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Medicare Basics

If you are new to Medicare, it is important to understand all aspects of the federal health insurance program. Although it provides familiar health insurance coverage, Medicare is unlike other group or private health insurance plans you may be used to.

Medicare coverage has specific rules, requirements, and enrollment periods that can be unique to you. Thus, it is important that you fully understand the program to ensure you do not miss any steps along the way.

To help you better understand the federal healthcare program, let’s dive into the basics of Medicare.

Medicare: Understanding the Basics

Medicare is the federal health insurance program in the United States, administered by the Centers for Medicare and Medicaid Services (CMS) and consists of four parts. Understanding the basics of Medicare will help you set a necessary foundation for a successful Medicare enrollment.

The Medicare health insurance program helps provide affordable coverage to those who are:

  • Age 65 and older or
  • Under 65 with a qualifying disability

Medicare is broken up into four parts that when combined, create comprehensive healthcare coverage. The four Parts of Medicare include:

  • Medicare Part A
  • Medicare Part B
  • Medicare Part C
  • Medicare Part D

No part of Medicare is mandatory. However, unless you have other health insurance in place, you could pay a late penalty if you delay enrolling in Medicare.

To find the most suitable coverage options for you, it is important to review your healthcare needs and determine which parts and plans best align with those needs. Typically, this is where the help of licensed insurance agent is crucial. Their knowledge can help ensure you are receiving the right coverage and are not overpaying or underinsured.

How Does Medicare Work?

Medicare works by providing benefits for preventative and medically necessary services to individuals who qualify. When you become eligible, you will likely enroll in Medicare Part A and Medicare Part B. This is known as Original Medicare.

Original Medicare has set premiums that typically do not change unless you are a high earner or are required to pay a late enrollment penalty.

Once enrolled in Original Medicare, your next step will be decided by the type of additional coverage you choose to enroll in. You have the option to choose between enrolling in Medicare Part C (Medicare Advantage) or a Medicare Supplement plan to help provide supplemental benefits to Original Medicare.

Ashlee Zareczny, compliance manager for Elite Insurance Partners states, “per federal law, you cannot enroll in Medicare Advantage and a Medicare Supplement plan at the same time. You must choose one.”

She continues to say “enrolling in both plan types would cause major issues when filing claims, so CMS has put rules in place to avoid this all together.”

Medicare Advantage and Medicare Supplement plans both have additional premiums that you must pay in addition to your Original Medicare premiums.

If you enroll in a Medicare Advantage plan, you will have several plan options available to you based on your ZIP Code.

If you decide to enroll in a Medicare Supplement plan, you will have the option to decide between one of 12 nationally standardized plans. Additionally, you will want to enroll in a Medicare Part D plan to receive prescription drug coverage.

The cost of your Medicare Part D plan is determined by the plan you choose and the carrier you enroll through.

You should compare all options available to you to determine the most suitable plan for you.

Learn More About Medicare Part C

Medicare Part C

Medicare Part C, also known as Medicare Advantage plans combine Original Medicare with additional benefits.
Learn More

Learn More About Medicare part D

Medicare Part D

Medicare Part D helps cover some of the cost related to prescription drugs at the pharmacy.
Learn More

Learn More About Medicare Supplement Plans

Medicare Supplement Plans

Medicare Supplement plans cover the out-of-pocket costs left over from Original Medicare.
Learn More

Once you have chosen your desired Medicare plan combination, you can begin using your benefits. There is no single “best” option when it comes to choosing which Medicare plans to enroll in. Rather, you should enroll in the plan the is most suitable for your individual needs.

Learn More About Medicare Eligibility

Medicare Eligibility

Review eligibility requirements such as age, disability status, and more!
Learn More

Learn More About Medicare Costs

Medicare Costs

Review Medicare costs such as premiums, deductibles, copayments, and more!
Learn More

Learn More About Medicare Parts

Medicare Parts

Review the four parts of Medicare, their costs, benefits, and more!
Learn More
Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare educator serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

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