What is Medicare and when do I become eligible?
Medicare is a health insurance program for people aged 65 or older or younger people with certain medical conditions or disabilities that qualify under government rules.
Unless you have a qualifying condition, you are first eligible to apply for Medicare 3 Months before you turn 65 and can apply up to 3 months after. If you still have health insurance through an employer, you can continue that coverage instead of switching to Medicare.
Let’s learn about Medicare and your plan options
Medicare is made up of parts with each part providing a specific health care coverage.
- Part A and Part B make up Original Medicare and are federally provided programs.
- Part C, also known as Medicare Advantage, is a plan through a private company that bundles parts A, B and usually D.
- Part D is your prescription drug coverage plan.
There are three main Medicare options:
Original Medicare is a health insurance program for people aged 65 or older or younger people with certain medical conditions or disabilities that qualify under government rules.
Original Medicare includes Part A and Part B and you can choose a separate Medicare drug plan to get drug coverage (Part D).
In general, Original Medicare pays for 80% of covered health care costs and you pay the remaining 20%.
Original Medicare does not cover most prescription drug costs or your vision, dental, hearing or long-term nursing home health needs.
Also known as Medigap, Medicare Supplement is extra insurance you can buy from a private company that helps pay your share of Original Medicare costs and carries a monthly premium you pay.
Medicare Supplements help cover your copay, coinsurance and deductible costs.
While some plans may include dental, vision and hearing, prescription drug coverage (Part D) is not included.
Medicare Advantage plans, also known as Part C, are Medicare-approved plans from private companies offering an alternative to Original Medicare for your health and drug coverage. These plans include Part A, Part B and Part D.
Medicare Advantage plans work to limit your out-of-pocket costs while providing access to other essential health and wellness benefits.
You still need to enroll in Original Medicare before you enroll in a Medicare Advantage plan.
Understanding Medicare Advantage
Medicare Part A
Also known as Hospital Insurance, Part A covers inpatient care in hospitals and certain skilled nursing facilities.
Medicare Part B
Also known as Doctor and Outpatient Insurance. Part B covers your primary care doctor, specialists, outpatient care, durable medical equipment, and many preventive services such as screenings, shots, vaccines and annual wellness visit.
Medicare Part C
Also known as Medicare Advantage plans, Part C is a Medicare-approved plan from a private company that bundles Parts A, B and usually Part D. Plans may also offer extra benefits not offered by Original Medicare such as vision, hearing, and dental services.
Medicare Part D
Also known as Prescription Drug Coverage. Part D is available to everyone with Medicare. To get prescription drug coverage, you must join an approved Medicare plan that offers prescription drug coverage. While optional, you must enroll by a certain deadline to avoid penalty costs added to your Original Medicare premium.
What is the right plan for me?
Your Medicare choice influences what coverage you receive along with the cost of your prescription drugs and other key health and wellness benefits.
To help you understand your plan options better, we have partnered with HealthShare 360. They would be happy to talk with you to discuss the basics of Medicare planning. They can help you:
- Ensure you do not miss your Individual Enrollment Period window and know your exact enrollment deadline
- Understand the different parts of Medicare and the plan options available to you
- Enroll in a plan that is appropriate for your personal needs
Before deciding on a plan
- Ensure the insurance plan covers the area where you live.
- Confirm your preferred doctors are in network.
- Confirm your prescription drugs are covered.
- Review the costs associated with the insurance plans and ensure it fits within your health care budget. What are the copays, coinsurance, and deductibles?
- If you chose to make Original Medicare your primary health insurance, you should enroll in Part A and Part B as soon as you are eligible and speak with a licensed health insurance expert on the plan options available to you.
There are other life events which may open a Special Enrollment Period (SEP) where you may be able to make changes to your Medicare program outside of either your Individual Enrollment Period or the Annual Enrollment Period (AEP). Some of these include:
- Working past 65 but now ready to retire and need healthcare coverage
- Being recently diagnosed with a new chronic condition
- Had a recent change in your medications
- Moved to a different county or state
If you have had a recent life event, talking with a licensed insurance agent can help you decide on the plan that best fits your healthcare needs.
Find the right medicare plan for you
New to Medicare or have questions about your options? It can be confusing. And finding the right Medicare plan for your individual needs is important.
That’s why we’re partnered with HealthShare360, an unbiased local resource who specializes in Medicare. They can help you compare your coverage options and select what works best for you.
Through our partnership, HealthShare360 offers you the ability to view, compare and get an estimate for Medicare plans that include Summit Health and Summit Health-affiliated doctors.
To learn more, visit HealthShare360:
New Jersey residents New York residents Oregon residents
HealthShare360 Inc. is a licensed and certified health insurance agency that works with Medicare enrollees to explain Medicare Advantage, Medicare Supplement Insurance, and Prescription Drug Plan options with a Medicare contract. Enrollment in any Medicare plan depends upon contract renewal. We do not offer every plan available in your area. Currently, we represent 7 organizations which offer 21 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. For accommodations of persons with special needs at meetings call 908-293-9729 (TTY 711).
Join us for our Medicare Fairs and learn everything you need to know about the different options you have.
- Hear from our Medicare Advisor, HealthShare360*, talk about Getting Ready for Medicare.
- Listen to Dr. Michael Myers, Summit’s Chief of Primary Care and Transformation, discuss how to get the most from your PCP visit.
- Representatives will be onsite to explain the Medicare plans accepted at Summit Health including Aetna, Braven Health, Humana, and United Healthcare.
Look out for upcoming Medicare Fairs for patients turning 65 in March and June. Dates will be posted in the new year.
LOCATION – Summit Health’s Berkeley Heights campus cafeteria, 1 Diamond Hill Road, Suite C-100 (inside the Lawrence Pavilion)
Let’s make getting ready for Medicare easy for you. Register for the Medicare Fair today by calling 908-741-6470 (TTY 711) or register online at NJMedicare.com.