You're eligible for Parts A and B if:
You're at least 65 years of age (even if you still work).
Or you may be entitled to Medicae if you're under 65 & Qualify due to a disability or other special circumstance.
AND You're a U.S. citizen or a legal resident who has lived in the United States for at least five consecutive years.
Parts of Medicare
Medicare Part A (Federal Government)
In general, Part A has no monthly premium for the majority of Americans. Part A helps to cover:
- Inpatient care in a hospital
- Skilled nursing facility care
- Hospice Care
- Home health care
Medicare Part B (Medical Insurance)
In general, Part B has a monthly premium and it's based on your income from two years ago. Part B will help to cover:
- Clinical research
- Ambulance services
- Durable Medical Equipment (DME)
- Limited outpatient prescription drugs
- Outpatient surgery
- Doctor office visits
Part C (Advantage Plans are Private Insurance)
Advantage Plans, sometimes called Part C, are health plans offered through private insurance companies. If you join one of these plans, you generally get all your Medicare-covered health care through the Medicare Advantage Plan. This coverage can include prescription drug coverage (Part D). Advantage Plans are network based healthcare and can vary greatly depending on where you live. Their networks include:
- Medicare Health Maintenance Organization (HMOs)
- Preferred Provider Organizations (PPO)
- Private Fee-for-Service Plans
- Medicare Special Needs Plans
Part D (Stand alone Prescription Drug Plan)
If you decide to keep original Medicare (A&B) you need to have credible drug coverage. For some this may include coverage through the VA, Tricare or Federal Health Benefits. For the majority though you'll need to sign up for a stand alone Part D Prescription Drug Plans.
It will help cover prescription drug costs and starting in 2025, prescription drugs under Medicare will have a $2,000 Maximum out of pocket.
It's important to do this on time because there's a permanent premium surcharge for enrolling late if you don't have equivalent drug coverage from another credible source.
Medicare Supplement (Medigap)
A Medicare Supplement (Medigap) insurance is sold by private insurance companies that can help pay some of the health care costs that Original Medicare doesn't cover, like co-payments, coinsurance, and deductibles.
If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Your Medigap policy pays its share.
A Medigap policy is different from a Medicare Advantage Plan and you cannot have both at the same time.
