Medicare: Let's Start with the Basics

Medicare Frequently Asked Questions

What is Medicare?

Medicare is divided into Parts A, B, C, and D. Here’s how they fit together:

• Part A Hospital Insurance includes in-patient care at hospitals, skilled nursing facilities (if you meet specific requirements), home health care, and hospice. Part A is included in Original Medicare.
• Part B Medical Insurance covers doctor visits, procedures that don’t require an overnight hospital stay, and some preventive care. Part B is included in Original Medicare.
• Part C Medicare Advantage combines Parts A and B through a health care provider. Medicare Advantage plans often include additional benefits.
• Part D Prescription Drug Coverage You can enroll in a stand-alone prescription drug plan with Original Medicare or with some Medicare Advantage plans. Part D can also be offered together with Part C Medicare Advantage.  Plans that combine Part C and Part D are referred to as MAPD Medicare Advantage plans.

Original Medicare vs. Medicare Advantage?

The key differences between Original Medicare and Medicare Advantage are what’s covered and who’s approving your coverage.

• Original Medicare administered by the government includes Parts A and B (hospital and medical insurance) but covers only 80% of your expenses. And it doesn’t include prescription drug coverage.
• Medicare Advantage combines hospital, medical, and (if a MAPD plan) prescription drug coverage all in one plan and often additional benefits. You choose the private healthcare provider that offers the best service for your needs. You need to have Part A and Part B, before you can get Part C Medicare Advantage. With a Medicare Advantage plan, costs are more predictable, and you often pay less out of pocket.

When Can I Enroll?

There are a few different Medicare enrollment periods you need to know about:

• The Initial Medicare Enrollment Period is a 7-month window that begins three months before your 65th birthday and ends three months after your birthday month. If you’re less than 65 and entitled to Medicare based on disability, you can enroll three months before and after your 25th month of disability benefit entitlement.
• The Medicare Annual Enrollment Period occurs every year from October 15 to December 7. You can sign up for, switch, or leave a Medicare Advantage plan during this time.
• The Medicare Advantage Open Enrollment Period occurs every year from January 1 to March 31. You can switch between Medicare Advantage plans or Original Medicare during this period.
• The Special Enrollment Period is triggered by certain qualifying events, including losing employer coverage, retiring, moving, and other situations. Enrollment timing depends on the situation.