Get coverage with Medicare
With Medicare, you have options in how you get your coverage. Once you enroll, you’ll need to decide how you’ll get your Medicare coverage.
Medicare
Advantage
Medicare
Suplement
Medicare Part D
Plans (PDP)
Medicare Advantage
Medicare Advantage Plans are another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D). In most cases, you’ll need to use health care providers who participate in the plan’s network. These plans set a limit on what you’ll have to pay out-of-pocket each year for covered services.
Some plans offer non-emergency coverage out of network, but typically at a higher cost. Remember, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services.
Keep your red, white, and blue Medicare card in a safe place because you may need to use your Medicare card for some services. Also, you’ll need it if you ever switch back to Original Medicare. Below are the most common types of Medicare Advantage Plans
With a Medicare Advantage Plan, you may have coverage for things Original Medicare doesn’t cover, like fitness programs (gym memberships or discounts) and some vision, hearing, and dental services (like routine checkups or cleanings). Plans can also choose to cover even more benefits. For example, some plans may offer coverage for services like transportation to doctor visits, over-the-counter drugs, and services that promote your health and wellness. Plans can also tailor their benefit packages to offer these benefits to certain chronically-ill enrollees.
These packages will provide benefits customized to treat specific conditions. Check with the plan before you enroll to see what benefits it offers, if you might qualify, and if there are any limitations.
Medicare Advantage Enrollment Period
- Initial Enrollment Period (IEP): Seven-month period, including the three months before, the month of, and the three months after the month you first become eligible for Medicare (either your 65th birth month or the 25th month you have collected disability benefits).
- The Part B Special Enrollment Period (SEP): Periods of time outside normal enrollment periods to enroll in Part B. The Part B SEP lets you delay enrollment in Part B without penalty if you were covered by job-based insurance when you first become eligible for Medicare. You can enroll in Medicare without penalty for up to eight months after you lose job-based coverage. You can enroll in an MA Plan after you have signed up for Part A and B coverage.
- General Enrollment Period (GEP): The January through March period each year when you can sign up for Medicare if you did not sign up for it when you originally became eligible. Coverage starts July 1. You can sign up for Medicare Advantage April through June, after you have signed up for Parts A and B during the GEP.
- Fall Open Enrollment Period: The October 15 through December 7 period each year when you can change your Medicare coverage. You can pick a new MA Plan, or switch between Original Medicare and Medicare Advantage. You can also change your Part D coverage during this time.
Medicare Suplement
Medigap is Medicare Supplement Insurance that helps fill “gaps” in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:
Medigap policies generally don’t cover:
Medicare Suplement Enrollment
Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy. However, even if you have health problems, during your Medigap open enrollment period you can buy any policy the company sells for the same price as people with good health.
Find your situation below:
I’m 65 or older
Your Medigap open enrollment period begins when you enroll in Part B and can’t be changed or repeated. In most cases, it makes sense to enroll in Part B when you’re first eligible, because you might otherwise have to pay a Part B late enrollment penalty.
I’m turning 65
The best time to buy a Medigap policy is the 6-month period that starts the first day of the month you’re 65 or older and enrolled in Part B. For example, if you turn 65 and are enrolled in Part B in June, the best time for you to buy a Medigap policy is from June to November.
After this enrollment period, your option to buy a Medigap policy may be limited and it may cost more. Some states have additional open enrollment periods.
I’m under 65
Federal law doesn’t require insurance companies to sell Medigap policies to people under 65. If you’re under 65, you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65. However, some states require Medigap insurance companies to sell you a Medigap policy, even if you’re under 65. If you’re able to buy one, it may cost you more.
I have group health coverage through an employer or union
If you have group health coverage through an employer or union because either you or your spouse is currently working, you may want to wait to enroll in Part B. Employer plans often provide coverage similar to Medigap, so you don’t need a Medigap policy.
When your employer coverage ends, you’ll get a chance to enroll in Part B without a late enrollment penalty. That means your Medigap open enrollment period will start when you’re ready to take advantage of it. If you enrolled in Part B while you still had the employer coverage, your Medigap open enrollment period would start. Unless you bought a Medigap policy before you needed it, you’d miss your open enrollment period entirely.
Medicare Part D Plans (PDP)
Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to join a Medicare Prescription Drug Plan (Part D) when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get Extra Help, you’ll likely pay a late enrollment penalty.
To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.
There are two ways to get drug coverage:
- A Medicare Prescription Drug Plan (Part D)
- A Medicare Advantage Plan (Part C), like an HMO or PPO, or other Medicare health plan that offers Medicare prescription drug coverage.
There are specific times when you can sign up for these plans, or make changes to coverage you already have. Generally, you can join, switch, or drop a Medicare drug plan: When you first become eligible for Medicare because you’re turning or turned 65.
You can sign up for a Medicare drug plan during your Initial Enrollment Period – 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 the month you turn 65.
If you sign up 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 the month you turn 65 or during the last 3 months of your Initial Enrollment Period, the start date for your coverage will be delayed.
If you get Part B for the first time during the General Enrollment Period, you can also join a Medicare drug plan from April 1 – June 30. Your coverage will start on July 1.
- During open enrollment, between October 15 – December 7 each year. Your coverage will begin on January 1 of the following year, as long as the plan gets your request during Open Enrollment.
- At any time, if you qualify for Extra Help. Extra Help is a Medicare program to help people with limited income and resources pay Medicare prescription drug program costs, like premiums, deductibles, and coinsurance.
- When certain events happen in your life, like if you move or you lose other insurance coverage. These chances to make changes are called Special Enrollment Periods (SEPs). Rules about when you can make changes and the type of changes you can make are different for each SEP.
DENTAL PLANS
If you’re not signing up for a Medicare Advantage plan that gives you unified coverage across medical and dental, a standalone dental plan is the next best way to get coverage.
You can purchase a plan directly from a private insurance company, and most let you sign up for dental insurance even if you don’t have medical insurance through the company. This plan won’t be connected to your other coverage through the Medicare program, but it can help you get cost-savings benefits so you get the dental services you need.
Benefits of standalone dental plans:
- Choose the level of coverage you want, with plans ranging from basic or preventative coverage to plans that cover more extensive dental treatments.
- Select the insurance company that has your preferred dentists in its network of providers without this choice influencing your medical plan.
Dental plans for seniors include Dental HMOs, which generally have lower monthly costs but only cover care from an in-network dentist. If you’d rather have the flexibility to see any dentist, choose a Dental PPO plan that provides broader coverage but generally costs more each month.
VISION PLANS
For people ages 65+, there are a number of ways to get vision insurance. For some, vision coverage options may come through the Medicare Advantage program, these plans are offered through private insurance companies approved by Medicare. You could also purchase a stand-alone vision plan through a private insurer.
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