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Medicare for Dummies (Navigating the Medicare Maze in 2021)


You find yourself quickly approaching that magic number, 65 years young. With that comes new learning curves, such as learning about Medicare and what this federal healthcare program has to offer. You might find yourself searching for Medicare for Dummies on Amazon. Thankfully, you won’t need to buy a Medicare for Dummies book, we have everything you need to know right here. Below we’ll go over just what Medicare really is, the different parts, and the best timeframes for enrollment.

Medicare for Dummies

Medicare is health insurance designed for individuals who are 65 years or older, certain individuals with disabilities, and those with End-Stage Renal Disease. If you do in fact qualify to receive Medicare, here are some of the key fundamentals of the different coverages to understand when starting this new journey.

Chapter 1

There are several types of Medicare coverage that you should familiarize yourself with, prior to enrollment. In our first chapter of Medicare for Dummies, we’ll go over the four parts of Medicare.

Medicare for Dummies FAQ

  • Part A: This is hospital coverage. It covers your stay in the hospital, a nursing facility, or any inpatient care.
  • Part B: This part is considered your outpatient medical coverage. Benefits include physician visits, labs, surgeries, any durable medical equipment, and more.
  • Part C: also known as Medicare Advantage plan, these plans replace Part A & Part B. You’ll be responsible to pay co-pays for any approved services and/or hospital and physician visits.
  • Part D: This is prescription drug coverage. These are considered your pharmacy benefits. (insurance that you purchase for all your medication needs) Prescriptions can be pricey, so this is a beneficial coverage to have.

Now that you have an idea of what types of coverage Medicare has to offer, here’s chapter two of Medicare for Dummies.

Chapter 2

Below, we’ll discuss some of the Medicare Enrollment Periods.

  • IEP – Initial Enrollment Period: This enrollment period lasts for seven months. It begins three months prior to turning 65 and lasts up to three months after turning 65.
  • SEP – Special Enrollment Period: If you are over 65 years of age and obtain private insurance through an employer, or a spouse’s employer, and the employer has more than 20 employees. If this criterion is met, you may delay enrollment for Medicare until after turning age 65.
  • GEP – General Enrollment Period: If you fail to apply for Medicare during your IEP or SEP, this will allow you to still sign up for Medicare. This enrollment period begins January 1 and runs until March 31.
  • Automatic Enrollment: You may be automatically enrolled in Part A and B at 65 years of age if you begin to receive retirement benefits from either the Railroad Retirement Board or from Social Security.

Breaking Down the Costs of Part B

When breaking down the costs of Medicare, it’s important to know that Part B is dependent upon an individual’s income. Most Medicare beneficiaries will pay a premium, while individuals in a higher income tier will have a higher premium.

When determining one’s income adjustment, Social Security will review previous tax returns, up to two years.

If you find that your income has decreased from the previous years, you may be able to file a reconsideration request. Social Security will require proof of income and will then reconsider your premium costs.

Once the premium costs are determined, they will be deducted from your monthly income.

Part B has a deductible. If you’re enrolled in a first-dollar coverage Medigap plan, then your Part B deductible will be covered 100%. Medicare changes include all first-dollar coverage plans going away for those newly eligible to Medicare.

Also, keep in mind, Part B only covers 80% of your medical costs. If you do not have a supplement plan, you’re left responsible for the remaining 20%.

Breaking Down the Costs of Part D

When breaking down the costs for Part D, it’s good to know that most states have many different Part D plans to select from. The average premium is right around $35 per month.

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

The insurance carriers will automatically pay your Part D premiums. However, it’s possible for Social Security to deduct the cost of your premium directly from your Social Security income benefits.

Now that you know what Medicare is and when the right time to apply is, we can move onto chapter 3 of Medicare for Dummies.

Chapter 3

Part A will cover the first 60 days in a hospital. There will be a hospital deductible that you will be responsible for. Once you have met 60 days consecutively in the hospital, Medicare’s share will begin diminishing, while your share will increase. It’s suggested to have a supplemental plan to help safeguard you from these increasing costs.

As mentioned above, Part B covers outpatient care while visiting your doctors’ office. A deductible must be paid annually, after which Part B covers 80% of this care. Again, it‘s recommended to carry supplemental coverage to help safeguard you from high out of pocket expenses associated with the remaining 20% you’re left responsible for.

Supplemental Coverage

As stated before, supplemental coverages can be a huge lifesaver in the event you find yourself in a flurry of hospital and physician charges.

  • Medigap Plans – These are plans that pay after Medicare pays. This will cover that 20% patient responsibility for your outpatient services. These supplemental plans will also cover additional out of pocket costs such as deductibles & co-pays.
  • Medicare Advantage Plans – Rather than these plans paying after Medicare, they pay instead of Medicare. This is private insurance that contains its own network of providers. You will be responsible to pay a copay for physician visits, facility stays, etc.

While Medicare can seem tricky to decipher at first, trust in knowing that beginning to understand the basics will make for a much smoother enrollment period for you. You are well on your way to smooth sailing into Medicare coverage!

How to Get Help Navigating the Medicare Maze in 2021

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.

