What is Medicare and how does it work?

Medicare is our country’s federal health insurance program for people age 65 and older, as well as some younger people with disabilities, or any age with end-stage renal disease (ESRD). Here’s a closer look at some Medicare basics, including the parts of Medicare, eligibility, enrollment and more.

What are the parts of Medicare?

There are 4 different parts of Medicare that help cover specific services:

Get started with Humana Medicare

Humana Medicare Advantage plans offer benefits beyond what Original Medicare covers. Explore all of the plans available in your area!

What are Medicare Supplement Plans?

Medicare Supplement plans, also known as Medigap, are private insurance plans that can help pay healthcare costs that Original Medicare doesn’t pay. Examples include copayments, coinsurance and deductibles.

How does Medicare work?

Original Medicare (Part A and Part B) is managed by the federal government. You’ll only need to sign up once, but each year, you can make changes to your health coverage during the Medicare Open Enrollment Period.

Your Medicare coverage choices

Once you become eligible for Medicare, you’ll need to decide how you get your coverage. Generally, there are 2 ways to get Medicare coverage:

  1. Original Medicare, which includes Parts A Part B only.
  2. Medicare Advantage, referred to as an “all-in-1” plan, bundles Parts A and B coverage and typically includes prescription drug coverage. Some Medicare Advantage plans include extra benefits that Original Medicare doesn’t cover, like dental, vision and hearing care services.

Keep in mind, if you choose Original Medicare, you’ll also want to consider prescription drug coverage (Medicare Part D) coverage and supplemental coverage (Medicare Supplement plan, also known as “Medigap”) to help manage out-of-pocket Medicare costs.

To learn more, read these tips for choosing the right Medicare coverage for you.

How much does Medicare cost?

Each part of Medicare has their own costs and coverage levels. Here’s a quick breakdown of common costs for each:

  • Medicare Part A: Most people pay $0 for the Part A premium because they or a spouse paid Medicare taxes long enough while working (generally at least 10 years).
  • Medicare Part B: In 2024, most Medicare members must pay a monthly premium of $174.70.
  • Medicare Part C: Medicare Advantage plans are offered by private insurance companies so they vary in cost.
  • Medicare Part D: Medicare prescription drug plans are offered by private insurance companies so they vary in cost.

For more detailed cost information, review the costs for Medicare in 2023.

Are you eligible for Medicare?

Original Medicare Parts A and B are available to people:

  • Age 65 or older
  • Younger than 65 with a qualifying disability
  • With ESKD, permanent kidney failure requiring dialysis or a kidney transplant

To find out if you’re eligible and calculate your Part B premium, try the Medicare.gov eligibility & premium calculator.

How to enroll in Medicare

Whether you’re new to Medicare or want to change your coverage, there are certain times during the year when you can enroll. Here’s a look at each Medicare enrollment period.

Medicare Enrollment Periods

  • Initial Enrollment Period (IEP): For many people, IEP begins 3 months before you turn 65 and ends 3 months after. This is your first chance to enroll in Original Medicare.
  • Initial Coverage Election Period (ICEP): ICEP begins 3 months before you become eligible for both Part A and Part B. This is when you can enroll in a Medicare Advantage plan with or without prescription drug coverage.
  • Annual Election Period (AEP): Also known as “Medicare open enrollment” and “annual enrollment period”, AEP is available each year from Oct. 15 – Dec. 7 to any Medicare eligible recipient who wants to enroll or change their coverage.
  • Special Election Period (SEP): SEPs are opportunities to enroll in or change a Medicare Advantage plan outside of ICEP or AEP. An SEP must be triggered by a qualifying event, like a change in residence or termination of your current plan.

Ways to enroll in Medicare

  • Apply online through the Social Security Administration
  • Apply by phone by calling the Social Security Administration at 800-772-1213 (TTY: 800-325-0778), Monday – Friday, 7 a.m. – 7 p.m., Eastern time.
  • Apply in person at your local Social Security office

Medicare vs. Medicaid

Medicaid and Medicare are 2 types of public health insurance programs. However, there are differences in availability and coverage. Medicare is open to most people ages 65 and older and to some people under 65 who have specific disabilities. People eligible for Medicare can get coverage through the federal government or through a private health insurance company like Humana.

Medicaid is open to people who meet income guidelines, qualified families and children, pregnant women, seniors and people with disabilities. People of any age can qualify to receive Medicaid benefits.

People who qualify for both Medicare and Medicaid are called “dual eligible.” If you have dual eligibility, Medicare will be your primary plan and cover most healthcare services. Your Medicaid plan will cover services and benefits that Medicare does not. Some private insurers offer dual eligible special needs plans, or D-SNPS, which are Medicare Advantage plans designed to meet the specialized needs of dual-eligible beneficiaries.

Connect with a Medicare expert

If you have questions about Medicare or Medicare Advantage plans, Humana is happy to help. Call a licensed Humana sales agent at 866-490-0136 (TTY: 711), Monday – Friday, 8 a.m. – 8 p.m., local time.

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