Continuing Coverage: Medicare
Original Medicare is administered directly by the federal government. It is the way most people get their Medicare, and has multiple parts:
- Part A (Hospital Insurance): Covers most medically necessary hospital, skilled nursing facility, home health, and hospice. It is free if you have worked and paid Social Security taxes for at least 40 calendar quarters (10 years). You will pay a monthly premium if you have worked and paid taxes for less time.
- Part B (Medical Insurance): Covers most medically necessary doctor services, preventive care, durable medical equipment, hospital outpatient services, laboratory tests, x-rays, mental health care, and some home health and ambulance services. You pay a monthly premium for this coverage.
- Medicare Part D (Outpatient Prescription Drug Insurance): The part of Medicare that provides outpatient prescription drug coverage. Part D is provided only through private insurance companies that have contracts with the government—it is never provided directly by the government (like Original Medicare is).
- If you want Part D, you must choose Part D coverage that works with your Medicare health benefits. If you have Original Medicare, choose a stand-alone Part D plan (PDP).
- Medicare Part C: This is not a separate benefit. Part C is the part of Medicare policy that allows private health insurance companies to provide Medicare benefits. These Medicare private health plans, such as HMOs and PPOs, are known as Medicare Advantage Plans. If you want, you can choose to get your Medicare coverage through a Medicare Advantage Plan instead of through Original Medicare.
- Medicare Advantage Plans: These plans must offer at least the same benefits as Original Medicare (those covered under Parts A and B), but can do so with different rules, costs, and coverage restrictions. You also typically get Part D as part of your Medicare Advantage benefits package. Many different kinds of Medicare Advantage Plans are available which can also offer dental, vision and hearing aid coverage. You may pay a monthly premium for this coverage, in addition to your Part B premium.
When Should Working Employees Enroll in Medicare?
As you approach or reach the age of 65, a significant milestone awaits: enrollment in Medicare. The initial Medicare enrollment period begins three months before turning 65 and extends for three months afterward. However, you may be eligible for a special enrollment period if you still work and have health coverage through your employer.
If you have health insurance through an employer, there are several factors to consider when deciding whether to enroll in Medicare, including spouse and family coverage, prescription drug coverage, provider access, and costs. The choice will be different for everyone, so it comes down to what’s best for you and your family. The decision to enroll in Medicare while continuing your employer-provided coverage depends on your unique needs and circumstances.