Medicare basics

Get to know Medicare

What is Medicare?

It’s the federal health insurance program here in the U.S.
It is for people aged 65 or older.
It is for some people under age 65 who have a disability.
You must be a U.S. citizen or lawfully living in the U.S.
It can be called Original Medicare, too.

What are the Parts of Medicare?

Medicare Part A is hospital insurance It covers:

A hospital stay
A skilled nursing facility stay
Hospice care (comfort care for someone at the end stage of an incurable illness)
Home health care

Medicare Part B is medical insurance. It covers:

Care from doctors and other providers (like a physician’s assistant)
Outpatient care
Medical supplies
Wheelchairs, walkers, and hospital beds
Many preventive services (for example, a diabetes screening and a yearly flu shot)

Medicare Part C is hospital and medical insurance rolled into one. It’s usually called Medicare Advantage. It is offered by private insurance companies like us. It covers:

Covers everything Medicare Part A and Part B cover
Can include prescription drug benefits
Offers extra benefits you don’t get with Medicare
Is an option you can choose instead of Original Medicare

Medicare Part D is prescription drug coverage. It is offered by private insurance companies. It covers:

Covers prescriptions drugs
Covers certain recommended vaccines at no cost
Covers insulins at no more than $35 for a one-month supply
Is provided through a prescription drug plan, or PDP for short

Now that you know what Medicare is, what are your choices for getting your health care? Well, you have a couple.

After enrolling in Original Medicare (Part A and Part B), you can choose to stay on Original Medicare. Or you can go with a Medicare Advantage plan. Let’s look at each choice.

If I stay on Original Medicare

Here’s what you can expect:

You may or may not have to pay the monthly Part A premium. If you or your spouse worked and paid Medicare taxes for a certain amount of time, you likely will not pay it.
You will pay the monthly Part B premium. This amount changes each year. In 2024, it is $174.70.
If you made more than an amount set by Medicare, you may have to pay an extra amount. This is called the Income Related Monthly Adjustment Amount. (Or IRMAA for short.) This extra amount is added to your monthly Part B premium.
You will need to have prescription drug coverage. Original Medicare does not cover this. You’ll need to enroll in a prescription drug plan (PDP) to get these benefits. You will likely have to pay a monthly premium for it.

Note! If you go without prescription drug coverage for more than 63 days in a row after you become eligible for Medicare, you may have to pay a late enrollment penalty. This would be added to your monthly premium.

Original Medicare generally covers 80% of your covered healthcare costs. You have to pay the rest out of your own pocket. You can buy more insurance to cover this 20%. It’s called a Medicare Supplement plan. It’s sometimes called Medigap. This will have a monthly premium you will have to pay, too.
You can see any provider who accepts Medicare
You do not have to choose a primary care provider (PCP)
You will not have to get a referral to see a specialist

If I choose a Medicare Advantage plan

Here’s what you can expect:

A Medicare Advantage plan combines Part A (hospital) and Part B (medical) services into an all-in-one plan. This plan may or may not have a monthly premium.
The plan can include prescription drug benefits
The plan may offer extra benefits that Original Medicare does not cover. Things like:
- Dental checkups, cleanings, and fillings
- Eyewear allowances
- Over-the-counter (OTC) items
- A fitness membership
- And more
You will have to choose a plan in your area
This plan will be offered by a private insurance company
All Medicare Advantage plans must be approved by Medicare. And they must follow all of Medicare’s rules.
Depending on the plan you choose, you will need to get your care from a provider in the plan’s network of providers, hospitals, and facilities. Some plans may have an out-of-network benefit. This means you can see a provider not in the plan’s network. This usually will cost you more than seeing a network provider.

There is so much to think about when choosing health care. What should I do?

We know this is a big decision. Before you decide, think about the following.

We know this is a big decision. Before you decide, think about the following.
Look at your budget. How much can you afford to spend each month on premiums and your care?
If you decide to go with a Medicare Advantage plan, look for one in your area.
Check the plan’s documents to see:
- Who is and isn’t in their provider network.
- The prescription drugs they cover. How much do they cost.
- If a referral is needed to get care.
- Or, if there are prior authorization requirements.
- What your out-of-pocket costs may be.
- What extra benefits you may get.
Talk with the Senior Health Insurance Information Program here in Arkansas. It’s a free program that helps people with Medicare. They can help you understand all your options and answer your questions. Call them at 800-224-6330. Or visit www.shiipar.com.
Give us a call. Visit our Customer Service page our phone number and hours. We will be happy to help.
Talk with a local health insurance broker or agent.

When can I enroll in Medicare?

There are certain times during the year when you can enroll in Medicare. These are called enrollment periods. Each enrollment period has a set time by when you need to enroll. And they occur at different times of the year. Let’s review each one.

