Welcome to Medicare: Learn the basics
By Jeremy Rodriguez
Medicare is confusing. To make the most of your benefits, it is vital to arm yourself with all the necessary information.
“As you near age 65, you need to make several important decisions about your Medicare coverage,” said a spokesperson for the Centers for Medicare & Medicaid Services (CMS). “These decisions can take some time to make, so be sure to review all of the information available to you so that you can make an educated choice about your Medicare health insurance coverage.”
What is Medicare?
Medicare is health insurance for people aged 65 and older, as well as some younger people who are living with disabilities or with end-stage renal disease.
Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance). Part A provides coverage for care given in a hospital, skilled nursing facility or hospice. Part B covers medical care and services from doctors and other health care providers; outpatient care; medical equipment; and preventive services, such as vaccines and screenings. Parts A and B also cover eligible home health services as long as you need part-time or intermittent skilled services and as long as you’re homebound, according to Medicare.gov.
Part D, which Medicare beneficiaries can join separately, helps cover costs for prescription drugs.
Through Medicare Advantage, which is sometimes referred to as “Part C,” you can select a Medicare-approved plan from a private insurance company as an alternative to original Medicare. These plans include Part A, B and sometimes D. Medicare Advantage requires you to use doctors in the plan’s network, and may offer extra benefits — such as hearing, vision and dental services. Depending on your needs, your out-of-pocket health care costs may be lower.
Who is eligible?
According to CMS, there are numerous factors for eligibility. For example, to receive Part A for free, an applicant must be entitled to receive Medicare based on their own earnings or those of a spouse, parent or child. The worker must have a specified number of quarters of coverage and file an application for Social Security. The number of quarters of coverage depends on whether the individual is filing based on age, disability status or end-stage renal disease.
There are additional factors to consider if a person is still working past age 65 and has health insurance. In this case, talk to your health insurance provider. You may want to consider waiting until you stop working before applying for Medicare. There is a helpful guide on Medicare.gov, titled “Working Past 65,” that provides information on what you need to know.
How do I sign up?
An application for retirement or disability benefits from Social Security also serves as a Medicare application. Once approved for either of these benefits, the applicant automatically receives Part A coverage upon becoming eligible for Medicare. Generally, applicants can apply for Medicare three months before turning 65 until three months after. For more information or to sign up for Medicare:
- Contact the Social Security Administration at 1-800-772-1213 or ssa.gov/medicare/sign-up. You can also go to a local Social Security office. To find a location, go to ssa.gov/locator.
- If you or your spouse worked for the railroad, contact the Railroad Retirement Board at 1-877-772-5772 or rrb.gov. The Philadelphia field office, located in the Nix Federal Building at 900 Market St., Room 301, is open weekdays from 9 a.m. to 3 p.m. Call for an appointment.
Upon completing the application, Medicare will send you a welcome package with a Medicare card. If you sign up the month before you turn 65, your coverage begins the month you turn 65. If you sign up during the month you turn 65 to three months after, then coverage begins the following month.
After your Initial Enrollment Period for Medicare ends, you can only sign up for Part B and Premium-Part A during one of the other enrollment periods, and you might have to pay a monthly late enrollment penalty:
- General Enrollment Period – January 1-March 31 each year.
- Special Enrollment Periods – Certain life situations, including loss of Medicaid or other health coverage, natural disaster or emergency, inaccurate or misleading information from your health plan or employer, and incarceration.
How do I use Medicare?
Once you receive your Medicare card, protect it like a credit card or any other personal information. Only show it to doctors, hospitals and other health care providers to ensure your visit is covered by Medicare.
For assistance and information about different cost-saving options, call 1-800-MEDICARE or go to medicare.gov. Philadelphia residents can also contact PA MEDI for free personalized health insurance counseling by calling the PCA Helpline at 215-765-9040. (For more information about PA MEDI, Click Here>>) Pennsylvania residents, outside of Philadelphia, can call the PA MEDI Helpline at 1-800-783-7067.
Jeremy Rodriguez is a freelance journalist, blogger, editor and podcaster.