Medicare for Dummies (2023)

When you find yourself quickly approaching 65 years young, you also find yourself reaching Medicare eligibility. With this milestone comes new learning curves, such as learning about Medicare and what the federal healthcare program offers. You might find yourself searching the web for Medicare for Dummies.

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Thankfully, a Medicare for Dummies book won’t be necessary. We have everything you need to know right here. Below we’ll go over what Medicare is, the different parts, and the best timeframes for enrollment.

Medicare for Dummies

Medicare is health insurance for individuals 65 years or older, specific individuals with disabilities, and those with End-Stage Renal Disease. If you qualify for Medicare, here are some fundamentals of the different coverage types to understand when starting this new journey.

Chapter 1: The Four Parts of Medicare

There are several types of Medicare coverage you should familiarize yourself with before you enroll. The first chapter of our Medicare for Dummies guide will review the four parts of Medicare.

  • Medicare Part A: Your hospital coverage through Medicare. It covers your stay in the hospital, a nursing facility, or any inpatient care.
  • Medicare Part B: Your outpatient medical coverage. Benefits include physician visits, labs, surgeries, and durable medical equipment.
  • Medicare Part C: A Medicare Advantage plan. These plans, through private insurance companies, combine Original Medicare benefits with additional benefits, such as dental, vision, hearing, and prescription drug plans. You will be responsible for copays for approved services and/or hospital and physician visits.
  • Medicare Part D: Prescription drug coverage. These are your pharmacy benefits, which you purchase through a private insurance company if you do not have a Medicare Advantage plan. Thus, Medicare Part D pairs with Original Medicare (Parts A and B). Prescriptions can be pricey, so this coverage is beneficial.

Now that you are familiar with the parts of Medicare, we will let you know how to enroll in these benefits.

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(Video) Medicare Explained in Two Minutes - 2022 Insights.

Chapter 2: Medicare Enrollment Periods You Need to Know

Medicare enrollment periods are when you can sign up for the various parts of Medicare. Below, we’ll discuss some of the most important Medicare Enrollment Periods.

  • Initial Enrollment Period: – Lasts for seven months. Begins three months before you turn 65 and lasts up to three months after your date of birth.
  • Special Enrollment Period: Occurs due to qualifying life events. The most common reason is if you are over 65 and terminate private insurance through your or your spouse’s employer with 20 or more employees. In this case (and others), you will receive a Special Enrollment Period for Medicare.
  • General Enrollment Period: If you fail to apply for Medicare during your Initial Enrollment Period or Special Enrollment Period, this will allow you to still sign up for Medicare. This enrollment period begins on January 1 and runs through March 31.
  • Automatic Enrollment: You may automatically enroll in Part A and Part B at 65 if you begin to receive retirement benefits from either the Railroad Retirement Board or Social Security.

Enrolling in a Medicare enrollment period is essential to avoid late enrollment penalties. You should never pay more for your healthcare coverage due to a lack of information. Therefore, we are dedicated to helping you understand each step of Medicare enrollment.

Chapter 3: Original Medicare Breakdown

Medicare Part A will cover the first 60 days in a hospital. You will be responsible for a hospital deductible. Once you have met 60 days consecutively in the hospital, Medicare’s share will begin diminishing, while your share will increase. We recommend Medicare Supplement plans to help safeguard you from these increasing costs.

Medicare Part B covers outpatient care while visiting your doctor’s office. You must meet an annual deductible, after which Medicare Part B covers 80% of costs. Again, investing in a Medicare Supplement (Medigap) plan can help safeguard you from high out-of-pocket expenses associated with the remaining 20% for which you are responsible.

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Chapter 4: Original Medicare Cost Breakdown for Dummies

When breaking down the costs of Medicare, you must be aware that the Medicare Part B premium depends on an individual’s income. Most Medicare beneficiaries will pay the standard premium, while those in a higher income tier will pay an increased cost.

Social Security will review your tax return from two years earlier when determining one’s income adjustment.

If your income is now lower, you may file a reconsideration request. Social Security will require proof of income and reconsider your premium costs.

For most, Medicare Part A has no monthly premium if you meet the requirements. You must work ten years (40 quarters) paying Medicare taxes to receive zero-premium Medicare Part A. If you do not meet this requirement, you could pay up to $499 for Medicare Part A each month.

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(Video) Medicare For Dummies Part 1

In addition to their premiums, Medicare Part A has a deductible and copayments, while Medicare Part B has a deductible. If you have a Medigap plan, your Medicare Part A costs and Part B deductible may be covered up to 100%.

Also, remember that Medicare Part B only covers 80% of your medical costs. If you do not have a Medicare Supplement plan, you must pay the remaining 20% out-of-pocket.

Chapter 5: Medicare Part D Cost Breakdown for Dummies

When breaking down the costs for Medicare Part D, it is good to know that most states have many prescription drug plan options to choose from through private insurance companies. The average premium price is around $33 per month.

