Understanding Your Medicare Options
What Is Medicare?
Medicare is federal health insurance generally available to people age 65 and older. Some people become eligible earlier because of a disability, End-Stage Renal Disease (ESRD), or ALS.
Understanding Medicare starts with knowing how its different parts work together. From there, you can decide how you want to receive your Medicare coverage and whether additional coverage makes sense for your situation.
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The Four Parts of Medicare
Part A — Hospital Insurance
Part A helps cover inpatient hospital care, skilled nursing facility care,
hospice care, and certain home health services.
Part B — Medical Insurance
Part B helps cover doctor visits, outpatient care, preventive services,
durable medical equipment, and other medically necessary services.
Part C — Medicare Advantage
Medicare Advantage plans are offered by private insurance companies approved
by Medicare. They provide your Part A and Part B benefits and often include
additional benefits and prescription drug coverage.
Part D — Prescription Drug Coverage
Part D helps pay for prescription drugs. Coverage is offered through
Medicare-approved private insurance companies.
Original Medicare or Medicare Advantage?
One of the most important Medicare decisions is how you want to receive your coverage. With Original Medicare, Part A and Part B are provided through the federal Medicare program. You can generally use any doctor or hospital that accepts Medicare, and you can add separate Part D prescription drug coverage.
Medicare Advantage is another way to receive your Medicare benefits through a private Medicare-approved plan. Plans may include prescription drug coverage and additional benefits, but provider networks, referrals, prior authorization requirements, and out-of-pocket costs can vary by plan.
Neither approach is automatically right for everyone. Your doctors, prescriptions, travel habits, budget, health needs, and preference for how you receive care can all matter when comparing the two.
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Where Does Medigap Fit?
Medicare Supplement Insurance, commonly called Medigap, works with Original Medicare. A Medigap policy can help pay some of the out-of-pocket costs left by Part A and Part B, such as certain deductibles, coinsurance, and copayments.
Medigap policies are sold by private insurance companies. They are not the same as Medicare Advantage plans: Medicare Advantage is another way to receive Medicare coverage, while Medigap supplements Original Medicare.
Premiums and available companies can vary, so comparing options can be worthwhile even when the standardized benefits of a particular Medigap plan letter are the same.
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When Should You Enroll in Medicare?
For most people becoming eligible at 65, the Medicare Initial Enrollment Period lasts seven months: it begins three months before the month you turn 65, includes your birthday month, and ends three months afterward.
Some people are enrolled automatically, while others need to sign up. Your situation can also be different if you or your spouse are still working and you have employer coverage. Waiting to enroll without qualifying for an enrollment exception can result in gaps in coverage or late-enrollment penalties.
The best time to start reviewing your options is before you need the coverage. That gives you time to understand your choices instead of making a decision under a deadline.
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