What is Medicare and who can get it?
Medicare is our country’s health insurance program. Although most commonly used by people age 65 or older, some younger people are eligible for Medicare, too. Those include people with disabilities, permanent kidney failure and amyotrophic lateral sclerosis (Lou Gehrig’s disease). Medicare helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care. Medicare has four parts:
Part A—Hospital insurance; Part B—Medical insurance; Part C—Medicare Advantage; and Part D—Prescription drug coverage.
What are the individual parts and cost if any?
Part A (hospital insurance): Hospital insurance helps pay for inpatient care in a hospital or skilled nursing facility (following a hospital stay), some home health care and hospice care.
The other three parts of Medicare require premium payments, and if you don’t enroll when you’re first eligible, you may have to pay a late enrollment penalty for as long as you have coverage. Also, you may have to wait to enroll, which will delay coverage.
Part B (medical insurance): Medical insurance helps pay for doctors’ services and many other medical services and supplies that hospital insurance does not cover.
Part C (Medicare Advantage plans): If you have Medicare Parts A and B, you can join a Medicare Advantage plan. Medicare Advantage plans are offered by private companies and approved by Medicare. These plans generally help you pay the medical costs not covered by Medicare Part A and B.
Part D (prescription drug coverage): Prescription drug coverage helps pay for medications doctors prescribe for treatment.
What is “Extra Help” under the Medicare prescription drug program?
How can I get help with my Medicare Part A and Part B premiums?
Can I sign up for Medicare Part B if I am working and have health insurance through an employer?
Choosing to sign up for Medicare is an important decision that involves a number of issues you may need to consider. The decision you make will depend on your situation and the type of health insurance you have. You may be able to delay signing up for Medicare Part B without a late enrollment penalty if you or your spouse (or a family member, if you’re disabled) is working, and you’re getting health insurance benefits based on current employment.
In most cases, if you don't sign up for Part B when you're first eligible, you'll have to pay a late enrollment penalty for as long as you have Part B.
Coverage based on current employment does not include:
- COBRA (Consolidated Omnibus Budget Reconciliation Act);
- Retiree health coverage;
- VA (Veterans Affairs) health coverage; or
- Individual health coverage (like through the Health Insurance Marketplace).
What are Medicare late enrollment penalties?
In most cases, if you don’t sign up for Medicare when you’re first eligible, you may have to pay a higher monthly premium.
More information on Medicare late enrollment penalties:
- Part A Late Enrollment Penalty (Medicare.gov)
- Part B Late Enrollment Penalty (Medicare.gov)
- Part D Late Enrollment Penalty (Medicare.gov)
How does the recent Supreme Court decision about same-sex marriage affect my enrollment in Medicare?
Should I sign up for Medicare Part B if I have Veterans’ Benefits?
Signing up for Medicare Part B may provide you with additional service and location options.
If you don’t sign up for Part B when you are first eligible:
- You may have to wait to sign up, which will delay your coverage, and;
- you may also have to pay a late enrollment penalty for as long as you have Medicare Part B.
What is the "Welcome to Medicare" physical exam?
The "Welcome to Medicare" physical exam is a one-time, preventive physical exam Medicare covers within the first 12 months that you have Medicare Part B. The visit will include a thorough review of your health, along with education and counseling about the preventive services you need, like certain screenings, shots, and referrals for other care.
This visit is a great way to get up-to-date on important screenings and shots and to talk with your doctor about your family history and how to stay healthy. During the “Welcome to Medicare” visit, your doctor will record your medical history and check your vision, blood pressure, and weight and height to measure your body mass index (BMI). Body mass index is a measure of body fat that applies to both adult men and women.
Your doctor will check that you are up-to-date with preventive screenings and services, such as cancer screenings and immunizations. Further tests may be ordered, if necessary, depending on your general health and medical history. Your doctor will also give you advice to help you prevent disease, improve your health, and stay well. You will get a written plan (such as a checklist) when you leave, letting you know which screenings and other preventive services you should get in the future.
Your doctor will also talk with you about creating advance directives. Advance directives are legal documents that explain in writing what kind of health care you would want if you were too ill to speak and/or make decisions for yourself. Talking to your family, friends, and health care providers about your wishes is important, but these legal documents help ensure your wishes are followed.
When do I get my "Welcome to Medicare" exam?
Once you enroll into Medicare Part B, schedule your “Welcome to Medicare” preventative visit right away. Medicare will only cover this physical exam if it occurs within the first 12 months from when you enroll into Medicare Part B.
If you've had Medicare Part B for over 12 months, you can get a yearly "Wellness" visit instead. This visit is also covered and can help you and your doctor develop a personalized health plan.
How much does the exam cost?
You pay nothing for your “Welcome to Medicare” preventative visit or the yearly “Wellness” visits if the doctor or health care provider accepts assignment. If you have additional tests or receive other services during this visit that aren’t covered under these preventative benefits, you may have to pay coinsurance and the Medicare Part B deductible may apply.
What should I bring with me to the exam?
You should bring the following things with you when you go to your “Welcome to Medicare” visit:
- Medical records, including immunization records.
- A list of prescription drugs, as well as over-the-counter drugs and supplements that you currently take, how often you take them, and why.
- Family health history. Try to learn as much as you can about your family's health history before your appointment.
- Any information you can give your doctor to help determine if you are at risk for certain diseases.
Do I need to renew my Medicare coverage?
In general, once you're enrolled in Medicare, you don't need to take action to renew your coverage every year. This is true whether you are in Original Medicare, a Medicare Advantage plan, or a Medicare prescription drug plan. As long as you continue to pay any necessary premiums, your Medicare coverage should automatically renew every year with a few exceptions as described below.
There are some exceptions where you'll need to take action to continue your coverage. Some situations where your Medicare Advantage or stand-alone Medicare Part D prescription drug plan coverage won't be automatically renewed include, but aren't limited to:
- Your plan reduces its service area, and you now live outside of its coverage area.
- Your plan doesn't renew its Medicare contract for the upcoming year.
- Your plan leaves the Medicare program in the middle of the year.
- Medicare terminates its contract with your plan.
If your Medicare plan doesn't renew its contract with Medicare for the coming year, your Special Election Period will run from December 8 to the last day of February of the following year. If you have Medicare Advantage and don't enroll in a new plan by the date that your current plan ends its contract with Medicare, you'll be automatically returned to Original Medicare.
Keep in mind that your new coverage starts on the first day of the month after you submit your enrollment application, meaning if you apply on February 8, your new Medicare plan wouldn't begin until March 1.
You'll also get a three-month Special Election Period if your Medicare Advantage or Medicare Part D Prescription Drug Plan terminates its contract with Medicare. This period starts two months before the contract ends and runs an additional month after the contract ends. If Medicare terminates your plan's contract, you will have a Special Election Period that begins 1 month before the termination effective date and ends 2 months after the effective date of the termination.
While you may not need to renew your Medicare coverage, it's still a good idea to review your coverage annually. Benefits, provider and pharmacy networks, drug formularies, and cost sharing can all change from year to year and affect how much you pay out of pocket. Comparing plans annually is one way to make sure your coverage continues to meet your health needs and budget.
