'll pay a monthly premium for it.

Late enrollment penalty: If you are required to enroll in Part A on your own and don't sign up when you are first eligible, your monthly premium could go up as much as 10 percent for twice the number of years that you delayed. A delay from one month or one year will result in the same 10 percent penalty.
For example: If you were eligible for Part A for 2 years but didn't sign up, you'll have to pay the higher premium for 4 years.

What is it? Medical insurance

What does it cover?

  • Doctor visits
  • Outpatient services
  • Other medical expenses

What does Part B cost?

There is a monthly premium for Part B, and most people usually have it taken directly out of their Social Security checks.

Late enrollment penalty: If you don't sign up for Part B when you're first eligible, you may have to pay a 10 percent late fee for each 12 month period you could have had Part B but didn't enroll — for as long as you have Part B coverage.

For example: If your monthly Part B premium is 100 dollars but you enrolled 1 year late, there may be a 10 dollar late fee added to your premium. If you delayed for two years, the late fee may be $20, and if you waited three years, you may pay an additional $30 a month — for as long as you have Part B coverage.

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You can choose to add additional coverage provided by private insurance companies

Part C: Medicare Advantage plans

Medigap plans (Medicare Supplement)

What is it? Health plans (for example, HMOs and PPOs)

What does it cover? Plan covers Part A and B benefits as well as preventive care. Many Medicare Advantage plans come with Part D prescription drug coverage built in. May include extras such as:

  • Vision
  • Hearing
  • Gym memberships

OR

What is it? Additional insurance to supplement Part A and Part B (Original Medicare)

What does it cover? These plans help with some or all of the out-of-pockets costs you're left with after Original Medicare pays its share. It does not include Part D benefits. While the monthly premiums are higher, some people choose a Medigap plan to reduce their deductibles, copayments, and coinsurance. These plans are identified by the letters A through N, and each one has a distinct set of benefits.

Part D: Drug coverage

What is it? Prescription drug coverage

What does it cover?

Part D covers the generic and brand names prescriptions that are listed on the plan's drug formulary list. (Every plan has a different formulary list. You should review each plan's formulary before enrolling.)

Late enrollment penalty: You will be required to pay a Part D late fee if you do not enroll in creditable prescription coverage when you are first eligible, or if you go without creditable coverage for 63 days or more in a row. The fee is currently 1 percent of the national base beneficiary premium multiplied by the number of months you were eligible for but didn't join a Medicare drug plan. The final amount is rounded to the nearest 10 cents and added to your monthly premium.

Scroll or swipe to reveal all table data.

Have additional questions? You can speak to an Independence Blue Cross Medicare Representative at a Medicare Basics Event.
Register now

Independence Blue Cross Medicare Videos

What Original Medicare Doesn’t Cover

Unfortunately, Original Medicare won't cover all of your costs. If you’re preparing to enroll in Medicare, knowing how much it is going to cost is important.

Medicare Parts A and B don’t cover everything. If you need certain services that they don’t cover, you'll have to pay for them yourself unless you have other insurance or you’re in a Medicare health plan that covers those services. Even if Medicare covers a service or item, you generally will have to pay your deductible, coinsurance, and copayments.

Some of the items and services that Medicare doesn’t cover include:

  • Long-term care (also called custodial care)
  • Most dental care
  • Eye examinations related to prescribing glasses
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and exams for fitting them
  • Routine foot care
  • Out-of-pocket expenses for Part D prescription drug coverage, including:
    • Yearly deductible, copayments, and coinsurance
    • The cost of drugs in the coverage gap (or donut hole)
    • Penalties if you enrolled late in Part D

Independence Blue Cross Medicare Videos

What You need to know about COBRA

COBRA is a federal law that may let you keep your employer group health coverage for a limited time after your employment ends or after you would otherwise lose coverage.

If you are considering COBRA coverage, here are some things you should know:

  • COBRA and retiree health plans aren't considered creditable coverage.
  • Don't delay signing up for Medicare Part B even if you are on COBRA:
    • You may have to pay a penalty.
    • You may have a gap in your health care coverage.
  • COBRA may end once you sign up for Medicare.
  • You will be eligible to purchase COBRA if you enroll in Medicare first.
  • COBRA coverage is generally secondary to Medicare.
  • COBRA coverage for your spouse and dependents can last up to 36 months from the date you became entitled to Medicare.

Read COBRA: 7 important facts.

What You Need to Know About Individual and Family Plans

Your coverage needs and enrollment deadlines may differ based on the type of coverage you currently have.

Individual and family plans

If you are currently enrolled in an individual or family plan (also known as an Individual Qualified Health Plan (QHP)) through a health insurance carrier or the Marketplace, you can keep your QHP coverage, but it may be a costly choice. Consider this:

  • Enroll in Medicare Parts A and B as soon as you are eligible for Medicare. You need to be aware of your Initial Enrollment Period and take steps to enroll during that period to avoid any late enrollment penalties
    • If you enroll in Medicare after your initial enrollment period ends, you may have to pay a late enrollment penalty for as long as you have Medicare. In addition, you can enroll in Medicare Part B (and Part A if you have to pay a premium for it) only during the Medicare general enrollment period (from January 1 to March 31 each year). Coverage doesn't start until July of that year. This may create a gap in your coverage.
  • After enrolling in Original Medicare, consider whether you would like the added coverage that comes with a Medicare Advantage or Medicare Supplement plan.
  • If you keep your QHP plan after enrolling in Original Medicare, you may not qualify for any tax credits to help pay for your plan’s monthly premium, which will make it much more expensive.
  • You cannot supplement Medicare with a Marketplace plan. It's against the law for someone who knows that you have Medicare to sell you a Marketplace policy. This is true even if you have only Medicare Part A or only Part B.
  • You may want to drop your QHP coverage — notify your plan at least 14 days before you want your coverage to end.

Have additional questions? You can speak to an Independence Blue Cross Medicare Representative at a Medicare Basics Event.
Register now

Independence Blue Cross Medicare Videos

Medicare Terms

Need a quick introduction to some Medicare terms? Here are some of the most common.

Deductible: The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.

Coinsurance: An amount you may be required to pay as your share of the cost for services or prescription drugs after you pay any deductibles. Coinsurance is usually a percentage (for example, 20 percent).

Copayment: An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor's visit, hospital outpatient visit, or a prescription drug. A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor's visit or prescription drug.

Medicare Advantage (MA): Part of traditional Medicare but offered through private insurance companies. MA plans can include a variety of health plans such as HMO or PPO, prescription drug plans, as well as wellness and prevention benefits.

Medicare Extra Help: A Medicare program to help people with limited income and resources pay Medicare prescription drug program costs, such as premiums, deductibles, and coinsurance.

Medicare Part D / Part D: The prescription drug coverage program offered under Medicare.

Network: Provider is the general term we use for doctors, other health care professionals, hospitals, and other health care facilities that are licensed or certified by Medicare and by the state to provide health care services. We call them network providers when they have an agreement with our plan to accept our payment as payment in full, and in some cases to coordinate as well as provide covered services to members of our plan. Our plan pays network providers based on the agreements it has with the providers or if the providers agree to provide you with plan-covered services. Network providers may also be referred to as plan providers.

Premium: The periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage.

Website Last Updated: 10/1/2016
Y0041_HM_17_43499 Approved 10/7/2016