ABOUT MEDICARE

Medicare is a U.S. Government program. This page gives you a basic understanding of Medicare. Medicare has four parts: A, B, C and D.

Medicare Parts A and B

"Original" Medicare (Parts A and B) started in April 1965. Medicare is available to: anyone 65 years or older; people of any age with certain disabilities; and everyone who has end stage renal disease. Part A covers hospitalization. Part B covers doctors, diagnostic tests and durable medical equipment.

Part A is FREE and automatic (once you turn 65) as long as you have worked for at least 10 years in the USA.

Part B is NOT free. It is available to anyone who has worked for at least 10 years in the USA. You must enroll in Part B, it is NOT automatic. Part B premium amounts are based on your prior income reported to the IRS. Part B is only required if you do not have credible coverage from your employer. Part B enrollment periods depend on individual circumstances.

Medicare Part C

Part C plans are private health plans that replace "Original" Medicare plans. These are offered by private health insurance companies.

These plans include HMO, PPO, COST and PACE plans. These plans offer low copays, coinsurances and sometimes deductibles, and may have low or no premiums. They involve local or national networks of doctors and facilities, depending on the plan. Some plans may require a referral to see a specialist.

Some plans may offer optional benefits such as, vision, hearing, podiatry, and/or dental for little or no additional cost.

Medicare Part D

Part D plans help pay for the cost of prescription drugs. It is strongly recommended that you maintain a Part D plan even if you do not currently have any prescriptions in order to avoid a late enrollment penalty and high prescription costs when you need them.

Prescription drugs are categorized through Tiers 1-5. Tiers 1 and 2 are preferred and non-preferred generic drugs. Tiers 3 and 4 are preferred and non-preferred brand name drugs. Tier 5 are drugs not on the formulary.

Enrollment periods depend on individual circumstances. Plans are based on where you live and what combination of prescriptions you are taking. Part D plans can only be changed once a year.

SOURCE: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, 2019