We're here to help you navigate the complicated world of MEDICARE
The four parts of Medicare
It's important to understand that Original Medicare (Part A and B) does not cover all of your medical expenses. Here's a quick overview of the four parts of Medicare and what they mean to you:
Hospital insurance – for inpatient stays and more
- Usually there is no monthly premium for Part A coverage.
- You may pay the Part A deductible and coinsurance, which are out-of-pocket expenses, when you receive inpatient hospital care. You are responsible for paying these expenses—unless you have a separate Medicare Supplement insurance policy to cover them.
Medical insurance— for doctor services and more
- Part B is optional coverage.
- You usually pay a monthly Part B premium.
- For most services, you have to meet the Part B deductible and pay coinsurance—unless you have a Medicare Supplement plan that covers those expenses.
- Medicare Advantage (MA) plans are health plans offered by private organizations, like health insurance companies, that contract with Medicare.
- They combine all the benefits of Medicare Part A and Part B, and usually include prescription drug coverage.
- Many plans include additional benefits like dental, hearing and vision benefits beyond those covered by Original Medicare.
- Premiums and deductibles vary by plan.
Medicare-approved prescription drug coverage
- Part D is sold only through private organizations, like Florida Blue Medicare, that are contracted with Medicare.
- Coverage can be purchased either as a “standalone” prescription drug plan (PDP) or may be included with a Part C Medicare Advantage plan. Plans that combine medical coverage and prescription drug coverage are called Medicare Advantage Prescription Drug (MA-PD) plans.
Medicare's annual timeline
Medicare Advantage Open Enrollment Period
From January 1 through March 31 each year. If you are in an MA plan you can make a one-time election to go to another MA plan or Original Medicare.
Annual Election Period (AEP)
From October 15 through December 7 you can choose to enroll in an MA plan or Original Medicare for the next year.
Initial Election Period
If you’re eligible for Medicare because you’re turning 65, your IEP is a 7-month window that starts 3 months before the month of your birthday, includes your birthday month, and ends 3 months after your birthday month.
Initial Election Period
Depends on your circumstances.
Answers to your Medicare questions
Medicare Advantage HMOs generally require you to use network doctors. With a Medicare Supplement plan, you can usually visit any doctor who accepts Medicare. With a Medicare Advantage PPO, you may use network and out-of-network doctors, but you usually pay lower out-of-pocket costs by using a network doctor.
Original Medicare doesn’t generally cover prescriptions, but most Medicare Advantage Plans and all Medicare Prescription Drug plans do. Also, the federal government offers a program called Extra Help to assist those with limited income and resources pay their prescription drug costs.
Medicare Part D has four stages: Deductible, Initial Coverage, Coverage Gap and Catastrophic. You reach the Coverage Gap–or Donut Hole–stage when what you pay PLUS what your Medicare Prescription Drug Plan pays reaches $4,020 for the year. After that, you pay no more than 25% of the cost of covered generic drugs and no more than 25% of the cost of covered brand-name drugs until you reach the Catastrophic Stage. Once you reach the Catastrophic Stage, you will pay no more than 5% of the cost of covered drugs for the rest of the year.
The Initial Enrollment Period (IEP) is for people who are newly eligible for Medicare. During the IEP one can enroll in Original Medicare, Medicare Advantage plans and Medicare approved prescription drug plans. You can enroll in a Medicare Supplement plan any time, but enrolling during your IEP is best.
If you already receive Social Security benefits, you’re automatically enrolled in Original Medicare when you turn 65. You may have to pay a late enrollment penalty if you don’t enroll in Medicare when you’re first eligible. If you’re covered by an employer’s health plan, either through your or your spouse’s employment, it is very important to talk to a Human Resources representative about your coverage options and the best time to enroll in Medicare.
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