What is Medicare?

What are the four parts of Medicare?

Medicare is the federal health insurance program for people who are 65 or older, people with End-Stage Renal Disease (ESRD), and certain people with disabilities.

The different parts of Medicare help cover specific services:

Medicare Part A

Medicare Part A (Hospital Insurance)

Part A provides Medicare benefits and coverage for:

Inpatient hospital care
Inpatient stays in most skilled nursing facilities
Hospice and home health services

Who is eligible for Medicare Part A?

Any legal resident over the age of 65 is eligible for Part A. Individuals with disabilities or End-Stage Renal Disease may also be eligible.

What does Medicare Part A cost?

If you or your spouse paid full FICA (Medicare) taxes for at least 10 years, you will receive Part A at no cost. If you do not qualify for free Part A, you can purchase it through Medicare for a monthly premium. Current costs can be found on medicare.gov.

When do you get Medicare Part A?

Individuals receiving Social Security at least four months before being eligible for Medicare are automatically enrolled in Part A. If you are still working at age 65 and not receiving Social Security benefits, you will have to apply for Medicare by contacting Social Security.

Important reminders about Part A

Part A does not fully cover your potential hospital costs. Additional coverage, such as a Medicare Advantage plan, is recommended reduce your out-of-pocket costs. You will also want to enroll in Medicare Part B for Medical Insurance and Part D for Prescription Drug Coverage.

Medicare Part B

Medicare Part B covers preventive services and medically necessary tests and supplies. For example, Part B will cover things such as:

Ambulance services
Medical equipment
Some outpatient prescription medications

Together, Medicare Parts A and B are considered "original" Medicare.

What does Medicare Part B cover?

Medicare Part B covers services, supplies and tests that are considered medically necessary as well as preventive services. Part B is often thought of as a "doctor" or "medical" insurance because it covers the doctor's visits and medical supplies you will need.

Who is eligible for Medicare Part B?

Anyone who is eligible for Medicare Part A is also eligible for Medicare Part B.

When do you get Medicare Part B?

If you are eligible for premium-free Part A, you can enroll and receive Medicare Part B anytime after you enroll in Part A. For those who have to pay a premium, you can join during different enrollment periods as required by law. When your Medicare coverage actually begins will depend on when exactly you enroll.

What does Medicare Part B cost?

Most people pay a monthly premium for Part B, which is paid directly to Medicare and usually deducted from the Social Security check. The premium can vary, and current amounts can be found on medicare.gov.

Medicare Part C

Medicare Part C (Medicare Advantage Plans)

Medicare Part C combines Medicare Parts A and B and often Part D, with a private insurance company to offer additional benefits and more potential cost savings. These plans include:

Health Maintenance Organizations (HMO)
Preferred Provider Organizations (PPO)
Medical Savings Account (MSA)

What does Medicare Part C cover?

Medicare Advantage plans combine Medicare Parts A and B with additional benefits and a network of providers. Sharp Advantage is a Medicare Advantage plan that could help you save money while still giving you access to complete health care coverage. Individual plan coverage will vary, but in general, they will include everything that Medicare Parts A and B cover (hospital stays and doctor visits), along with prescription drugs and other benefits, such as vision and chiropractic care.

Who is eligible for Medicare Part C?

Anyone who is already enrolled or eligible for original Medicare (Parts A and B) is eligible for Medicare Part C. In most cases, individuals must live in the local area for the plan and not have end-stage renal disease requiring kidney dialysis and/or a transplant. Special circumstances, such as a move or care in a long-term care facility can also make you eligible for Part C Medicare Advantage plans.

When can you get Medicare Part C?

If you are new to Medicare, you may enroll for Medicare Part C during your initial enrollment or a Special Enrollment Period (SEP). If you are already using Medicare, you can get Medicare Part C during the general enrollment period from October 15 to December 7.

What does Medicare Part C cost?

Specific plan prices vary. Costs include the Medicare Advantage plan premium and the Part B Medicare premium, if applicable.

Important reminder about Part C

If you miss the Medicare Advantage plan open enrollment period, certain circumstances, such as a move or receiving care in a long-term nursing facility, can qualify you for a Special Enrollment Period (SEP). Qualifying events for Special Enrollment Periods can be found on medicare.gov.

Medicare Part D

Medicare Part D is a prescription drug plan available to everyone with Medicare. You can get prescription drug coverage by:

Buying a standalone Part D Prescription Drug Plan (PDP)
Enrolling in a Medicare Advantage Plan that includes prescription drugs

What does Medicare Part D cover?

Medicare Part D covers prescription drugs and is offered by Medicare-contracted insurance and/or private companies. The specific type of prescription drug coverage that you will get will depend on the type of plan you choose to enroll in.

Who is eligible for Medicare Part D?

Anyone eligible for Medicare Parts A and B (Original Medicare) is also eligible for Medicare Part D.

When do you get Medicare Part D?

You can get Medicare Part D at the same time you enroll in Medicare. Otherwise, you may face a late enrollment penalty. If you miss the initial enrollment or want to change your prescription drug coverage, there are open enrollment periods from October 15 to December 7.

What does Medicare Part D cost?

Prices vary. Most Medicare Part D plans require you to pay a monthly fee and the costs of your deductible and/or copayments on prescriptions. You will also continue to pay your Part B premium.

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Sharp Direct Advantage is offered by Sharp Health Plan. Sharp Health Plan is an HMO with a Medicare contract. Enrollment with Sharp Health Plan depends on contract renewal. Read the full disclaimer.

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Page Last Updated: 9/10/2024

9/10/2024 5:25:25 PM
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