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Welcome to Medicare 101

Since 2011, when the first Baby Boomers became eligible, nearly 10,000 people a day age into Medicare. Many of these people become eligible for Medicare without knowing much about this federal program. We want to take this opportunity to offer a primer on what Medicare is and how it works.

This is the first in a monthly series on Medicare topics.

What is Medicare?

Medicare is a federal health insurance program for:

•    People 65 years of age or older
•    Some people with disabilities under age 65
•    People with end-stage renal disease

Medicare is often confused with Medicaid, which is a program funded by a partnership of federal and state governments. Medicaid provides health coverage for many low-income individuals and families, people with disabilities and some older individuals. Medicaid is available only by application and only to those who meet certain criteria.

Your initial enrollment period for Medicare is three months before you turn 65, the month of your 65th birthday and three months afterward. If you receive Social Security or Railroad Retirement Board benefits prior to your 65th birthday, you are automatically enrolled in Medicare’s Part A, which is hospital insurance. If you do not receive Social Security or Railroad Retirement Board benefits, you will need to submit an application to the Social Security Administration.

What are Medicare Advantage Plans?

Medicare Advantage Plans are Medicare plans offered by private companies that have been approved by Medicare. They often offer specific benefits, such as prescription coverage or medical coverage, at no cost or at a low cost.

There are premiums associated with Medicare’s medical coverage, which is taken from your Social Security benefit each month. Some Medicare Advantage Plans charge a separate premium to join, while others do not.

You can enroll in these plans, sometimes called MA Plans or Part C, only at certain times of the year. You can enroll either during your initial enrollment period or during the plan’s open enrollment period, from Oct. 15 to Dec. 7. If you choose to enroll in regular Medicare at 65 but want to enroll in a Medicare Advantage Plan afterward, you can do so only during the plan’s open enrollment period.

How does Medicare offer coverage?

Medicare coverage has three parts – hospital insurance (also known as Part A), medical insurance (Part B) and prescription drug insurance (Part D).

Part A (hospital insurance) covers inpatient hospital care, skilled nursing facilities, hospice care and some home health care. Most people get Part A automatically when they turn 65. They do not have to pay for Part A because they or a spouse paid Medicare taxes while they were working.

Part B (medical insurance) covers doctors’ services, outpatient hospital care, physical therapy, lab, X-rays. You pay the Part B premium monthly (taken from your Social Security check).

Part D (prescription drug coverage) plans are available through private insurance companies with various plans and premiums. Help with premiums for Part D is available to beneficiaries with limited income.

In our next column, we will discuss expenses associated with Medicare, such as deductibles.

As you approach Medicare eligibility, it is important to know all the facts about how Medicare works and what options you have.

Here are several helpful Medicare resources for you.

•    Medicare: 800.MEDICARE or online at medicare.gov
•    Social Security Administration: 800.772.1213 or www.ssa.gov
•    Lovelace Medicare Plan: 800.262.3757 (TTY/TDD: 711), 8 a.m. to 8 p.m., seven days a week

Marlene Baca is Lovelace Health Plan’s Chief Programs Officer. “Aging into Medicare” is a monthly series on Medicare topics. She is happy to take questions for future columns. Email Raschel.brennan@lovelace.com.

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