New to Medicare
Medicare is the federal government program that provides health insurance to those age 65 and older or those under 65 with certain disabilities or chronic conditions. If you are new to Medicare, there can be a lot to learn around your enrollment and coverage choices.
Medicare Part A (inpatient coverage) and Part B (outpatient coverage)
Some people are automatically enrolled in Medicare. For example, if you are already receiving retirement benefits from Social Security when you become Medicare-eligible, or if you’ve been collecting Social Security Disability Insurance for two years. If you are automatically enrolled, you should receive a package in the mail with your Medicare insurance card telling you so. Otherwise, there are three times to enroll in Parts A and B:
Initial Enrollment Period (IEP): The three months before, the month of, and the three months after your 65th birthday.
Special Enrollment Period (SEP): Allows you to delay Medicare enrollment without owing a late enrollment penalty. You may qualify for an SEP if:
- You or your spouse (or sometimes another family member) are still working, and you are covered by the employer health insurance. Note that you shouldn’t delay Medicare enrollment if this employer coverage pays secondary to Medicare.
- You have experienced other exceptional circumstances, like losing Medicaid coverage, being released from incarceration, being misinformed by an employer, or being impacted by an emergency or disaster.
General Enrollment Period (GEP): Every year from January 1 through March 31. You may owe a late enrollment penalty and face gaps in coverage if you use the GEP.
New to Medicare
Choosing between Original Medicare and Medicare Advantage is a big choice when you are new to Medicare. Below are some key differences to consider.
| Original Medicare | Medicare Advantage | |
| Costs | Part A and Part B costs, including monthly Part B premium. 20% coinsurance for Medicare-covered services if you see a participating provider and after meeting your deductible. | Cost-sharing depends on plan. Usually pay a copayment for in-network care. Plans may charge a monthly premium in addition to Part B premium. |
| Supplemental insurance | Have the choice to pay an additional premium for a Medigap policy to cover Medicare cost-sharing. | Cannot purchase a Medigap policy. |
| Provider access | Can see any provider and use any facility that accepts Medicare (participating and non-participating). | Typically, can only see in-network providers. Some plans allow you to see out-of-network providers at a higher cost. |
| Referrals | Do not need referrals for specialists. | Typically need referrals for specialists. |
| Drug coverage | Must sign up for a stand-alone Part D prescription drug plan. | In most cases, plan provides prescription drug coverage (you may be required to pay a higher premium). |
| Other benefits | Does not cover routine vision, hearing, or dental services. | May cover additional services, including vision, hearing, and/or dental (you may owe an extra premium) |
| Out-of-pocket limit | No out-of-pocket limit. | Annual out-of-pocket limit. Plan pays the full cost of your care after you reach the limit. |