What Is Medicare?

As we near our 65th birthday, we may hear the term “Medicare” more often when it comes to health care services. But what exactly is Medicare? And what are its benefits? We will explain how it works, step by step, and why it is an essential component of your health care.

Medicare is the federal government's health insurance program for people 65 years of age or older. It is also available to younger people who have certain conditions or disabilities.

The Medicare coverage is divided into 4 parts, each identified with a different letter: A, B, C, and D. Each part covers different health services.

Medicare Part A: Hospital Services

Part A covers hospitalizations, at-home health services, hospice, skilled nursing facilities, and blood donations starting from the third pint of blood.

In most cases, you won't need to pay a monthly premium for Part A if you or your spouse contributed to the Social Security while working.

Medicare Part B: Medical Services

Part B helps cover 80% of outpatient medical services, laboratories, and emergencies, among others, after meeting an annual deductible.

Most people pay the standard premium amount for Part B. Once you request this part, Medicare will automatically deduct the payment from your Social Security check.

The combination of Parts A and B are known as Original Medicare.

Medicare Part C: Medicare Advantage

Part C includes all the benefits of Original Medicare (Parts A and B) but provides a more comprehensive coverage to include additional services. Medicare Advantage covers expenses such as prescription drugs, dental services, OTC items, an allowance for food and bill payments, vision care, transportation, hearing aids, durable medical equipment, and health and wellness programs.

It is the most complete coverage available for your health care. This plan is offered by private insurance companies and regulated by Medicare. Triple-S Advantage is one of them. Your Medicare Advantage benefits may vary depending on the private insurance company you choose.

Medicare Part D: Pharmacy Coverage

Part D helps cover the costs of prescription drugs. Most Medicare Advantage plans (Part C) already include this coverage at no additional cost.

When Can I Enroll in Parts A and B?

Enrolling in Parts A and B is easy, but there are a few details we need to keep in mind, because the enrollment dates are important. Although you may enroll all year round after turning 65 years old, you could incur penalties if you do so outside certain periods. Here we tell you how to enroll without having to pay these penalty fees.

For Part A: if you receive Social Security benefits, you will automatically receive your benefits on the first day of the month you turn 65. If you receive disability benefits, your Part A benefits will begin after having received disability benefits for 24 months.

For Part B: you must enroll independently, using Form CMS-40B “Application for Enrollment in Medicare - Part B”.

When should you enroll? There are 3 different periods when you can do it:

Initial Enrollment Period

This period spans 7 months around your 65th birthday. It starts 3 months before your birthday month, includes the month of your birthday, and ends 3 months after your birthday. For example, if you turn 65 in July, you may enroll from April through October.

Special Period

If you have Medicare due to a disability and didn't enroll in Part B in your Initial Period because you were covered under a group health plan through your current employer or that of your spouse or family member, you may enroll during the Special Period.

If you qualify for this period, you may enroll at any of the following times: while you remain covered by your group health plan, or during the 8-month period starting the month after your group health coverage or related employment ends, whichever comes first.

General Period

If you did not enroll in the initial period and do not qualify to enroll in the special period, you have a third chance to enroll, from January 1 to March 31 of each year.

In this case, you may pay a higher premium for Part A and/or Part B as Medicare will apply a late enrollment penalty charge.

How Do I Enroll if I Have a Disability?

Medicare isn't just for people 65 years of age and older. Younger people who have a disability or certain medical conditions are also eligible to enroll in Medicare.

If you're under 65 years old and have a disability, you will automatically get Part A after receiving your Social Security disability benefits for 24 months.

If you wish to enroll in Part B, you must do so using Form CMS-40B, “Application for Enrollment in Medicare - Part B”. • If you do not enroll when you become eligible for the first time, you will be required to pay Medicare's late enrollment penalty for as long as you have Part B.

What Do I Need to Be Eligible for a Medicare Advantage Plan, and When Do I Join?

If you've already enrolled in Original Medicare (Parts A and B) and live in the plan service area, you may enroll in a Medicare Advantage plan.

To enroll for the first time after turning 65, you have an initial period spanning 7 months around your 65th birthday. This period includes 3 months before you turn 65, the month of your birthday, and 3 months after the month you turn 65. For example, if you turn 65 in July, you may enroll for the first time from April through October.

If you don't enroll in a Medicare Advantage plan when you become eligible for the first time, you may do so during what's known as the Open Enrollment Period. This period spans from October 15 to December 7 every year, and the plan is activated in January of the following year.

There is another period, from January 1 to March 31, when you have an additional opportunity to:

• Change your coverage under the same Medicare Advantage plan
• Switch from one Medicare Advantage plan to another
• Go back to Original Medicare

During this period, you cannot enroll in a Medicare Advantage plan if you have Original Medicare with or without prescription drug coverage. However, there are exceptions for people who have moved out of the plan service area or who become eligible for Medicaid.