Navigating Medicare
CMS is the Centers for Medicare and Medicaid Services. Medicare is a department under the CMS.
The Official U.S. Government Medicare Handbook.
From CMS: Original Medicare (Part A and B) Eligibility and Enrollment
CMS Fact Sheet: Deciding Whether to Enroll in Medicare Part A and Part B When You Turn 65
As you are approaching your senior years, Medicare and Social Security are benefits to be scheduled.
*** As of 2021, Medicare has full coverage for COVID-19. Medicare has nearly complete coverage to help prevent COVID-19. In addition, Medicare has additional coverages if you contract COVID-19. ***
*** As of 2021, during the COVID-19 pandemic, some people may be able to get renewed Skilled Nursing Facility coverage without first having to start a new benefit period. If you’re not able to be in your home during the COVID-19 pandemic or are otherwise affected by the pandemic, you can get Skilled Nursing Facility care without a qualifying hospital stay.
Medicare provides health insurance when you turn 65.
Social Security provides supplemental income from the age of 62 or later.
Here we will be discussing how to navigate signing up for Medicare. Note, these discussions are for people 65 or older or nearing the age of 65 to obtain Medicare. These discussions do not cover younger people with disabilities obtaining Medicare.
Disclaimer: for specific details for signing up for Medicare, contact Medicare direct (Medicare.gov or 1-800-633-4227 (1-800-MEDICARE)) or contact the Social Security Administration (https://www.ssa.gov/benefits/medicare/ or 1-800-772-1213). You can also visit your local Social Security office. (Call first to make an appointment.) You can find the local Social Security office here. Most, if not all, Social Security offices are now open to the public. You should be aware that the offices are very busy and appointments should be made before visiting an office. Even with an appointment there could be long wait times.
(No longer applicable: On March 17, 2020, Social Security suspended face-to-face service to the public in field offices and hearings offices nationwide until further notice. However, critical services are still provided via phone, fax and online. You can use the local office lookup to obtain additional phone numbers).
Any information at SeniorViewsUSA is to ease the process but is not the final say in how the process works.
There will be links in this article to various SeniorViewsUSA and Medicare sites. Just click on the link to get more details.
As of 2021, approximately 63.6 million people are on Medicare. That’s up from 57 million in 2016. As of 2019, about 23 percent (14.5 million) of all beneficiaries have a Medigap policy. That’s up from 20 percent in 2016.
IMPORTANT: Keep track of when to enroll for the various parts of Medicare. If you don’t enroll during the correct periods, you may be penalized or you may not be able to obtain Medicare Supplemental Coverage (Medigap) because of pre-existing conditions.
When to enroll for Medicare Supplemental Coverage (Medigap).
If you are already receiving Social Security at least 4 months before you turn 65, in most cases, you’ll automatically get Part A and Part B starting the first day of the month you turn 65.
There are different parts of Medicare.
You should research your Original Medicare options (e.g. Parts A, B, D, Medicare Supplement (Medigap) thoroughly before electing to take a Medicare Part C (Medicare Advantage) plan. There are Limitations that should be reviewed and Questions that should be asked before making this major life decision. On the Medicare Advantage (Medicare Part C) page there is a brief list of some of the Limitations/Question that should be reviewed.
• Medicare Part A, hospitalization and more, which most everyone signs up for and most everyone gets for free. There are some exceptions to services received and possible monthly premium.
• Medicare Part B, doctors’ services, outpatient care, medical supplies, and preventive services, which most everyone signs up for and most everyone pays $174.70 in 2024 ($164.90 in 2023 , $170.10 in 2022, $148.50 in 2021, $144.60 in 2020, $135.50 in 2019, $134.00 in 2018). There are exceptions to services received and monthly premium.
• Medicare Part D, prescription drug plan, which most everyone signs up for, unless you elect to go with a Medicare Advantage (Medicare Part C) plan. Monthly premiums vary by provider, plan, services, etc.
• Medicare Supplemental Plans (Medigap), helps pay some of the health care costs that Original Medicare doesn’t cover, like Copayments, Coinsurance, Deductibles, and maybe more. About 40% of Original Medicare beneficiaries (23% of all Medicare beneficiaries) sign of for Medigap policies. Medicare Supplemental Plan (Medigap) is not available if you sign up for Medicare Advantage.
• Medicare Advantage (Medicare Part C), Medicare Advantage (e.g. HMO, PPO) is a type of Medicare health plan offered by a private company that contracts with Medicare. It is an alternative to Original Medicare. Medicare Advantage Plans provide almost all of your Part A and Part B benefits and more than likely Part D benefits. You will still need to sign up for Medicare Parts A & B before signing up for Medicare Advantage (Part C). You cannot get a Medicare Supplemental Plan (Medigap) if you sign up for Medicare Advantage.
Medicare options are different if you have End-Stage Renal Disease (ESRD).
If you have ESRD, you’ll usually get your health care through Original Medicare. There are some variables. Starting January 2021, people with ESRD can choose either Original Medicare or a Medicare Advantage Plan when deciding how to get Medicare coverage.
When to enroll for Medicare Supplemental Coverage (Medigap)
When will Medicare coverage start?
How does moving (different city, county, region, state) affect your Medicare Coverage?
How does moving outside the United States affect your Medicare Coverage?
Additional Information – Terms/Definitions/Explanations