Medicare 101: What You Need to Know
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If you’re nearing retirement—or already over 65 and still working—you may have questions about Medicare. With different parts, enrollment rules, and coverage options, it can feel overwhelming. Here’s a clear overview to help you understand the basics.
What Is Medicare?
Medicare is federal health insurance for:
- People 65 and older
- People under 65 with certain disabilities
- People of any age with End-stage Renal Disease (permanent kidney failure)
The Four Parts of Medicare
Medicare is divided into four parts, each covering different needs:
Part A – Hospital Coverage
- Covers inpatient hospital care, skilled nursing facilities, hospice, and some home health services.
- Most people don’t pay a monthly premium if they paid Medicare taxes while working.
Part B – Medical Coverage
- Covers doctor visits, outpatient care, and other medically necessary services not included in Part A.
- Requires enrollment and a monthly premium (based on your income), plus a deductible.
- Many people also purchase a Medigap policy to cover gaps.
Part C – Medicare Advantage Plans
- Offered by private insurers approved by Medicare.
- Usually combines Part A, Part B, and sometimes Part D.
- Must cover medically necessary services, but copays, deductibles, and coinsurance vary by plan.
Part D – Prescription Drug Coverage
- Helps pay for prescription medications.
- Available through private Medicare-approved companies for a monthly premium.
Getting Started With Medicare
About three months before you’re eligible, Medicare will send you a questionnaire to set up your file. Be sure to:
- Complete the questionnaire carefully, especially if you have group health insurance through an employer or family member.
- Update your file if your coverage changes by calling the Medicare Coordination of Benefits Contractor at 855-798-2627.
- Schedule your free “Welcome to Medicare” preventive visit within your first 12 months of coverage. This helps establish a baseline for your health.
- Create an account at Medicare.gov to track claims and access your information.
- Fill out an Authorization Form if you want family or friends to speak to Medicare on your behalf.
Coordination of Coverage
If you have Medicare and other insurance, figuring out who pays first can be tricky. In general, a group health plan pays before Medicare—but there are exceptions. For personalized answers, call 855-798-2627 or visit Medicare.gov.
Final Thoughts
Medicare can feel complicated, but breaking it down into parts makes it easier to navigate. Whether you’re planning ahead or signing up soon, take time to understand your options and how they coordinate with any other coverage you may have.
For more guidance, visit Medicare.gov or contact an insurance professional who can walk you through your choices.
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Disclaimer: This article is for informational purposes only and does not constitute legal advice. Employers should consult with legal counsel or safety professionals for specific compliance recommendations.