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February 6

A Comprehensive Guide to Medicare

Understanding Medicare Plans Part A, B, C, D, and Medigap

Medicare is the federal health insurance program that was created in 1965 to ensure that older Americans have reliable coverage beyond their working years. Medicare is insurance for individuals aged 65 and older, as well as younger people who have certain disabilities, end-stage renal disease, or ALS.

Although most people understand that Medicare is a type of health insurance, they might not be familiar with how the coverage actually works. As people approach age 65, they should begin learning more about Medicare so that they can enroll at the right time with the options that work best for their circumstances.

What is Medicare?

This program made medical insurance available to adults over the age of 65, most of whom had retired and lost the insurance provided by their jobs. Medicare was first created with Part A for hospital coverage and Part B for medical coverage. The program has evolved quite a bit since 1965, but its foundation as an affordable and comprehensive insurance plan remains solid.

Who qualifies for Medicare?

People who are 65 or older qualify for Medicare. The Initial Enrollment Period runs from 3 months before the month in which a person turns 65 until 3 months after their birthday month. This 7-month period is the timeline to enroll in Medicare to begin receiving benefits either on the 1st day of one’s birth month, or the 1st day of the month after enrollment is complete.

People younger than 65 might qualify for Medicare if they have certain disabilities. Individuals who are receiving Social Security Disability payments can enroll in Medicare. Additionally, individuals who have end-stage renal disease that requires dialysis and/or a kidney transplant, or people with Amyotrophic Lateral Sclerosis (ALS) are eligible for Medicare.

The purpose and benefits of Medicare

The purpose of Medicare is to ensure that older, retired, or disabled Americans have access to affordable, quality healthcare. Because health insurance benefits are usually part of a person’s work benefits, most people would lose their insurance after retirement. Medicare is the insurance plan that can replace those workplace benefits.

The benefit of Medicare is that older individuals can see their doctors, go to the hospital when needed, and get their medicines without having to pay the full price out of their own pockets. Since some of the cost of Medicare has already been paid through taxes, the actual plans are either free or low-cost for most eligible enrollees.

When people enroll in Medicare, they have a few options beyond the basic plans. These options might cost more, but they will also have additional benefits that cover things not included with original Medicare. These are benefits like hearing, dental care, and vision coverage, gym memberships, and health-related services. Medicare has grown to offer a full range of options to fit the budgets and health priorities of the individuals it covers.

Understanding Medicare Part A (Hospital Insurance)

Medicare Part A is part of Original Medicare and provides hospital insurance. When someone on Medicare is admitted to a hospital, Medicare Part A is the insurance they will use. 

What is covered under Medicare Part A?

Medicare Part A pays for hospital stays as well as time spent in a skilled nursing facility if it is prescribed after the hospital. This Medicare also pays for some hospice and home health care, but it depends on the circumstances.

Enrollment requirements and process

People who have already started receiving Social Security benefits are automatically enrolled in Medicare Part A and don’t need to do anything to get started. People who are not enrolled yet should call 1-800-772-1213. Individuals can enroll during the 3 months before their 65th birth month, or for the 3 months after the month of their 65th birthday.

Anyone who has worked at least 10 years in the U.S. qualifies for Part A without having to pay a premium. The premium is either $285 or $518 for people who have not met the work requirement. There are also deductibles and copays that people will have to pay themselves anytime they are admitted to the hospital. These amounts change each year.

Understanding Medicare Part B (Medical Insurance)

Medicare Part B is also part of Original Medicare, but it is the insurance for standard medical care. This is the insurance used for doctors and other services that are not part of hospital inpatient care. 

What is covered under Medicare Part B?

Medicare Part B covers doctor visits, outpatient medical care, services from physical or occupational therapists, some home health care, and even some medical equipment. Medicare coverage is only for care that is medically required. 

Differences between Medicare Part A and Part B

Since they are the two original parts of Medicare as it was first designed back in 1965, Medicare Parts A and B have always covered completely different things. Sometimes, a patient might not know for sure which Part of Medicare covers the service they need, but their care providers understand the system very well and will know how to do the paperwork correctly. For example, someone might need to stay overnight at the hospital, but not be admitted. This would still fall under outpatient care, and Medicare Part B will be applied. Or, if someone receives X-rays or lab work during a hospital stay, both Parts A and B will be needed.

