New to Medicare
If you are new to Medicare, then there are certain things to know about Medicare eligibility, enrollment, and costs.
What is Medicare?
Medicare is a federal health insurance program designed to provide affordable healthcare coverage primarily for individuals aged 65 and older, as well as for those under 65 with certain disabilities and people of all ages with End-Stage Renal Disease (ESRD) .
This comprehensive program is divided into four parts: Hospital Insurance (Part A), Medical Insurance (Part B), Medicare Advantage (Part C), and Medicare Prescription Drug Benefit (Part D), ensuring that beneficiaries have access to a wide range of medical services and prescription drugs .
Whether you're planning for retirement or managing a disability, Medicare offers a robust framework to support your healthcare needs.
Medicare Eligibility
Medicare provides essential health coverage for millions of Americans, but understanding your eligibility is the first step toward enrollment. Most people become eligible for Medicare when they turn 65 years old, as long as they're U.S. citizens or permanent legal residents who have lived in the United States for at least five consecutive years. However, age isn't the only pathway to Medicare coverage.
If you're under 65, you may still qualify for Medicare if you've received Social Security Disability Insurance (SSDI) benefits for 24 months. Additionally, individuals diagnosed with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig's disease) can qualify for Medicare immediately upon diagnosis, regardless of age.
For those receiving Social Security retirement benefits, enrollment in Medicare Part A (hospital insurance) and Part B (medical insurance) typically happens automatically at age 65. However, if you're still working and covered by your employer's health plan, you might choose to delay Part B enrollment to avoid paying premiums for coverage you don't yet need.
It's important to note that Medicare eligibility differs from Medicaid eligibility, which is based on income and resources rather than age or disability status. Some individuals may qualify for both programs, known as "dual eligibility."
When Do I Enroll in Medicare?
Initial Enrollment Period (IEP)
Your Initial Enrollment Period spans seven months—starting three months before your 65th birthday month, including your birthday month, and extending three months after. During this time, you can enroll in Original Medicare (Parts A and B), Medicare Advantage (Part C), or Medicare Prescription Drug coverage (Part D). Missing this period could result in permanent late enrollment penalties, so marking these dates on your calendar is crucial.
Annual Enrollment Period (AEP)
From October 15 to December 7 each year, Medicare beneficiaries can make changes to their coverage. During this time, you can:
• Switch from Original Medicare to Medicare Advantage
• Change from Medicare Advantage to Original Medicare
• Switch between Medicare Advantage plans
• Join, switch, or drop Medicare Part D coverage.
Medicare Advantage Open Enrollment Period (MA-OEP)
If you're enrolled in a Medicare Advantage plan, you have another opportunity from January 1 to March 31 each year to: • Switch to a different Medicare Advantage plan
• Return to Original Medicare and enroll in a Part D plan.
Special Enrollment Periods (SEPs)
Certain life events qualify you for a Special Enrollment Period, allowing you to make changes outside standard enrollment periods. Qualifying events include:
• Moving outside your plan's service area
• Losing current coverage
• Your plan ending its Medicare contract
• Qualifying for Extra Help with Medicare prescription drug costs
General Enrollment Period (GEP) If you missed your Initial Enrollment Period, you can sign up for Original Medicare (Parts A and B) from January 1 to March 31 each year. Coverage will begin July 1, but you may face late enrollment penalties.
Need help navigating your Medicare enrollment options?
Contact our Medicare specialists today for personalized guidance.
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What Does Medicare Cost?
Original Medicare Costs
Medicare Part A (Hospital Insurance) Most people receive Part A premium-free if they’ve worked and paid Medicare taxes for at least 10 years. If you don’t qualify, the monthly premium for 2025 is $285 or $518, depending on your work history. The deductible for Part A is $1,676 per benefit period, with daily coinsurance of $419 for hospital stays beyond 60 days.
Medicare Part B (Medical Insurance) The standard Part B premium in 2025 is $185.00 per month, though this may increase based on your income. The annual deductible for Part B is $257. After you meet this deductible, you typically pay 20% of Medicare-approved services.For higher-income beneficiaries, Part B premiums range from $259.00 to $628.90 depending on your income level. About 8% of Medicare beneficiaries are affected by these income adjustments.
Additional Coverage Costs
Medicare Advantage (Part C) Medicare Advantage plans offer additional benefits beyond Original Medicare. While you still pay your Part B premium, many plans include coverage for dental, vision, and prescription drugs. Plan costs vary by location and provider.
Medicare Part D (Prescription Drug Coverage) Part D premiums differ by plan. For 2025, higher-income beneficiaries may need to pay an additional monthly adjustment ranging from $13.70 to $85.80, depending on income.
Cost-Saving Tips
Review Coverage Regularly: Check your options annually during enrollment periods.
Compare Plans: Look for the best value based on your needs and location.
Consider Your Healthcare Needs: Make informed choices about the coverage you select.
Explore Medicare Savings Programs: See if you qualify for additional assistance.
Understanding Medicare costs is crucial for making informed healthcare decisions. Contact us today for a personalized review of your Medicare options and potential costs for 2025. We’re here to help you navigate your healthcare journey with confidence!
