How does Medicare work?

Whether you’re approaching retirement or have reached retirement age, learning about Medicare becomes a necessity. Medicare eligibility, enrollment periods, and changing benefits can feel like a lot to learn for newcomers. Fortunately, plenty of resources exist to help you get up to speed and choose the right Medicare plan to meet your unique health needs. 

Let’s explore them together.

Medicare organizes coverage into four basic parts: A, B, C, and D. These are the building blocks of coverage for everyone and learning the ABCs and Ds of Medicare is a good place to start.

Medicare benefits are designed for retired people who are older than 65. Benefits, however, do apply to younger people who meet specific qualifications.

65 or older

•  U.S. citizen or legal resident
• Receiving social security benefits; or worked long enough to receive benefits
• Government employee who has paid Medicare payroll taxes

Under 65

• Entitled to disability benefits for 2 years
• Disability pension from the railroad
• Diagnosed with Lou Gehrig’s disease
• Diagnosed with kidney failure requiring transplant or dialysis

It’s important to note that you will have a separate Medicare plan than your spouse, so make sure you are each qualified individually, and that you choose the plan that works for you. 

Those close to retirement will need to understand the differences between Medicare vs. Medicare Advantage, especially when first considering options and making healthcare decisions. 

Key differences between Medicare Advantage and Medicare include:

• Medicare—or Original Medicare—is a government-provided program, while Medicare Advantage plans are health plans offered by private insurance companies
• Medicare Advantage plans often include additional coverage for prescriptions, dental, and vision, whereas Original Medicare requires members to enroll in separate parts or supplemental plans to receive full coverage
• Medicare and Medicare Advantage have different annual enrollment periods

How much Medicare costs, or additional premiums, depends on the plan you choose.

Reading and researching Medicare options before retirement will give you a greater understanding of all the options—and increased confidence making the right choice. 

It's important to know the annual enrollment periods, both for Medicare and Medicare Advantage. A seven month window exisits for enrollment which newcomers need to be aware of.

Over time, if your situation changes or you prefer another plan, you can switch plans during specified times during the year. 

When ready to sign up for Medicare, you can source:

• You can enroll through online government resources
• Educational sessions held at public locations like libraries or your primary care doctor
• Current employer if you’re planning on retiring from work
• Your current private healthcare provider

Medicare enrollment generally happens for Parts A and B. You’ll be responsible for deciding on additional parts, Medigap or Medicare supplement plans, or choosing to go with a Medicare Advantage plan.

Related articles:

• Medicare 101
• What is Medicare Part ABCD?

Content contained on this page is for informational purposes only and does not constitute medical advice. Consult your health care provider before beginning any new fitness or dietary plan. References provided are for informational purposes only and do not constitute endorsement of any websites or other sources. Should you have any health-related questions, you should contact your health care provider.

Sources:

• https://www.ameriprise.com/financial-goals-priorities/insurance-health/what-is-medicare
• https://www.medicare.gov/basics/get-started-with-medicare/sign-up