MEDICARE

Original Medicare + Add-ons

ORIGINAL MEDICARE

ADD-ON

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HOSPITAL
PART A
WHAT IT IS

Access to emergency and hospital services.

HELPS COVER
  • Inpatient hospital stays
  • Care in a skilled nursing Facility
  • Hospice care
  • Some home health care following a hospital or skilled nursing facility stay
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DOCTORS
PART B
WHAT IT IS
Access to primary care physicians and outpatient specialists.
HELPS COVER
  • Outpatient care
  • Many preventative services
  • Some home health care
  • Durable medical equipment
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PRESCRIPTIONS
PART D
WHAT IT IS
Helps cover the cost of prescription drugs. Plans are run by private insurance companies that follow rules set by Medicare.
HELPS COVER
  • Prescription drugs, including recommended shots and vaccines. Covered drugs and payments vary by plan.
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HOSPITAL
MEDIGAP
WHAT IT IS
Medicare Supplement Insurance covers your share of costs in Parts A & B. Plans are run by companies that follow rules set by Medicare. All plans with the same letter have the same coverage.
HELPS COVER
  • Your out-of-pocket expenses for Original Medicare.

Medicare Advantage

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HOSPITAL
MEDIGAP
WHAT IT IS
One plan that combines hospital (Part A), medical (Part B), and often prescription (Part D) insurance. Plans are run by companies that follow rules set by Medicare. You cannot also have a supplement plan.
HELPS COVER
  • Everything you get in Original Medicare (Parts A and B and usually D, but not Supplement). May include benefits not covered by Original Medicare, like dental, vision, and hearing coverage.

WHEN YOU NEED TO TAKE ACTION

Enrolling at 65

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PART A (HOSPITAL)
If you are already approved for Social Security, you will be automatically enrolled in Part A at 65. If you are not receiving Social Security benefits, you should apply for Part A on the Social Security website during your 7-month initial enrollment period, which begins 3 months before your 65th birthday month and ends 3 months after your birthday month.
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PART B (DOCTORS)
If you are already approved for Social Security, you will be automatically enrolled in Part B at 65. If you are not receiving Social Security benefits, enroll in Part B on the Social Security website during your initial enrollment period.
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PART D (PRESCRIPTION DRUGS)
Once you are enrolled in Parts A and B, you may enroll in a Part D plan during your initial enrollment period.

Retiring after 65

When your employer coverage ends, you have 8 months to enroll in Part B and 63 days to enroll in a Prescription Drug or Medicare Advantage plan. If you work for an employer with fewer than 20 employees past the age of 65, you may be able to save you and your employer money by enrolling in Medicare while continuing to work.

Changing your coverage

Annual Election Period: Between October 15 and December 7 you can join, switch, or drop Prescription Drug or Medicare Advantage plans. Changes become effective on January 1.

Birthday Rule: If you live in CA, OR, ID, IL, or NV and you're enrolled in a Medicare Supplement Insurance plan, you may change to another plan of equal or lesser value each year in the period following your birthday. Special rules apply if you live in IL.

Open Enrollment Period: Between January 1 and March 31, Medicare Advantage enrollees can either switch Medicare Advantage plans or switch to Original Medicare with a Prescription Plan. Each year, you can only change plans once during this period.

This worksheet explains some aspects of how the Medicare program works, but it isn't a legal document. The official Medicare program provisions are found in the relevant laws, regulations, and rulings and on Medicare gov.

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