New to Medicare? Here’s where to start

Would Original Medicare or Medicare Advantage suit you best? Learn more in this article.

A joyful gathering of friends and family, celebrating a 65th birthday with smiles, laughter, and a delicious cake on the table.

Medicare is a federal health insurance program for people who are 65 or older, as well as for some younger people with disabilities. With the right plan, you can receive benefits you’ll actually use and savings you’ll actually get. We’re here to help you learn the basics of Medicare, along with essential tips for choosing the right plan for you.

Who is eligible for Medicare?

To qualify for Medicare, you must be 65 years or older, or younger with certain disabilities. You must also meet the United States citizenship and residency requirements.

What are the As, Bs, Cs and Ds of Medicare?

There are four parts to Medicare (A, B, C, and D), each covering different healthcare services.

Part A (Hospital Insurance): This helps cover the big stuff, like inpatient hospital stays, skilled nursing facility care, home health care and hospice care.
Part B (Medical Insurance): This helps cover services from doctors and other healthcare providers. It also helps cover outpatient care, medical supplies and durable medical equipment (like wheelchairs and oxygen tanks).
Part C (Medicare Advantage): Part C, also known as Medicare Advantage, is an alternative to Original Medicare. It's offered by private insurance companies approved by Medicare and provides all Part A and Part B coverage.
Part D (Medications): This covers prescription drug medication.

Your coverage options: how does it work?

Parts A and B are known as “Original Medicare”. After enrolling in Medicare Parts A and B, you can choose how you want to get your health coverage. There are lots of details with this choice, but here’s the big picture – you have 2 basic options: Original Medicare or a Medicare Advantage plan.

One option for coverage: Original Medicare, with optional add-ons

Let’s say you choose Original Medicare, which includes Parts A and B.

Part A

Part A will help cover hospital stays and most of the services you receive as an inpatient in a hospital or skilled nursing facility, and will be free for most people.

Part B

Part B will cover care you get as an outpatient in a clinic or hospital setting, including most doctor visits, doctor services and some preventive care. However, Part B comes with a monthly baseline premium of about $174 (or more, depending on income). The other important thing to know is that Part B covers 80% of the cost of these services, and you will have to pay 20%.

So, with Original Medicare you get most hospital care covered, and 80% of your doctor and outpatient care covered. But, what about medications? Visits to the dentist or eye doctor? Coverage for other out-of-pocket costs? With Original Medicare, you can choose to add Part D plans and/or Supplemental plans to cover these kinds of situations, but they typically come with an added premium cost.

Drug coverage (Part D):

For drug coverage under Original Medicare, you can join a separate Medicare drug plan, which is available to everyone with Medicare. Most of these Part D plans have an additional premium that you pay in addition to your Part B premium.

Adding on Part D is optional, but without this, you may not receive coverage for medications with Original Medicare alone. Additionally, you may have to pay a late enrollment penalty depending on when you enroll. Specifically, a penalty may apply if after your Initial Election Period (IEP) is over, there are 63 or more days in a row when you don’t have Medicare drug coverage. There are ways to avoid the Part D late enrollment penalty, including enrolling in Medicare drug coverage when you first become eligible, even if you don’t need it right now.

Medicare Supplement (Medigap):

Medicare Supplement plans, or Medigap for short, are additional insurance plans that you can purchase that helps “fill the gap” that Original Medicare leaves, by helping pay for out-of-pocket costs like deductibles and coinsurance. Some of these plans may cover you when you travel out of the U.S., and offer some more flexibility with choosing doctors. These also cost an additional premium, in addition to your Part B premium.

Remember that if you go down the Original Medicare path, you’ll need to piece together different plans that make sure you get the coverage you need across drugs, dental and vision, and other out-of-pocket costs.

Another Option for Coverage: Medicare Advantage, a single package

On the other hand, you can enroll directly in a Medicare Advantage (Part C) plan, which combines Part A, Part B, and often Part D, into a single plan. In other words, these plans roll up all the benefits of Original Medicare and prescription drug coverage (in many cases) into one neat package for you. Medicare Advantage often covers extra benefits as well that Original Medicare does not cover, such as vision, hearing and dental services.

Medicare Advantage plans are offered by Medicare-approved private companies, like Devoted, and must follow guidelines and rules set by Medicare. You can check online to see if plans like these are offered in your area.

If you go with a Medicare Advantage plan, you would get coverage for all medically necessary services that Original Medicare covers, as well as some of those extra services that Original Medicare doesn’t cover, as mentioned above. You won’t need to add on Part D (drug coverage) in most plans, and you won’t be able to buy a Medigap plan. In some cases, you may need referrals to see a specialist, and you often need to stay in a plan’s network.

Most folks who enroll in Medicare Advantage have one plan, one card and one point of contact–which can keep things simple.

Which Medicare coverage is right for you?

Do you value the additional coverage options of Original Medicare with part D and a Medigap plan, or do you want to get your Medicare and medication coverage in a single package? It’s always a good idea to double check that your doctors and drugs are covered by a plan.

No matter what you decide, you can always change your mind. For instance, if you sign up for Original Medicare and find yourself wanting a Medicare Advantage plan, you can usually switch during the Medicare Annual Enrollment Period (October 15 - December 7) and/or a Special Enrollment Period for a qualifying life event. Learn more about the special times you can enroll in or switch plans.

How Devoted can help

We have licensed representatives available to help you with your questions or answer more questions about Devoted Health Medicare Advantage plans. Call us at 1-800-483-8066 (TTY 711) for personalized assistance.

You can also learn more about your Medicare options in this free Medicare Comparison Guide.

Other Medicare resources

You can sign up for Medicare online, by phone, or in person at a Social Security office. For more information, visit Medicare.gov. Or, if you prefer to speak with someone over the phone from the Medicare offices, try the Medicare hotline at 1-800-MEDICARE (1-800-633-4227) TTY 1-877-486-2048.