Medicare | AgeWise

What is Medicare?

Medicare Part A

(Hospital Insurance): Part A helps cover inpatient hospital care, skilled nursing facility care, hospice care, and some home healthcare services. Most people are eligible for Part A without paying a premium, as long as they or their spouse have paid Medicare taxes while working.

Medicare Part B

(Medical Insurance): Part B covers medical services and supplies necessary for the diagnosis and treatment of medical conditions, including doctor visits, outpatient care, preventive services, durable medical equipment, and some home healthcare services. Part B requires payment of a monthly premium, which is based on income and may be deducted from Social Security benefits.

Medicare Part C

Medicare Advantage: Part C is an alternative to Original Medicare (Part A and Part B). It allows private insurance companies to offer Medicare benefits. These plans must provide at least the same services as Original Medicare, and many offer extra benefits like prescription drug coverage, dental care, and vision care. Beneficiaries enrolled in Medicare Advantage still pay their Part B premium.

Medicare Part D

(Prescription Drug Coverage): Part D provides coverage for prescription drugs. Medicare beneficiaries can choose to enroll in a standalone Medicare Part D plan, which is provided by private insurance companies and helps cover the cost of prescription medications. Part D plans have their own formularies (lists of covered drugs) and may have different tiers and copayment structures.

Medicare Eligibility

Medicare eligibility is based on several factors, including age, disability status, and certain medical conditions. Here are the main criteria for Medicare eligibility:

Age-based eligibility

Individuals who are 65 years old or older are generally eligible for Medicare.

Disability-based eligibility

People under the age of 65 may qualify for Medicare if they have been receiving Social Security Disability Insurance (SSDI) benefits or Railroad Retirement Board disability benefits for at least 24 months.

Medicare Enrollment

Medicare Part A

Most individuals are automatically enrolled in Medicare Part A when they turn 65 and are already receiving Social Security. In this case, you will receive your Medicare card in the mail about three months before your 65th birthday.
If you are not automatically enrolled, you can sign up for Medicare Part A during your Initial Enrollment Period, which begins three months before the month you turn 65 and ends three months after the month you turn 65.

Medicare Part B

Most individuals are not automatically enrolled in Medicare Part B and need to sign up for it.
You can sign up for Medicare Part B during your Initial Enrollment Period, which is the same seven-month period as your Part A Initial Enrollment Period.
If you didn't sign up for Part B during your Initial Enrollment Period, you can enroll during the General Enrollment Period from January 1 to March 31 each year. However, there may be a late enrollment penalty for late sign-up.

Medicare Part C

To enroll in a Medicare Advantage plan, you must first be enrolled in Medicare Part A and Part B.
You can join or switch to a Medicare Advantage plan during the Annual Enrollment Period from October 15 to December 7 each year.
Special Enrollment Periods may also be available in certain circumstances, such as when you move or qualify for other specific conditions.

Medicare Part D

To enroll in a Medicare Part D plan, you must first be enrolled in Medicare Part A or Part B.
You can join or switch Medicare Part D plans during the Annual Enrollment Period from October 15 to December 7 each year.
Special Enrollment Periods may also be available in certain circumstances, such as when you lose creditable prescription drug coverage.