When selecting a Medicare Part D plan, choose one that fits your medication needs and that the prices will work for you.

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The insurance carriers will set your Medicare Part D premiums. However, Social Security can deduct the cost of your premium directly from your Social Security income benefits.

Now that you know what Medicare is and the right time to apply, we can move on to chapter 6 of Medicare for Dummies.

(Video) Medicare Basics: Parts A, B, C & D

Chapter 6: Medicare Supplemental Coverage for Dummies

Again, supplemental coverage can be a huge lifesaver if you are in a flurry of hospital and physician charges. Below are the two main types of policy you can buy through a private insurance company once you have Original Medicare.

  • Medicare Supplement (Medigap) Plans: These policies are secondary coverage that pay after Original Medicare pays. They will cover your 20% patient responsibility for your outpatient services. These supplemental plans will also cover additional out-of-pocket costs such as deductibles & copays.
  • Medicare Advantage Plans: This is Medicare Part C, as introduced above. Rather than paying after Medicare, a Medicare Advantage plan pays your claims in place of Original Medicare. Medicare Advantage is private insurance that comes with a network of providers. You will be responsible for copays for physician visits, facility stays, etc. These policies usually include benefits that Original Medicare and Medicare Supplement plans do not.

While Medicare can seem tricky to decipher at first, trust in knowing that your understanding of the basics will make for a much smoother enrollment for you. With this knowledge, you can be on your way to smooth sailing into Medicare coverage!

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Medicare for Dummies FAQs

What are the basics of Medicare?

The basics of Medicare include Parts A through D. Medicare Part A covers hospital and skilled nursing care, while Part B covers your doctors’ visits and preventive care. Meanwhile, Medicare Part C (Medicare Advantage) and Part D prescription drug coverage are available through private insurance companies.

How do I get started with Medicare?

You can get started with Medicare by creating an account on MyMedicare.gov. You can see your enrollment status, check claims, and more.

How do I get a Medicare and You handbook?

You can download the Medicare and You handbook from Medicare. You can also call Medicare directly to receive a paper copy.

(Video) Medicare Explained | Understanding How Medicare Works
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How to Understand Medicare for Dummies

For more information regarding Original Medicare coverage, we can help. You can call our Medicare benefits helpline at the number above. Our services are 100% free to you. Our agents and client care team are here to help you navigate the Medicare maze. You can also compare rates using our online form here.

Sources:

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. Medicare Program - General Information, CMS . Accessed August 2022.
    https://www.cms.gov/Medicare/Medicare-General-Information/MedicareGenInfo
  2. What Medicare Covers, Medicare. Accessed August 2022.
    https://www.medicare.gov/what-medicare-covers
  3. An Overview of Medicare, KFF. Accessed August 2022.
    https://www.kff.org/medicare/issue-brief/an-overview-of-medicare/

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

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FAQs

What is the best resource to understand Medicare? ›

The best resource is Medicare's Plan Finder, a comprehensive list of the Part D and Medicare Advantage plans (called “Medicare Health Plans”) available in your area.

How does Medicare work simple? ›

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Do You Need Medicare Part B? ›

You Need Part B if Medicare Is Primary

Once you retire and have no access to other health coverage, Medicare becomes your primary insurance. Part A pays for your room and board in the hospital. Part B covers most of the rest. Enrolling in Part B when Medicare is primary will help you avoid unexpected medical bills.

Why do you need Medicare? ›

Medicare is the federal health insurance program for: People who are 65 or older. Certain younger people with disabilities. People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

Who is the best person to talk to about Medicare? ›

Do you have questions about your Medicare coverage? 1-800-MEDICARE (1-800-633-4227) can help. TTY users should call 1-877-486-2048.

How can I remember Medicare Parts? ›

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Why do I have to pay for Medicare Part B? ›

Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. premium deducted automatically from their Social Security benefit payment (or Railroad Retirement Board benefit payment).

How much is Medicare B monthly? ›

Part B (Medical Insurance) costs. $170.10 each month (or higher depending on your income). The amount can change each year. You'll pay the premium each month, even if you don't get any Part B-covered services.

What happens if I don't want Medicare Part B? ›

You may face a late enrollment penalty if you do not enroll in Part B when eligible. Your monthly premium may go up 10% for each 12-month period you could have had Part B but didn't.

What are resources for Medicare? ›

Definition of resources for Medicare Part D Extra Help. Resources are cash and other assets that an individual owns that could convert to cash to be used for his or her support and maintenance.

Is Medicare confusing? ›

Despite evidence of a widespread lack of knowledge about Medicare – and a high percentage of beneficiaries admitting that Medicare is confusing and difficult to understand – many of the same beneficiaries reported a high amount of confidence in their knowledge of Medicare terms, their understanding of Medicare coverage ...

What percent of seniors choose Medicare Advantage? ›

Recently, 42 percent of Medicare beneficiaries were enrolled in Advantage plans, up from 31 percent in 2016, according to data from the Kaiser Family Foundation.

Videos

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