What Is Medicare?
Medicare is a federally funded health-care insurance program. It primarily serves people age 65 years and older, but people with disabilities and certain illnesses may qualify as well.
The program has four parts: A, B, C, and D. Parts A and B are the foundation of most Medicare plans and are called Original Medicare. You can also purchase Medicare supplement plans, as well as separate dental and vision coverage.
There are lots of carriers for Medicare and lots of coverage options. It’s important to build a plan that works best for you and your unique health-care needs.
Who Qualifies for Medicare?
You qualify for Medicare if you are a US citizen or a legal resident who has lived in the United States for at least five consecutive years, and have also paid into Medicare for 40 quarters or qualify based on your spouse’s qualifications.
You must also meet one of the following criteria:
- You are 65 years or older.
- You are younger than 65 but have a qualifying disability.
- You are younger than 65 but have a diagnosis of end-stage renal disease or amyotrophic lateral sclerosis (ALS).
When Do You Apply for Medicare?
For most people, the Medicare enrollment period opens three months before your 65th birthday. The enrollment window remains open during your birthday month and closes three months later.
For example, if your birthday is on June 6th, your enrollment window will open on March 1st and close on August 31st.
You can also sign up or change plans during the Medicare open enrollment period, which runs from October 15th to December 7th each year. You can learn more about open enrollment on the US Centers for Medicare & Medicaid Services website. If you miss your initial enrollment period of 7 months, you’ll have to wait for GEP or General Election Period.
How Do You Apply for Medicare?
Enrolling in Medicare can be a complex process. There are generally three ways you can enroll: automatically, on your own, or with the help of an agent.
Here’s how to apply for Medicare.
First, you must be eligible for automatic enrollment in Medicare.
If you receive Social Security Disability Insurance (SSDI) or Railroad Retirement Board benefits, you automatically receive Medicare Part A once you are eligible. Medicare Part A is usually premium-free for people who receive these benefits.
As a Michigan resident, you will also start receiving Medicare Part B. Because Medicare Part B does come with a monthly premium, you can choose whether to keep this coverage. There are very few instances where not choosing part B makes sense.
Applying on Your Own
If you do not qualify for automatic enrollment, you will need to enroll in Medicare yourself. For Medicare Parts A and B, you can either apply online, over the phone, or at your local Social Security office.
For coverage outside of Medicare Parts A and B, you’ll need to apply with the carrier directly. There are lots of options available, so you’ll want to carefully weigh different carriers to find the best plan for you.
Working with a Medicare Agent
There are a lot of considerations that go into building a Medicare plan. For many people, Parts A and B simply aren’t sufficient to cover their health-care costs, and they need additional insurance. Others may only need Original Medicare at first, but their needs could change later on.
To streamline the enrollment process, many people choose to work with a Medicare agent, like the ones at Sunnyside Medicare. An agent knows the ins and outs of different coverage options and can help you build a plan that meets your needs.
Plus, when you work with an agent at Sunnyside Medicare, you have an agent for life. You’ll speak to the same person, every time, for as long as they’re with us. If you need to change your Medicare plan later, your agent can help you adjust your plan.
What Does Medicare Cover?
Different Medicare plans provide benefits for different health-care needs. Here’s a brief overview of what each plan covers.
Medicare Part A
Medicare Part A provides coverage for hospital stays and expenses. It also includes coverage for most inpatient services that you would receive at one of these facilities.
Your coverage will include the following benefits:
- A semi-private room
- Hospital meals
- Skilled nursing services
- Hospice care for the terminally ill
- Care in specialized units, such as intensive care
- Operating room and recovery room services
- Laboratory tests, x-rays, and medical equipment
- Drugs and medical supplies during an inpatient stay
Medicare Part B
Medicare Part B provides coverage for care that you receive at a clinic, as well as outpatient hospital services. This coverage will include the following services:
- Doctor’s visits
- Skilled nursing services
- Mental health care
- Your annual wellness visit
- Preventive services, such as flu shots
- Clinical laboratory services, like blood and urine tests
- Diagnostic tests such as MRIs and x-rays
- Certain health programs, like smoking cessation
- Home medical equipment, like wheelchairs
- Diabetes education, supplies, and screenings
- Ambulance and emergency room services
Medicare Part C aka Medicare Advantage
Medicare Part C, or Medicare Advantage, is a plan that you enroll in through a private insurance carrier. These plans combine Part A and Part B benefits, and many provide additional benefits:
- Prescription drug coverage, or Medicare Part D
- Hearing exams and hearing aids
- Eye exams, eyeglasses, and contact lenses
- Wellness benefits, like gym memberships
- Transportation to medical appointments
- Dental exams, cleanings, and routine care
Medicare Part D
Medicare Part D provides coverage for prescription medications and some vaccines. You can enroll in a stand-alone Part D plan or receive this coverage as part of a Medicare Advantage Plan.
Usually, Part D includes the following benefits:
- Drugs that Medicare requires Part D plans to cover under federal standards
- Specific brand-name and generic drugs in the plan’s formulary
- Commercially available vaccines that Part B does not cover
Medicare Supplement Plans
Medicare supplement insurance, also known as Medigap, works alongside Original Medicare to pay for costs that you would otherwise pay out of pocket.
Coverage can vary, but all Medigap plans include the following benefits:
- Coinsurance plus coverage for 365 additional days for hospital stays
- Coinsurance for hospital outpatient services and hospice stays
- Coverage for the first three pints of blood transfusions per calendar year
How Much Does Medicare Cost?
The cost of Medicare can depend on a number of factors:
- Your location
- Your provider
- Your income
- The plans you select
- The number of quarters you paid Medicare taxes
- And your eligibility for premium-free coverage
The experts at Sunnyside Medicare can help you estimate your Medicare costs and find the right plan for your budget.
Find the Right Plan with Sunnyside Medicare
The health-care journey can be complex, so it’s best to have someone on your side who can help you navigate through it.
At Sunnyside Medicare, our licensed agents are here to help you learn more about your Medicare options and answer your Medicare questions. Contact us today to schedule your meeting with an expert and start building your custom health-care plan.
Looking for a Helping Hand?
Call us at 1-248-277-5948 to talk with a Sunnyside Agent. Our licensed Medicare Agents are friendly, knowledgeable and always willing to take the time to find the right plan for you! Not ready to talk on the phone? Send us an online message and an Agent will get back to you shortly. We look forward to helping you.