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Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

16 thoughts on “Medicare for Dummies (Navigating the Medicare Maze in 2021)

  1. Hi Lindsay!

    I hope you can help me. My 9 yo daughter has been approved for Medicare (due to disability). I currently have her on my healthcare through my employer; can she remain enrolled in my employer healthcare even though she is now covered by Medicare (Parts A & B)? Does it make a difference that my healthcare is a high deductible plan with a health savings account? I would obviously like to keep her enrolled in my plan if possible so I am not faced with footing the bill for that 20% portion Medicare does not cover. Many thanks in advance for sharing your insight!

  2. My wife, age 61 receiving disability is eligible for Medicare. We have coverage through my employment. Do we need to sign her up for Part B? The enrollment pamphlet says we may face penalties if we wait. Why is this so unclear and is there actually someone to contact that isn’t just trying to sell insurance?

  3. Good afternoon,

    I will be turning 65 this July. I am employed and have health insurance through my employer. Yes, they employ over 20 employees. I plan on retiring next year. Can I wait until then to apply for medicare without being penalized?

  4. From a quick glance it looks like Medicare B cost rise significantly as you go to higher income brackets. Does this hold true if you elect to go for a private plan instead? How easy is to to change electives if your start with one option and later want to switch to another?

    1. Hi Dave! Yes, the Part B premium does significantly increase if you’re a higher income earner. Unfortunately, it does hold true even if you go with a private Medicare Advantage plan since you still have to have Part B to enroll in one of these plans. There is a 12-month trial period for Medicare Advantage that gives you a Special Election Period to drop the plan and go back to Orginal Medicare and enroll in a Medigap plan. However, if you’re overall healthy, you should have no problem dropping your Medicare Advantage plan to enroll in a Medigap plan later, but you will have to answer health questions. Medigap plans have a once in a lifetime Open Enrollment Period that ends 6 months after your Part B becomes active. During this time frame, you can enroll in a Medigap plan without answering health questions. Outside this time frame, you could be denied coverage due to pre-existing conditions. Basically, it’s a risk to enroll in a Medicare Advantage plan because if you do get sick laterand need better coverage, you may not be able to get it since you’re outside your Open Enrollment Period.

  5. I know you have to enroll in Medicare even though I dread it. I have zero prescriptions, no pre-existing conditions and no health problems. What is the least complicated, least expensive plan I can get away with? Thanks!

    1. Hi Phyllis! I love these questions. You don’t have to enroll, Medicare is not Mandatory. However, you can incur penalties when you enroll later that will stick with you the rest of your life if you don’t have other creditable coverage. In addition, you could be denied a supplemental plan if, at the time you enroll, you do have a pre-existing condition. Just like all other insurance, you enroll before you need it, not after. Part A is your hospital coverage and is premium-free for most. So, it makes sense to enroll in at least Part A. Then, Part B is your doctor coverage. The current premium is around $145 but can change annually. Then for your prescription coverage, you will want Part D. You can choose to not have any prescription coverage, but you will incur a 1% penalty for each month you don’t enroll. The least expensive plan will come with the least amount of benefits. You could go with just Part A and Part B and not have any drug coverage. You’ll be responsible for out-of-pocket costs including deductibles and the 20% coinsurance for all outpatient services. If you want that covered, you would need to enroll in a Medigap plan. Ideally, having Part A, Part B, Part D, plus Medigap will get you the most comprehensive coverage, but won’t be the least expensive. If you rather have low or zero-dollar premiums and payout of pocket for services as you use them, you could leave Original Medicare and enroll in a Medicare Advantage plan. However, I would take a very close look at the differences between the two before you decide. You could always give us a call and speak to an agent. They can go over all the options in your area and explain this in further detail to help you decide on the best option for you.

  6. if you have state medicaid should you get medicare advantage plan or medigap? I have 10 prescriptions at this moment and I need hearing aids?

    1. Hi Thomas! No, you won’t need to get a supplemental plan. You’re Medicaid will act as your supplemental coverage since Medicare will pay first. You could get a dual eligible SNP if there is one in your area since some include additional benefits like hearing & vision, but not necessary. Let me know if you have any more questions!

  7. If you’re eligible for Tricare for Life as a military retiree, is there any point in getting a Advantage Plan? Tricare will pay the 20% and has dental and vision plans. Thank you.

    1. Hi Dave! If you choose to enroll in a Medicare Advantage plan, it will become your primary coverage and your TRICARE will become secondary. Your TRICARE will cover the copays left by your Medicare Advantage plan, leaving you will minimal out of pocket spending. In addition, your TFL includes drug coverage, so you can pick up an Advantage plan that doesn’t include drug coverage. This will more than likely give you a zero-dollar premium. The only thing to be cautious about is the network of doctors. Since the Advantage plan will become primary, you will be limited to only using the doctors within your plan’s network. When compared to TFL network of doctors, the Advantage network of doctors is significantly smaller. I hope this helps!

  8. Is author and senior editor, Patricia Barry, no longer working for AARP? I wanted to ask her questions from Medicare for Dummies.

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