- Your Medicare coverage options include Original Medicare, Medigap, Medicare Part D and Medicare Advantage.
- Most Americans are eligible for Medicare at age 65, but there are exceptions.
- The enrollment process for Medicare varies by the plan you choose.
- Each type of Medicare coverage has its own costs, similar to other health insurance you’ve purchased over the years.
- Opportunities for changing your Medicare coverage are limited.
How can I get the best Medicare coverage possible?
If you’re aging into Medicare, there’s actually a lot you can do to ensure that you end up with the right Medicare plan – and that you don’t incur unnecessary costs (including penalties) along the way.
For starters, although many assume that enrollment in Medicare is automatic, you’ll actually need to make informed choices about how much coverage you need and when you want that coverage to take effect. Your plan costs, your Medicare benefits, your enrollment windows – and the penalties for missing them – all depend on your plan-buying decisions.
What are my Medicare coverage options?
Most new Medicare beneficiaries opt to go with one of these coverage scenarios:
- Original Medicare (Part A and Part B)
- Original Medicare plus a prescription drug (Part D) plan and/or a Medicare supplement (Medigap) plan
- Medicare Advantage coverage
If you have coverage from a current employer that will provide primary coverage, you have the option to delay Part B. And if you have employer-sponsored coverage (including retiree coverage) that supplements your Medicare coverage, you may not need to purchase a Part D plan or a Medigap plan. But assuming you don’t have other supplemental coverage, you’ll need to consider the various supplemental coverage options that become available once you’re eligible for Medicare.
The scenario you choose will define the range of benefit and services covered, your access to providers and your out-of-pocket costs, as well as your flexibility in changing your options down the road if you’re not satisfied with your plan. (Find out why most beneficiaries don’t elect for Original Medicare coverage alone.)
For millions of Americans, eligibility for Medicare is as straightforward as reaching their 65th birthday. That said, some Americans are not eligible to enroll in Medicare because they haven’t lived in the United States for at least five years. And others are eligible to enroll but have to pay a premium for Medicare Part A (which is free for most enrollees) because they haven’t worked for at least 10 years in the United States.
Although most Medicare beneficiaries are eligible due to their age, about 15 percent of all Medicare beneficiaries are under 65. That’s because people also become eligible for Medicare due to having a disability for at least two years, or being diagnosed with ALS or end-stage renal disease.
Learn whether you’re eligible for the various Medicare plans.
How do I enroll in Medicare plans?
The enrollment process for those options is different – each with its own enrollment windows and corresponding penalties for missing those windows, including
How you go through the enrollment process depends on whether you’re comfortable and confident doing plan research on the internet, or whether you feel like you need a personal interaction with a broker or agent. (If you’d like to talk to a licensed agent about your coverage options, you can call the number at the top of this page.)
If you do decide to enroll online, here’s the information you’ll need.
How much does Medicare cost?
A common misconception about Medicare is that it’s a free government safety net that awaits beneficiaries when they reach retirement. The fact is, each type of Medicare coverage does have its own costs, similar to other health insurance you’ve purchased over the years.
So expect premiums, copays, and coinsurance. Also, expect those costs to change each year.
Here’s a look at the costs associated with each of the plans.
There is assistance available for beneficiaries who may have difficulty paying for Medicare expenses – including premiums and out-of-pocket costs. Many lower-income beneficiaries are eligible for help via the Medicaid system, which includes Medicare Savings Programs as well as full dual-eligibility for both Medicare and Medicaid.
Can I change my Medicare coverage?
The options for changing your Medicare coverage is limited but they include:
- An annual Medicare open enrollment period for Medicare Advantage and Part D
- An annual Medicare Advantage open enrollment period for people who already have Medicare Advantage
- General enrollment for Medicare Part B (and Part A, if you have to pay a premium for it and didn’t sign up when you were first eligible).
- An annual five-star enrollment period
- A one-time trial period during your first year of Medicare Advantage coverage
Beneficiaries change their coverage for a variety of reasons, including changes in provider networks, increases in premiums, the availability of new plan benefits, and changes in Part D formularies – as well as changes in beneficiaries’ own situations. Read more here:
- Four signs you need to change your Medicare Part D coverage
- Four reasons to change your Medicare Advantage coverage
- Four ways to adjust your Medicare coverage
If you choose to go with a Medigap plan, you should definitely take note of the fact that Medigap plans aren’t guaranteed issue in most states after your initial enrollment period ends. That means if you apply for a Medigap policy later on — either for the first time, or because you want to switch plans — the carrier generally has the option of denying the application or charging you a higher premium based on the company’s underwriting requirements.
There are limited guaranteed-issue opportunities for Medigap plans after the initial enrollment window, and a few states have annual opportunities for people to enroll in Medigap on a guaranteed-issue basis.
Knowing your Medicare coverage options is critical
How well do you understand Medicare’s coverage options? Take our new Medicare Smarts Quiz to see if you are ready to shop for new coverage.
Ready or not, you can always learn more right here. The articles on this site are authored by a team of veteran healthcare writers who know the health insurance industry, understand the political battles over healthcare – and, most importantly, who know the needs of consumers.
In these pages, you can tap into an extensive collection of resources, including:
- overview of Medicare’s plan options and benefits, from physical therapy to hospital beds and hospice care;
- explanations of when you can – and can’t – change your Medicare coverage
- an explanation of the gaps in Medicare’s coverage
- eligibility and enrollment guidelines;
- a glossary of Medicare terms;
- answers to the most frequently asked questions.
We hope you’ll find the answers to all your burning questions. If you can’t, please don’t hesitate to send us your questions.
Are you ready for Medicare?
- How will my costs be affected by inpatient or observation status?
- Have Medicare’s enrollment rules changed in response to the coronavirus?
- Can I get a Medicare late-enrollment penalty removed?
- The latest edition of Medicare Heads Up
- What is the Medicare phone number and when should I use it?
- Will Medicare cover the costs of coronavirus testing or treatment?
- The Medicare Part B Special Enrollment Period
- Can you deduct Medicare premiums on your tax return?
- Four reasons to change your Medicare Advantage coverage
- Medicare Advantage’s new supplemental benefits