Medicare Made Clear

10 Key Medicare Facts

Your Medicare journey may be smoother when you understand the rules of the road.

Medicare is a complex subject. Watch this video to get the main ideas behind it. Then you can dig deeper into what’s most important to you

10 Key Medicare Facts Summary

1. There are two main ways to get Medicare.

   • Original Medicare (Parts A and B) which is provided by the federal government
   • A Medicare Advantage plan (Part C) offered by a private insurance company

2. With Original Medicare, you may pay a share of the cost.

   • You contributed to Medicare by paying taxes. That’s why you’re eligible for Medicare when you turn 65.
   • Original Medicare may not pay for everything. You may pay a share of the cost in monthly premiums and copays.

3. Medicare supplement insurance helps with some out-of-pocket costs.

   • Medicare supplement insurance plans help with some of the expenses Medicare Parts A and B don't pay.
   • Medicare supplement insurance plans are offered by private insurance companies

4. Prescription drug coverage may help limit drug costs.

   • Original Medicare does not include prescription drug coverage. However as a Medicare member you can get Medicare Part D prescription drug coverage.
   • Prescription drug plans, also known as PDP, and Medicare Advantage plans are offered by private insurance companies.
   • You can enroll in a stand-alone Part D plan to go with your Original Medicare coverage.
   • You can enroll in a Medicare Advantage plan that includes prescription drug coverage.

5. Coverage choices vary by plan type and state.

   • Original Medicare (Parts A and B) is the same across the United States.
   • Medicare Advantage (Part C) and prescription drug (Part D) plans are offered by private insurance companies and may be available only in certain counties, states or regions.
   • Medicare supplement plans travel with you nationwide. The plans are standardized, but the availability may vary by state.

6. Your initial enrollment in Medicare is time sensitive.

   • The Initial Enrollment Period (IEP) is your first chance to enroll in Medicare. It’s the three months before your 65th birthday month, the month of your birthday, and the three months after your birthday month.
   • If you are eligible for Medicare due to disability, your IEP is based on your disability date.
   • Late enrollment penalties may be incurred for missing certain enrollment periods for Part B and prescription drug coverage.

7. Your health care needs may change over time.

   • After you choose your Medicare coverage, you can make changes once a year during Medicare Open Enrollment, October 15 through December 7.
   • You may change your coverage at certain other times if you qualify for a Special Enrollment Period.
   • Review your coverage each year to see if it still fits your needs.
   • These enrollment period restrictions do not apply to Medicare supplement insurance.

8. Special Enrollment Period (SEP).

   • In some cases you may be able to enroll in or switch plans at times besides your IEP or Medicare Open Enrollment.
   • You may qualify for an SEP if you retire and leave a health care plan sponsored by your employer or union.
   • You can usually use an SEP to change your coverage if you move out of your current plan’s service area.

9. Medicare can work with other health insurance.

   • Group or retiree health insurance sponsored by an employer or union can work with Medicare.
   • Your plan administrator can help you figure out how Medicare could work with your current coverage.
   • Medicare supplement plans work with Original Medicare, but not with Medicare Advantage plans.

10. Help is available.

    • Medicare can be complicated, but help is available.
    • You may qualify for financial help.

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