Enrollment requirements and costs

There is no automatic enrollment for Part B. Individuals need to sign up during an enrollment period near their 65th birthday, and they will have to pay a penalty if they don’t enroll when they are eligible. The initial enrollment period for Part B is the same as Part A. There are some exceptions to enrolling in Part B when a person is first eligible. The most common one is that the person is still covered under insurance through work. If this is the case, the person must enroll in Part B within 8 months of losing that coverage.

Medicare Part B comes with a monthly premium minimum of $185 (in 2025). It might be higher based on income. If someone enrolls in Part B late, they will pay a penalty every month with their premium.

Part B has lower deductibles and copays than Part A. The deductible only has to be met one time for the whole year, while copays will be paid every time the person receives medical services.

Understanding Medicare Part C (Medicare Advantage)

Medicare Part C, or Medicare Advantage, was introduced in the 1990s to provide additional benefits for people who wanted access to more services through their insurance plans.

What is Medicare Part C/Medicare Advantage?

Medicare Advantage bundles Part A and Part B, and also adds more options to Medicare plans. Most Advantage plans also include Part D for prescription medications.

Comparing with Original Medicare (Part A and Part B)

Medicare Part C combines the official Medicare coverage with private services. People will still pay their Part A or Part B premiums to Medicare, and they will also pay premiums to a private insurance carrier for the additional services they want to cover. They need to be enrolled in Medicare Part A or Part B before they add the Advantage plan they want.

Types of plans available under Medicare Advantage

Medicare Advantage is not required coverage. It is simply an available option for people who want more coverage. Advantage plans cover things like dental care, vision care, hearing services, prescription drug plans, and even health and wellness products or services.

Medicare Advantage is the choice for many people who want to keep the consistency of the type of coverage they had through their jobs. When people search for Medicare plans online, what they usually see first is a list of private insurance companies that offer a variety of plan options. Everyone should review the coverage and costs of every Advantage plan carefully to make sure they really are getting the benefits they expect. 

Understanding Medicare Part D (Prescription Drug Coverage)

Medicare Part D is an optional plan that was introduced in 2003 and is offered through private insurance companies. 

What is Medicare Part D?

Prescription Drug Coverage makes medications far more affordable for retirees than they were before these plans became available. Although Medicare Part D plans are offered by private companies, they are required to make certain medications available with limits on copays. 

Importance of Part D

Senior citizens are enjoying longer, healthier lives than ever. But most people still have at least one health issue that requires medication. Whether someone needs insulin for diabetes, blood pressure medicine, or something to keep their cholesterol in check, they rely on insurance plans like Medicare Part D to keep their prescriptions available and affordable. 

Part D is especially important for older adults with diabetes, because insulin is legally capped at $35 for a month’s supply. This makes disease management much easier for thousands of people on Medicare. 

How to enroll in Medicare Part D

If someone is enrolled in Medicare and does not have prescription drug coverage from a non-Medicare source, they should enroll in Part D. There are late penalties assessed if someone enrolls in Part D after not having coverage that’s at least as good as what Part D offers. Anyone who wants to enroll in Prescription Drug Coverage must already be enrolled in Medicare Part A or Part B. Many Medicare Advantage plans bundle Part D right into the premium pricing, so individuals can create a comprehensive insurance plan that covers all of their healthcare needs at an affordable rate.

Exploring Medicare Supplement Plans (Medigap)

Medigap plans exist to help cover out-of-pocket expenses like deductibles and copays. These plans are optional, but they need to be purchased within 6 months of turning 65 or joining Medicare Part B. This means seniors need to consider whether or not this coverage is worthwhile at the same time they enroll in Medicare. Plans might still be available after that initial enrollment period, but they cost more and are not guaranteed. There are 10 types of Medigap plans, and each type is standardized no matter which private insurance company offers it.

How to Choose the Right Medicare Plan

As individuals get close to age 65, they need to start learning about their Medicare options and requirements. While a lot of the coverage is standard for everyone, the additional benefits need to be carefully considered. Everyone has a unique situation, so it is helpful to work with a Medicare professional who understands what each plan has to offer. Medicare insurance agents do not charge any fees to the person enrolling in Medicare, so seniors don’t have to worry about paying to have their questions answered.

Medicare Choices and Next Steps

Medicare provides the insurance coverage that adults aged 65 and older need in order to care for their health needs. While enrolling in Medicare can be pretty simple, it’s important to review all the options and sign up for the plan that is right for each person’s circumstances and budget. LCH has Certified Application Counselors at our West Grove and Oxford locations who are happy to answer questions and assist with Medicare enrollment for patients. Call us at 610-444-7550, to learn more about Medicare enrollment.