While they’re working, many Americans become accustomed to getting health insurance through their employer. They make their initial selections and then update their choices once a year when it’s time to renew and during life events, like adding to the family or, perhaps, starting a new job.
But virtually all U.S. residents face a milestone when they reach age 65 and qualify for Medicare, which provides a new and, possibly, more complex approach to health insurance.
Keep in mind that even if you take early Social Security benefits at age 62, you must wait until age 65 for Medicare.
BREAKING DOWN MEDICARE’S PARTS
Part A: Hospital insurance
Helps pay for:
Part A also helps with short-term inpatient care in Medicare-certified skilled nursing facilities, but only if the patient is there for rehabilitation — not for long-term or custodial care.
Qualifying:
Once you reach age 65, you qualify for Part A. It’s unlikely you will be charged a monthly premium if you have worked and paid the Medicare payroll tax for a minimum of 10 years.
Part B: Medical insurance
Helps pay for:
Qualifying:
All U.S. citizens and all legal aliens who have lived in the United States for at least five years qualify for Part B at age 65. No work history is required, but everyone who wants Part B must pay a monthly premium.
Monthly premiums are based off the worker’s modified adjusted gross income (MAGI) from filed taxes with higher income individuals paying more. Your first opportunity to sign up for Part B is the initial enrollment period, which begins three months before and ends three months after your 65th birthday month.
Part C: Medicare Advantage
Part C offers an option to buy health insurance from the private sector as an alternative to joining the “traditional Medicare” program that comes from the government.
If you choose a Part C plan, you will generally get all of your Medicare-covered services, including all services, supplies and drugs that are otherwise covered by Parts A, B and D, from your Part C plan instead. However, Part C plans typically restrict your choices of health care providers.
Medicare enrollees who choose Part C must continue to pay their Part B premiums, and Medicare will pay the plan a monthly fee. You might have to pay an additional monthly premium depending on the plan.
Part D: Prescription drug coverage
The optional Part D covers prescription drugs. If you have Part A, Part B or both, you will qualify for Part D.
Like Part C, Part D comes from a private company, not directly from the government. When you turn age 65, you will have the right to enroll in one of several Medicare-approved Part D prescription drug plans.
Medicare pays most of the cost of Part D. However, if you choose Part D, you will pay a monthly premium to the company you select.
Supplementing your coverage
Medicare alone is not likely to be enough. To help minimize out-of-pocket expenses, many retirees have some other arrangement to supplement Medicare’s coverage. Some options include:
This article contains basic information about Medicare, services related to Medicare, and services for people with Medicare. If you would like to find more information about the government Medicare program, please visit the official U.S. government site at medicare.gov.
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