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Sharp Health News

5 things you need to know about Medicare

Oct. 5, 2021

5 things you need to know about Medicare

Medicare is an essential government health insurance program for millions of older and disabled Americans. Navigating the ins and outs of Medicare can be a challenge, especially if you are new to it.

Whether you are signing up this year, in the near future or are helping someone else enroll, here are five things you need to know about Medicare.

1. Know when your enrollment period begins and ends.

Medicare is a complex system. To get the most out of these benefits, you'll need to know the kinds of choices and deadlines that exist.

In most cases, you won't receive any official notice about when or how to enroll. That means you have to make an effort to find out when your personal deadline is to enroll in Medicare.

For example, if you are eligible based on age, your initial enrollment period is a seven-month window that starts three months before your 65th birthday and ends three months after it.

2. If you don't enroll on time, your costs may go up or you may experience a delay in coverage.

If you don't sign up for Medicare when you first become eligible (during your initial enrollment period) and you aren't automatically enrolled, permanent late penalties can be added on to your monthly premium.

Keep in mind that there are other factors, aside from when you enroll, that contribute to whether or not you'll face a penalty. In most cases, you will not pay a penalty if you have other creditable coverage, such as through an employer. To be sure, you should always confirm with Medicare before delaying enrollment.

3. Medicare is not free, and it doesn't cover everything.

Medicare covers many medical services, such as doctor's visits, hospital visits and medical equipment, but there are gaps for dental, hearing and vision care. Medicare also does not provide family or dependent coverage.

You will most likely have to pay monthly Part B premiums to receive services, unless you qualify for a low-income program that will cover your costs. You may also be charged a premium if you enroll in a Medicare Advantage plan or Part D prescription drug plan.

4. When you're Medicare-eligible, you can choose between two types of plan.

Medicare is made up of three basic building blocks:

  • Part A - provides hospital insurance
  • Part B - covers costs for doctors' services, outpatient care and medical equipment
  • Part D - covers prescription drug costs
Original Medicare includes Part A and Part B. You can sign up for extra coverage with a Medigap plan, which offers to pay for certain health care costs that aren't covered by Medicare. You can also sign up for prescription drug coverage with a Part D plan.

Medicare Advantage plans, on the other hand, are an all-in-one alternative to Original Medicare - they include Part A, Part B and, usually, Part D. Some Medicare Advantage plans also provide extra benefits like vision, hearing or dental care that aren't covered by Original Medicare.

Medicare Advantage is also known as Part C. Some Medicare Advantage plans charge no additional premium - you only have to pay your Part B premium.

5. Free help is available.

Learning about Medicare is no easy task, which is why there are resources dedicated to helping you understand everything you need to know. No matter your income level, you can get help to find the best option for you:

Medicare: Call Medicare's help line at 800-633-4227 (TTY 877-486-2048) for general information and help with coverage.

Social Security: Call Social Security at 800-772-1213 (TTY 800-325-0778) for information and help signing up for Medicare or applying for Extra Help benefits in the Part D drug program.

State Health Insurance Assistance Program (SHIP): SHIP offers counsel and advice on Medicare and long-term care insurance. In California, the SHIP is called the Health Insurance Counseling & Advocacy Program (HICAP). Call HICAP at 800-434-0222 to find a location near you.

Still have questions about Medicare?
Sharp hosts free online seminars, where you'll learn more about enrollment periods and how Medicare works. Sign up for the "Understanding How Medicare Works" seminar or the "Understanding Your Medicare Open Enrollment Options" seminar.

These classes are also available in Spanish. Please visit Entienda Cómo Funciona Medicare and Entienda Sus Opciones de Medicare Durante la Inscripción Abierta for more information.

This story was updated February 4, 2021, to reflect the most up-to-date Medicare information.

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