New To Medicare? Start Your Journey Here

Medicare is a federal government health insurance program, designed to provide health insurance for Americans and legal U.S. residents over the age of 65. It also covers individuals under the age of 65 with certain qualifying disabilities or medical conditions.

Medicare includes four parts: A, B, C, and D. Here’s a quick explanation of each.

Original Medicare, including Part A (hospital/inpatient insurance) and Part B (medical/doctor/outpatient insurance), is administered by the federal government through the Social Security Administration (SSA) and the Centers for Medicare and Medicaid Services (CMS).

Medicare Part C, commonly known as Medicare Advantage, is only available from private insurance companies, like Anthem. Medicare Advantage plans, a.k.a. “all-in-one" plans, cover Original Medicare Parts A and B, and much more. They typically include Part D prescription drug coverage, as well as dental, vision, hearing, and more.

Medicare Part D covers the costs of prescription drugs. These plans are also only available from private insurance companies and can be purchased as stand-alone coverage or as part of a Medicare Advantage plan. Anthem does not sell standalone Part D plans in the state of New York.

To be eligible for Medicare, you must be a U.S. citizen or legal permanent resident. Legal permanent residents must live in the U.S. for at least five continuous years prior to the month they apply for Medicare. You must also meet at least one of the following requirements:

• Age 65 or older
• Younger than 65 with a qualifying disability
• Any age with a diagnosis of end-stage renal disease (ESRD) or Lou Gehrig’s Disease (ALS)

In general, most people enroll during their Initial Enrollment Period, which is a seven-month window around your 65th birthday:

• Three months before the month you turn 65
• The month you turn 65
• Three months after the month you turn 65

If you are eligible to enroll due to a disability, your seven-month Initial Enrollment Period includes the month you receive your 25th disability check, the three months before, and three months after.

Many people confuse the terms Medicare and Medicaid. While they’re both government-run health insurance programs, they generally help two different groups of people:

• Medicare is a federal program and provides health coverage to those older than 65 and to some younger individuals with certain disabilities, at any income level.
• Medicaid provides health coverage for people with low incomes.  Medicaid programs are administered at the state level and are often assisted by funds from the federal government.

If you are eligible for both Medicare and Medicaid, you may qualify for a Dual Special Needs Plan that offers extra benefits at little to no extra cost.

Here are a few things to consider if you’re still working past 65.

• You don’t have to enroll in Medicare when you turn 65 if you work for a company with 20 or more employees. Make sure you have adequate coverage through your employer if you are delaying enrollment.
• If you work for a company with fewer than 20 employees or have an individual or family plan, you should enroll in Medicare at age 65 or you might face penalties.
• You can enroll in all or part of Medicare even if you’re still working. A Medicare plan could offer valuable benefits at no cost to you.
• You can no longer contribute to a Health Savings Account (HSA) if you enroll in any part of Medicare while you’re still working. If you delay Medicare enrollment until after you turn 65, you should stop contributing to your HSA at least six months before you enroll in Medicare.
• You may be eligible for a Special Enrollment Period if you decide to wait to enroll in Medicare once your employer coverage ends.
• You should always check with your employer’s health plan benefits administrator before enrolling in Medicare or changing your coverage.