Medicare can be confusing and a little scary. If you feel lost, you are not alone. Basically, anyone who is 65 in America, even permanent residents who have lived here at least 5 years can get Medicare. People who have qualified for 24 months of Social Security disability also become eligible. For people aging into Medicare at 65, it doesn’t matter if you are taking Social Security benefits yet.

Once you’ve confirmed you qualify for Medicare, we recommend starting with the basics. People get confused when jumping right into figuring out Medigap plans, and Medicare Advantage plans before they even understand how their Original Medicare benefits work.

Original Medicare consists of Part A and Part B. These are provided to you by the federal government. In fact, you will enroll in these two parts through the Social Security office. Anything in your mailbox that comes from the Social Security office or the Centers for Medicare & Medicaid Services is mail you want to keep.

The Different Parts of Medicare

Medicare is divided into different sections to cover various aspects of healthcare:

  • Part A (Hospital Insurance): Covers hospital stays, skilled nursing facility care, some home health care, and hospice.
  • Part B (Medical Insurance): Covers doctor visits, outpatient care, medical equipment, and preventative services.
  • Part C (Medicare Advantage): These plans are offered by private insurance companies and combine Part A and Part B (often with extra benefits like vision, hearing, and dental).
  • Part D (Prescription Drug Coverage): Helps with the cost of prescription medications.

You are eligible for Part A, B and D of Medicare on the first day of the month in which you turn 65 (or earlier if you have qualified for Medicare due to disability). Medicare Part A is free for most people, as long as you or a spouse have worked for at least 10 years in the United States.

Medicare Costs for Part B depends on your income. People new to Medicare in 2024 have a base rate of $174.70 month. However, people in higher income brackets will pay an “Income Adjustment.” Really that’s just a way to explain that people who earn higher incomes pay higher costs for Medicare.

If you will continue to work past age 65 for a large employer (20+ employees), that will continue to be your primary insurance. Medicare will be secondary, so you can consider delaying Part B since your group insurance probably includes outpatient benefits already.

Understanding Medicare Part D costs is a bit tricky because plans have varying premiums. Beneficiaries also might pay more due to their income, as mentioned above. Most states have more than 20 different Part D plans to choose from. The national average Part D premium is currently around $34.70/month.

Now that we’ve outlined the basics of Medicare, we can touch on supplemental insurance and if it is necessary for you. This includes most of the solicitations that will be filling up your mailbox as open enrollment season approaches.

Medigap Plans (also called Medicare supplements)

Medigap plans pay AFTER Medicare. They pay for things that are normally your share. Medicare will pay 80%, and your Medigap plan will then pay the other 20% of your Part B outpatient expenses. Some Medigap plans also cover your Part A and B deductibles. You can choose your own Part D drug plan to go alongside this coverage.

Medigap plans also allow you freedom of choice in your medical care. You can see any physician or healthcare provider that participates in Medicare. These plans cost more than Advantage plans because they are more comprehensive. They also give you more freedom in choosing your providers.

Medicare Advantage Plans (also called Part C)

Understanding Medicare Advantage plans can be a bit confusing because the Medicare Advantage program is also called Part C of Medicare.

Medicare Advantage plans pay INSTEAD OF Medicare. These plans are optional, and they were created to give a low-cost alternative to Medigap.

Advantage plans are private insurance plans with their own local network of providers, generally an HMO or PPO style plan. When you join an Advantage plan, you’ll see these providers in order to get the lowest co-pays.

You will pay co-pays for doctor visits, hospital stays, and any other Medicare-approved services. Medicare Advantage plans generally have lower premiums than Medigap plans. That’s because you agree to share in the costs by paying co-pays for services as you obtain them. (Whereas with a Medigap plan, you often will have NO co-pay, depending on the plan you choose.)

Most Medicare Advantage plans also include a rolled-in Part D drug benefit. Depending on whether that rolled-in benefit includes the specific medications you need, this can be a benefit or a hindrance. Each type of plan has its advantages and disadvantages. You’ll want to be thinking about what things are most important to you.

At Ohio Health Benefits, we’ve been helping people new to Medicare for many years. Our service is free, and you can read the many 5-Star reviews about our service right here on our website. We will guide you through the next steps to enroll in the right parts of Medicare. We will also help you find the most suitable supplemental coverage and a cost-effective drug plan.

We also recommend our clients give themselves an annual “Medicare Check-up” to see if the available plans will meet their needs for the coming year. If you have questions, call us toll free at 330-633-3837or click here to email us your name and phone number for us to call you.

Original Medicare consists of Part A and Part B. These are provided to you by the federal government. Once you’ve confirmed you qualify for Medicare, we recommend starting with the basics.