New to Medicare?

New to Medicare? Relax. You've come to the right place.

It's not always easy for new Medicare beneficiaries to sort through and understand their options. But for you, it's going to be easier than you imagined.

You probably know that Original Medicare doesn't cover all of your medical expenses ... and that's probably why you're here.

The following information will answer some of your important questions as a new Medicare beneficiary. It also will help explain some of your rights and options for getting additional coverage you may need.

Medicare eligibility

Generally, you are eligible for Medicare if you or your spouse worked at least 10 years in Medicare-covered employment and you are 65 years or older and a citizen or permanent resident of the United States. If you are not yet 65, you may qualify for coverage if you have a disability or you have End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant). You can get Part A at age 65 without having to pay premiums if:

  • You already get retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible to get Social Security or Railroad benefits but haven’t yet filed for them.
  • You or your spouse had Medicare-covered government employment.
  • If you are under 65, you can get Part A without having to pay premiums if you have: Received Social Security or Railroad Retirement Board disability benefits for 24 months, Have End-Stage Renal Disease and meet certain requirements. (back to top)

Enrolling in Medicare

  • Decide if you want Original Medicare (Part A and Part B) or if you want a Medicare Health Plan / Medicare Advantage Plan (Part C).
  • Decide if you want Prescription Drug Coverage (Part D). If you selected a Medicare Advantage Plan then most likely this plan includes prescription drug coverage. If you selected Original Medicare, then you can choose the Prescription Drug Plan that best fits your needs.
  • Decide if you want Supplemental Coverage. If you selected Original Medicare, you may want to get private coverage that fills gaps in Original Medicare Coverage. You can choose to buy private supplement coverage, like a Medigap policy. Costs vary by policy and company. This does not include prescription coverage. You will need to enroll in a Prescription Drug Plan for prescription coverage.

You can enroll in Medicare Part A and Part B at your local Social Security Office, or call 1-800-772-1213, TTY users call 1-800-325-0778. (back to top)

Medicare Basics

Medicare Part A (Hospital Insurance)

  • Helps cover inpatient care in hospitals (includes critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals).
  • Helps cover skilled nursing facility (not custodial or long-term care), hospice, and home health care services.
  • Most people do not have to pay a premium. If you get Social Security or Railroad Retirement Board (RRB) benefits, you are automatically enrolled beginning the first day of the month you turn 65.

Medicare Part B (Medical Insurance)
  • Helps cover doctor services and outpatient care.
  • Helps cover some preventive services to help maintain a person’s health and to keep certain illnesses from getting worse.
  • Generally pays 80% of the Medicare-approved amount for covered services after the Part B deductible ($147 for 2013) has been met.
  • Monthly premium starts at $104.90 per month in 2013. This amount will change annually. Enrollment is your choice; you can sign up anytime during a 7 month period that begins 3 months before you turn 65.

Medicare Part C (Medicare Advantage Plans)
  • A way to get Medicare benefits through private companies approved by and under contract with Medicare.
  • Includes Part A, Part B, and usually other benefits Medicare doesn’t cover. Most plans also provide prescription drug coverage.
  • There is a monthly premium in addition to your Medicare Part B premium. The amount varies by Health Plan.
  • Enrollment is your choice; you can sign up anytime during a 7 month period that begins 3 months before you turn 65. You can also enroll during annual election periods (AEP), which begin on October 15 and end on December 7 each year. You also have another, more limited enrollment period from January 1 through February 14 each year. During this period (called the “Medicare Advantage Annual Disenrollment Period”), you could switch from our plan to Original Medicare. If you choose to switch to Original Medicare during this period, you can also enroll in a separate Medicare prescription drug plan at the same time.

Medicare Part D (Prescription Drug Coverage)

Run by private companies approved by Medicare, which can either be Medicare Advantage Plans or separate Medicare Prescription Drug Plans. Helps cover the cost of prescription drugs. Each plan can vary in cost and drugs covered.
  • There is a monthly premium in addition to your Medicare Part B and Part C premiums.
  • Enrollment is your choice; you can sign up anytime during a 7 month period that begins 3 months before you turn 65. You can also enroll during annual election periods (AEP), which begin on October 15 and ends on December 7 each year. You also have another, more limited enrollment period from January 1 through February 14 each year. During this period (called the “Medicare Advantage Annual Disenrollment Period”), you could switch from our plan to Original Medicare. If you choose to switch to Original Medicare during this period, you can also enroll in a separate Medicare prescription drug plan at the same time. (back to top)

Medicare Advantage Plans

Medicare Health Plans (like HMOs and PPOs) also known as Medicare Advantage Plans are approved by Medicare but are run by private insurance companies. They are part of the Medicare Program, and sometimes called “Part C.” When you join a Medicare Advantage Plan, you are still in Medicare. With Medicare Advantage Plans please note the following:
  • Depending upon the Insurance Company – some of the plans require referrals to see specialists.
  • In many cases, the premiums or the costs of services (co-pays and deductibles) can be lower than they are in Original Medicare or Original Medicare with a Medicare Supplement Policy. Medicare Health Plans charge different premiums and have different costs of services, so it is important to check with the plan before you join.
  • The plans provide all of your Part A (hospital) and Part B (medical) coverage and must cover medically necessary services.
  • They often have networks, which mean you may have to see doctors who belong to the plan or go to certain hospitals to get covered services.
  • They generally offer extra benefits, and many include prescription drug coverage.
  • In many cases, your costs for prescription drug coverage can be lower than in the stand-alone Medicare Prescription Drug Plans.
  • Some of the plans coordinate your care, using networks and referrals, more than others. This can help manage your overall care and also result in savings to you.
  • You do not need to buy a Medicare Supplement Policy.
Medicare Health Plans Include:
  • Health Maintenance Organization (HMO) Plans must cover all Medicare Part A and Part B health care. Some HMOs cover extra benefits, like extra days in the hospital. In most HMOs, you can only go to doctors, specialists, or hospitals on the plan’s list except in an emergency. Your costs may be lower than in Original Medicare.
  • Preferred Provider Organization (PPO)
    You pay less if you use doctors, hospitals, and providers that belong to the plans network. You can use doctors, hospitals, and providers outside of the network for an additional cost.
  • Private Fee-for-Service (PFFS) Plans
    You may go to any Medicare-approved doctor or hospital that accepts the plan’s payment. The insurance plan, rather than the Medicare Program, decides how much it will pay and how much you pay for the services you use. You may pay more or less for Medicare covered benefits. You may have extra benefits that Original Medicare does not cover.
  • Medicare Medical Savings Account (MSA) Plans
    There are two parts to these plans. The first part is a high-deductible Medicare Advantage MSA Health Plan. The health plan won’t begin to pay covered costs until you have met the annual deductible, which varies by plan. The second part is a Medical Savings Account into which Medicare deposits money that you may use to pay health care costs.
  • Medicare Special Needs Plans
    Provides all Medicare Part A and Medicare Part B health care and services to people who can benefit the most from things like special care for chronic illnesses, care management of multiple diseases, and focused care management. These plans may limit membership to people in certain institutions (like a nursing home), are eligible for both Medicare and Medicaid, or with certain chronic or disabling conditions.

Remember, we're here for you.

After you've read through this information, we are sure you will have more questions. Just give us a call or drop by our office. We've got friendly Medicare experts to help you.



Last modified: October 1, 2013
H3811_MA4001_2013A CMS Approved 11/06/2013