Initial Enrollment Period

This is called your IEP. It’s a seven-month window around your 65th birthday. It starts the three months before your birthday month. It includes your 65th birthday month. And it ends at three months after your birthday month.

If you qualify for Medicare when you turn 65, this is the best time to enroll in Medicare. If you don’t enroll during this time, you may have to pay a penalty.

Note! After enrolling, your coverage will start on the first day of the month. The month it starts depends on when you enroll.

Here’s another example. If you enroll before the month of your 65th birthday, coverage starts the month you turn 65. If you enroll the month you turn 65 (or sometime during the three months after), your coverage will start the next month after enrolling.

Annual Enrollment Period

This is called AEP. It takes place every October 15th through December 7th. This is when you can change, drop, or start a Medicare plan and/or prescription drug coverage.

During this time, you can switch from:

Original Medicare to a Medicare Advantage plan
One Medicare Advantage plan to another Medicare Advantage plan
A Medicare Advantage plan back to Original Medicare (if you do this, you’ll need to make sure you have prescription drug coverage)

Note! When you enroll during AEP, your new coverage will start on January 1st.

Open Enrollment Period

This is called OEP. It takes place every January 1st through March 31st. This may be the last time you can make a change to your health coverage for the rest of the year.

During this time, you can:

Enroll in Medicare if you missed your Initial Enrollment Period (keep in mind you may have to pay a late enrollment penalty if you missed your IEP)
Switch from your current Medicare Advantage plan to another one
Go back to Original Medicare from your current Medicare Advantage plan

Special Enrollment Period

This is called an SEP. If you have a big change in your life during the year, you may be able to make a health coverage change.

Life changes can include if you:

Move to a new address that’s not in your current plan’s service area (where the plan is offered)
Lose your current health care (like Medicare, your employer’s health plan, etc.)
Are on a plan that Medicare decides to close down or will not allow people to enroll in
Become eligible for Medicare and Medicaid
Become eligible for “Extra Help” (this is a federal program that helps people pay for their prescription drugs)

If any of these things happen to you during the year, you may qualify for an SEP.

How do I enroll in Medicare?

Some people may automatically get enrolled in Medicare Part A and Part B. Others may have to enroll. How do you know which applies to you? Let’s go over it together.

I’m already getting Social Security

If you get a Social Security check or benefits from the Railroad Retirement Board (RRB) right now, you will automatically get Medicare Part A and Part B. This will start on the first day of your 65th birthday month. You will receive your red, white, and blue Medicare card in the mail. It will arrive about three months before your 65th birthday.

I’m already getting Social Security

You will automatically be enrolled in Medicare Part A and Part B. This will take place after you have received two years of disability benefits from Social Security or the RRB.

I’m not getting Social Security

You will have to enroll in Medicare. As your 65th birthday gets closer, you will have a couple of ways to enroll. Here’s how:

Go to the Social Security website

Call Social Security toll-free at 800-772-1213 (TTY: 800-325-0778)

Call the RRB toll-free at 877-772-5772 (TTY: 312-751-4701)

Find a Social Security office near you

Be sure to get ready for your call or visit with Social Security or the RRB. Here are a few tips. You should:

Take these personal documents with you if you make an in-person appointment:
Your original birth certificate or a certified copy
Your Social Security card (or have your number ready)
Your W-2 tax forms for the last two years
Have these same documents ready if you have an appointment over the phone
Ask your spouse, partner, daughter/son, or close friend to be there with you to help if you don’t understand something
Ask lots of questions (write them down and take them with you or have ready for the call)

Of course, you can always call us. Visit our Customer Service page for our phone number and hours. We’ll be happy to help you.

Or if you want to work with a sales agent, call her or him.

What if I keep working past my 65th birthday? What should I do?

If you keep working past your 65th birthday, you can enroll in Medicare Part A and/or Part B. This should be done during the eight-month period that begins the month after your employer’s health plan coverage ends.

We know this is another big decision. We have a brochure that may be helpful. It’s our Healthcare in Retirement brochure. We invite you to read through it.

Still need help? We’ve got you covered.

We hope you found all this information useful. If you still have questions, give us a call. If a family member is helping you make decisions, have her or him call us. We want to make sure you get answers to your questions.

Another great tool is the Medicare website. Go to www.medicare.gov. There you can:

Learn more about Medicare
Read the Medicare and You Handbook
Find Medicare Advantage health plans in your area

View brochure

Don’t forget!

Our website has a lot more information on it. You can find:

Details about our extra benefits
Our plan documents, like our Provider Directory, Pharmacy Directory, Summary of Benefits, and more
Forms you may need
How to make a complaint
What you can do to save money with your health care
How to keep your health information safe
And so much more

We wish you good health!

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