Medicare Explained

Medicare is federal health insurance for people ages 65 and over, under 65 with permanent disabilities, and anyone with End-Stage Renal Disease. To know how Medicare works, it helps to review the different parts of Medicare and the services they cover.

What Are the 4 Parts of Medicare?

  • Medicare Part A covers hospitalization expenses (Original Medicare).
  • Medicare Part B is general medical insurance for outpatient needs (Original Medicare).
  • Medicare Part C (Medicare Advantage) includes benefits not covered by Medicare.
  • Medicare Part D only covers prescription drugs.

Inpatient Hospital Coverage

Outpatient Medical Coverage

Medicare Advantage Plans

Prescription Drug Coverage

Medicare Part A Coverage

Any inpatient hospital care falls under Part A coverage. That includes:

  • Nursing services
  • Hospital stays up to 60 days (semi-private rooms)
  • Intensive care services
  • Surgery and recovery costs
  • Part-time home nursing care
  • Rehabilitation and therapy services
  • Lab tests and X-rays taken while hospitalized

Medicare Part B Coverage

Part B covers outpatient needs, including:

  • Doctor visits
  • Necessary medical supplies
  • Tests, screenings, and X-rays
  • Outpatient mental health care
  • Flu shots and other vaccinations
  • Medically necessary preventative care

Medicare Part C Coverage

More Medicare benefits can mean more peace of mind. That’s why many folks choose Part C, better known as Medicare Advantage. These private health plans include Parts and B, and many plans include prescription drug coverage (Part D) — along with additional benefits not covered by Medicare, like:

  • Dental cleanings and dentures
  • Eye exams, glasses, and contacts 
  • Hearing aids
  • Fitness classes

Medicare Part D Coverage

Parts A and B don’t cover prescription medications. Because of that, you can either pick a Medicare Advantage plan that merges with Part D to include prescription drug coverage or a separate Part D plan that solely covers prescription drugs.

Who’s Eligible for Medicare?

Most people qualify for Medicare Parts A and B when they turn 65. However, the rules about Medicare eligibility and when you can sign up for Original Medicare can be confusing. The criteria are based on your age, whether you’re retired or still actively working, and whether or not you’re getting Social Security benefits.

Can You Qualify for Medicare Under 65?

Yes. If you’re permanently disabled and have been receiving Social Security Disability Insurance (SSDI) benefits for two years, you qualify for Medicare and will be auto-enrolled in Parts A and B. 

If you have End-Stage Renal Disease (ESRD), you’re eligible for Original Medicare regardless of your age. Enrollment is not automatic though, so you’ll need to sign up when you first become eligible for Medicare. You can contact Social Security for more information.

If you have ALS (Amyotrophic Lateral Sclerosis), aka Lou Gehrig’s disease, you’ll be auto-enrolled in Parts A and B the month that your disability benefits begin.

When Should You Enroll?

If you’re applying for the first time, you’ll want to sign up during your Initial Enrollment Period (IEP) — a 7-month window that begins three months before you turn 65 and ends three months after. It’s best to sign up during this time to avoid late penalties and delayed coverage.

3 Months Before

65th Birthday Month

3 Months After

If you already applied for Parts A and B but realize you need to make changes, you can do so during the fall Annual Enrollment Period (AEP) from October 15 through December 7. AEP is your chance to add, drop, or change your Medicare benefits.

Medicare Costs

If Medicare was nonexistent, healthcare may become very expensive at 65 and beyond. Most people don’t have to pay a premium for Part A because they paid taxes during their working years. Part B premiums are affordable. You can get additional benefits through independent agencies like us to help you cover services and costs that Original Medicare doesn’t cover. There are also certain programs available if you need more help paying Medicare costs.

Medicare FAQ

Yes! We’re here to serve you and help you make all the right Medicare choices for you and your family.

There’s typically a list of covered drugs with most Medicare Plans. Your out-of-pocket costs for prescription drugs will vary plan to plan. Most Medicare Advantage Prescription Drug Plans do cover Rx costs. Alternatively, you can opt for a supplemental standalone plan to assist with prescription costs.

If you have a pre-existing condition, you can enroll in Original Medicare or a Medicare Advantage Plan as long as you sign up during your Initial Enrollment Period. The period is a seven-month window that starts 3 months before the month you turn 65, through 3 months after.

With Original Medicare you can visit any doctor, hospital, or facility that’s enrolled in Medicare and accepting new Medicare patients.

Your Primary Medicare Options

You decide how to get your Medicare benefits. For many, Original Medicare is far from complete coverage, so it’s important to consider getting more insurance to lower your out-of-pocket costs when you receive care.

Your first option is to stay on Original Medicare and add a Medicare Supplement (Medigap) plan and/or a stand-alone Part D plan for your prescription costs. Medicare Supplement Insurance can help cover the deductibles, copays, and coinsurance leftover by Parts A and B. 

If paying a premium for supplemental insurance does not appeal to you, you have the option to join a Medicare Advantage (Part C) plan that replaces Original Medicare. Many Medicare Advantage plans have a monthly premium as low as $0 and include extra benefits for routine dental, vision, and hearing care!

The Two Main Ways to Get Medicare

Original Medicare

  • Part A
  • Part B 

You can add:

  • a Part D plan

You can also add:

  • Supplemental insurance

This includes a Medicare Supplement (Medigap) plan

Medicare Advantage (Part C)

  • Part A
  • Part B 

Most plans include:

  • Part D
  • Extra benefits

Some also include:

  • Lower out-of-pocket costs

Talk to your insurance agent to figure out which option makes the most sense for you.

Choosing a Medicare Plan Has Never Been So Easy.

We understand the importance of choosing the right Medicare plan. It brings peace of mind for you and your spouse, allowing you to spend retirement how you want instead of worrying about insurance or healthcare costs. 

Here at Quantum Insurance Advisors, we provide excellent service to our community and are thoroughly trained on what options are available. Book a FREE consultation with us today!