Understanding Medicare Basics & Medicare Eligibility

The following is meant to explain the basics of Medicare in Plain English. If at any time you have questions and would prefer to speak to a licensed agent free of charge, simply call us at 888-654-3129 ext. 3.

Medicare Basics

Medicare is the Federal Government program that provides health care coverage (aka health insurance) to eligible people. The following people are eligible for Medicare:

  • People aged 65 and older
  • People under 65 with certain disabilities / receiving Social Security Disability Insurance (SSDI)
  • People under 65 with end-stage renal disease

Note: you must be a citizen or legal resident who has lived in the US for at least 5 consecutive years.

Medicare is run by the Centers for Medicare & Medicaid Services (CMS), and is funded via taxes, premiums, and the federal government.

Wait, what’s the difference between Medicare and Medicaid?

Quick answer: Medicare is a program for Seniors 65 and older (and those with certain disabilities/afflictions), where Medicaid is for low income people of all ages. More here.

What Are Medicare Coverages and Medicare “Parts”?

You have probably heard of different Medicare “parts” (Medicare Part A, Medicare Part D, etc.) Here they are, with a brief explanation of each:

  • Medicare Part A – Inpatient Hospitalization Insurance (provides hospital stay coverage) Learn More
  • Medicare Part B – Outpatient Medical Insurance (provides outpatient coverage) Learn More
  • Medicare Part C – Medicare Advantage Health Plan (optional coverage that is similar to an HMO) Learn More
  • Medicare Part D – Prescription Drug Coverage Learn More

Note: Parts A and B are known as “Original Medicare”

Medicare Enrollment – When Should I Enroll in Medicare?

From 6 months before to 6 months after your 65 th birthday, you should complete certain steps. Here they are:

6 Months Before Your 65th Birthday

Schedule your Welcome to Medicare visit. The purpose of this visit is to create a record of your health and family history; check measurements like your blood pressure and weight; ensure that you’re up to date with preventive screens, and order any necessary tests based on your health. Learn more by visiting medicare.gov (external site).

3 Months Before Your 65th Birthday

Sign up for Part A and Part B. Learn more at medicare.gov (external site) and socialsecurity.gov (external site).

Consider enrolling in the Medicare Advantage (Part C), Medicare Supplement Insurance Plan, and/or Medicare Part D (Prescription Drug) plan that fits your budget and needs. Note that your plan won’t be effective until you turn 65.

If you are considering a Medicare Supplement Insurance plan, please note that you may be subject to a waiting period and have to complete a medical questionnaire if you wait too long after your birthday. 14

3 Months After Your 65th Birthday

If you are thinking about enrolling in a Medicare Advantage (Part C) or a Part D (Prescription Drug) plan, make sure to do so by this time.

Please note that if you don’t enroll in Part D Prescription Drug plan when you are first eligible, you may have to pay a penalty if you enroll later.

6 Months After Your 65th Birthday

If you are thinking about enrolling in a Medicare Supplement Insurance plan, make sure to do so by this time.

More information regarding Medicare Enrollment Periods

Annual Enrollment Period

October 15 – December 7

If you enroll during this period, your plan will be effective on January 1.

During this time each year, you can make changes like the following:

  • Switch from original Medicare to a Medicare Advantage plan and vice versa
  • Change to a different Medicare Advantage plan
  • Purchase a Part D Prescription Drug plan or drop Part D coverage
  • Change to a different Part D Prescription Drug plan

Disenrollment Period

January 1 – February 14

* For Medicare Advantage (Part C) Plans

During this time you can choose to drop your Medicare Advantage plan and switch back to Original Medicare. If you do, you have the option to enroll in a Part D plan

Special Enrollment Period

* For Medicare Advantage (Part C) and Part D (Prescription Drug) Plans

You can make changes to your Medicare Advantage or Part D plan when certain types of events happen in your life such as moving or dropping coverage provided by an employer or union. Learn more at medicare.gov (external site).