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Medicare Overview

Start from here if you are new to Medicare. This article provides a high-level summary of eligibility, various Parts and different Enrollment Periods for Medicare. Subsequent articles explore each of these in more detail. 

Medicare Overview

Medicare is a health insurance program of the United States federal government primarily covering healthcare needs of those who are 65+ years of age, people with disabilities who have been receiving social security disability benefits (SSDI) for two years, those affected by kidney failure (end-stage renal disease – ESRD), and those who have ALS (Amyotrophic Lateral Sclerosis aka Lou Gehrig disease).

If you are already getting benefits from Social Security or the Railroad Retirement Board (RRB), enrollment in Medicare (Parts A and B) takes place automatically starting the first day of the month you turn 65. Otherwise, you can apply up to three months in advance before the month you turn 65.

Medicare comprises of four parts :

  • Part A (hospital insurance),
  • Part B (medical insurance),
  • Part C (Medicare Advantage or MA plans), which includes both hospital and medical insurance. Plans are provided by private carriers, and
  • Part D (Prescription Drug Plans – PDP), covering outpatient prescription drugs. Plans are offered by private carriers.

Part A and Part B of Medicare are sometimes also called ‘Original Medicare'. They are managed by the government. Also, in addition to MA-only plans there are MA-PD plans, which include both Part C and Part D, offered by private carriers. Lastly, there are Medicare Supplement plans (sometimes referred to as 'Medigap'), which are also offered by private carriers. 

Part A coverage includes inpatient hospitalization, skilled nursing facility, home health care and hospice.

Part B coverage includes doctors’ services, outpatient care, home health services, durable medical equipment and some preventive services.

Part C covers both Part A (hospital insurance) and Part B (medical insurance) and is provided by private insurance companies. Under Part C, you will typically need to use doctors, hospitals and other providers in a plan’s network. Part C plans may provide extra coverage, for which they may charge an additional premium. You will also need to keep paying your Part B premium.

Part D covers outpatient prescription drugs, either through a Medicare Advantage plan including prescription drugs (MA-PD) or as a stand-alone Prescription Drug Plan (PDP). Prescription drugs are a significant component of healthcare costs so choose carefully.

Medicare Supplement Insurance (sometimes also called Medigap), offered by private insurance companies, provides coverage that is supplemental to Medicare Parts A & B. There are various types of Medicare Supplement plans, but their coverage is standardized. For example, Plan type F in a service area will provide the same coverage irrespective of carrier. However, costs may still vary by geography, carrier and other factors for the same type of Medicare Supplement plan.

On time enrollment in Medicare is critical to ensuring continued healthcare coverage and in avoiding potential future penalties. If you are not enrolled automatically, you may have to apply on your own. Therefore it is vital to keep track of the various enrollment periods  – Initial Enrollment Period (IEP), Annual Enrollment Period (AEP), General Enrollment Period (GEP) and Special Enrollment Periods (SEPs), which may be applicable. Failure to enroll in the program at the right time may result in late enrollment penalties.

                                                                                                                                                  

Click here to learn more about Medicare, its various Parts, different enrollment periods and your costs. 

We have also created videos to help you better understand various topics related to Medicare. Select and watch a video explaining the topic of your interest in a simple and intuitive manner.

Remember that you cannot choose just any combination of Parts and Plans. Let Lighted Road Insurance guide you step-by-step through the Medicare ecosystem and help you in selecting the right plan(s) for your needs. 

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General / Informational Disclaimers

This website (LightedRoadInsurance.com) contains information about and access to insurance plans for eligible and soon to be eligible Medicare beneficiaries and their advisors. It is operated by Lighted Road Insurance Services, an agency affiliated with HealthCompare Insurance Services Inc., a licensed health insurance agency to sell Medicare products.

LightedRoadInsurance.com and Lighted Road Insurance Services are not endorsed by the Centers for Medicare & Medicaid Services (CMS), the Department of Health and Human Services (DHHS), or any other government agency.

HealthCompare Insurance Services Inc. is a licensed and certified representative of Medicare Advantage HMO, POS, PPO and PFFS organizations and Medicare Prescription Drug plans with a Medicare contract. Enrollment in any plan depends on contract renewal.

For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.

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Last Updated: 11-17-2019