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Making Sense of Medicare

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Many people know Medicare as government-provided health insurance for people over 65 and disabled individuals of all ages. However, Medicare does not cover all medical expenses and Medicare is not free. Many people are surprised to find out they must still pay premiums, deductibles, co-insurance, copayments and excess charges. Understanding what Medicare does and does not cover is essential so that you make wise decisions for your future.


When you first turn 65, you have a seven-month window called your Initial Enrollment Period (IEP). Three months before your 65th birthday, the month of your 65th birthday and three months after your 65th birthday. During this IEP, you have more options than you will the rest of your life.

During your IEP, you can choose any plan you wish and they must take you and cover your pre-existing conditions. After your IEP, Medicare Supplement Plans can turn you down based on your pre-existing conditions and you will have to wait until the yearly Open Enrollment Period (OEP) to change Part C and Part D plans. OEP is only available from October 15th through December 7th each year.


The two basic aspects of Medicare are Part A (inpatient care) and Part B (medical care). Part A can have up to 6 deductibles per year and other charges, while Part B carries monthly premiums that vary by income, along with an annual deductible, co-insurance, and possible excess charges.


If you keep original Medicare, you can also purchase a supplement plan which pays all or part of the your out-of-pocket expenses. These supplements are provided by private insurers. You cannot purchase a Medigap plan if you switch to Part C (a Medicare Advantage Plan.)


Medicare Advantage Plans are provided by private insurers who agree to cover at least as much as Original Medicare (Parts A & B) and have been approved by Medicare. Many Medicare Advantage Plans also provide additional coverage, including prescription drug coverage, hearing aids, dental insurance and vision care – although extra costs are often involved.


Medicare Prescription Drug Plans are provided by private insurers who have been approved by Medicare. Each insurance company charges different premiums, has different co-payment, covers different drugs (called formularies) and are contracted with different pharmacies.

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