Medicare was created to provide affordable healthcare coverage to older Americans. As a group, seniors were underserved by the existing health insurance market, which centered around employer-linked plans. The program has seen great success, and an overwhelming majority (94%) of Americans over the age of 65 choose to enroll in Medicare.
Unfortunately, enrolling in Medicare isn’t always easy. If you or a loved one has ever gone through the process of signing up for Medicare, you may have witnessed first-hand just how overwhelming it can feel to sort through all the different parts and plans available. But Medicare doesn’t have to be complicated. In fact, it’s often incorrect and unclear information that makes Medicare guides fail.
That’s why we started Chapter. Chapter makes Medicare simple with unbiased Medicare advice to help older Americans understand, choose, and use their Medicare insurance.
Not sure where to start? The guide below has plenty of information to help you learn the basics of Medicare. We’re also here to help, no matter where you’re at on your Medicare journey. Give us a call at (855) 900-2427 or schedule a free consultation to discuss your Medicare options.
Original Medicare (also sometimes called traditional Medicare) includes Part A and Part B, which were introduced when Medicare was established. Original Medicare is funded by the federal government, and is available to every American over the age of 65—in addition to some Americans with disabilities and chronic conditions. Original Medicare provides the same coverage for every beneficiary and is the most widely accepted insurance in the US. This makes Original Medicare the most universal insurance program available to older Americans.
What you need to know:
Medicare Part A is your hospital insurance. It covers inpatient care, which is care from a doctor or nurse after being admitted for at least one night. In some cases, Part A will also cover home health services.
What you need to know:
Medicare Part B covers outpatient care—for anything that doesn’t require you to stay overnight. It can include medically necessary healthcare as well as preventative care.
Some covered equipment and services include:
What you need to know:
Original Medicare only covers about 80% of medical costs, leaving about 20% leftover for beneficiaries to cover on their own (out of pocket). Now, you can imagine that if you have any underlying medical conditions, 20% of your medical expenses could cause significant financial hardship, especially considering many older Americans are living on fixed incomes. This is why additional Medicare options were added—to help limit Medicare beneficiaries’ out of pocket costs.
Medicare Advantage, also known as Medicare Part C, is a bundled option for your Medicare coverage. It often covers dental, By law, Medicare Advantage plans must cover at least the same services as Part A and Part B. They generally provide additional benefits, which can include:
What you need to know:
Medicare Part D covers prescription drugs, which are not covered by Original Medicare. You first become eligible for Medicare Part D during your Initial Enrollment Period, and you should consider signing up as soon as you’re eligible to avoid late penalties.
What you need to know:
Medicare Supplement (Medigap) plans sit on top of Original Medicare and help to cover the remaining 20% of costs not covered by Original Medicare. There are 10 Medicare Supplement plans, and each one is required to provide the same coverage, regardless of the insurance carrier. If you live in Massachusetts, Minnesota, or Wisconsin, your Medicare Supplement plans may offer different options from policies sold in the rest of the country.
What you need to know:
Perhaps one of the most common (and costly) mistakes that Medicare-eligible Americans make is missing or skipping enrollment periods. Unfortunately, missing enrollment can sometimes result in penalties for the duration of your Medicare coverage, so it’s important to make note of these different periods.
If you’re starting Medicare by way of turning 65, you will have a 7-month period to notify Social Security that you intend to enroll in Medicare. The window begins three months before the month in which you turn 65, includes your birth month, and continues for three months after your birth month. For example, if your birthday falls on September 9 then your window begins June 1 and ends December 31. If your birthday falls on the first of the month, it shifts the 7-month window up by a full month. For example, if you were born on September 1, then your window would begin on May 1 and end on November 30.
What you need to know:
The Medicare Annual Enrollment Period lasts from October 15-December 7. During the Annual Enrollment Period, you can do the following:
If you add or switch coverage during the Annual Enrollment Period, your new coverage will come into effect on January 1.
If you miss your Initial Enrollment Period and you don’t qualify for a Special Enrollment Period, then you’ll have to wait for the General Enrollment Period to sign up for Medicare for the first time. The General Enrollment Period lasts from January 1 to March 31 every year. Once you sign up, your coverage will begin July 1 of that same year.
The Medicare Advantage Open Enrollment Period lasts from January 1-March 31 every year. If you find your Medicare Advantage plan isn’t working for you, then you may use this period to choose a different Medicare Advantage plan or switch to Original Medicare. If you switch to Original Medicare, you may also use this time to enroll in a standalone Part D plan. If you switch coverage during the Open Enrollment Period, then your new coverage will come into effect on the first day of the following month.
Special Enrollment Periods (SEP) allow you to start or make changes to your Medicare coverage outside of the standard periods, due to exceptions based on life events. The most common life events that make you eligible for an SEP are:
Not sure where to start? We’re here to help! Give us a call at (855) 900-2427 or schedule a free consultation to discuss when to enroll in Medicare, which coverage is best for you, and how to get the most value from your Medicare insurance.
© 2024 Chapter Medicare
Memoir, Inc. d/b/a Chapter is a privately-owned, data and technology-enabled advisory that helps older Americans navigate retirement. Insurance agency services are provided by Chapter Advisory LLC, a licensed health insurance agency and wholly owned subsidiary of Memoir, Inc. In California, Chapter Advisory LLC does business as Chapter Insurance Services (Lic. No. 6003691). The information on this site has been developed for general informational and educational purposes.
Chapter and its affiliates are not connected with or endorsed by any government entity or the federal Medicare program. Chapter Advisory LLC represents Medicare Advantage HMO, PPO, and PFFS organizations and stand alone prescription drug plans that have a Medicare contract. Enrollment depends on the plan’s contract renewal. While we have a database of every Medicare plan nationwide and can help you to search among all plans, we have contracts with many but not all plans. As a result, we do not offer every plan available in your area. Currently we represent 43 organizations which offer 16,706 products in your area [nationwide]. That said, we search and recommend all plans, even those we don’t directly offer, and the number of carriers and plans we offer in your specific zip code may be different. Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Average potential savings are based on premium, co-pay, and out of pocket savings estimates self-reported by consumers that worked with Chapter Advisory LLC to enroll in a Medicare Supplement, Medicare Advantage, and/or Part D Prescription Drug Plan. The average is limited to consumers that chose to self-report. Savings information is subject to periodic updates and corrections. There is no guarantee of savings and any savings may vary by policy type, state, or other factors.