How Medicare Works
The more you know about Medicare, the better decisions you’ll make. We’re here to help you make sense of the Hows and Whens. So you can choose what coverage will work best for you, year after year.
Hospital insurance that’s free as long as you've worked and paid Medicare taxes for at least 10 years. It helps cover costs if you’re a patient in a hospital, a skilled nursing facility or hospice care.
Medical insurance that helps cover costs for doctors’ services, outpatient hospital care, durable medical equipment and other medical services. You must continue paying Part B premiums if you enroll in a Medicare Advantage plan.
Medicare Part C – also known as Medicare Advantage plans– allows private health insurance companies like Blue KC to provide Medicare benefits. These plans replace Original Medicare and include hospital, medical and extra benefits - all under one plan.
Outpatient prescription drug coverage offered through private health insurance companies at a separate cost, or built into a Medicare Advantage plan.
Extra benefits may include routine hearing exams and hearing aid coverage, SilverSneakers fitness membership and preventive dental visits.
When’s the right time to enroll?
You become eligible for Original Medicare, which includes Parts A and B, at the age of 65. Everyone is granted a seven-month Initial Enrollment Period (IEP) when signing up for Original Medicare. This enrollment period begins three months before the month you turn 65, includes the month you turn 65, and ends three months after you turn 65.
If you do not sign up during your IEP, you'll need to sign up during the General Enrollment Period (January 1 – March 31) the following year or during a Special Enrollment Period (SEP) – which is most common for people who work past 65.
Those who do not sign up during the IEP and do not qualify for a SEP may face a late enrollment penalty. You may also face Part B and Part D penalties that will be indefinite.
Once you enroll in Medicare, you can always switch Medicare plans during the Annual Enrollment Period (AEP) (October 15 – December 7) each year. You can also switch Medicare Advantage plans during the Open Enrollment Period (January 1-March 31).
It can take weeks or even months for your Medicare application to be processed. So it’s best to enroll as early as possible. You can enroll as early as 3 months prior to the month of your 65th birthday.
How a Medicare Advantage Plan Works
Original Medicare is comprised of Parts A and B and is the traditional fee-for-service program offered through the federal government. Under Original Medicare, you may be responsible for paying annual deductibles and 20 percent of your medical bills for services covered under Parts A and B, with no limit on expenses.
Medicare Advantage plans (Part C) are a private option to Original Medicare. It actually replaces Original Medicare Parts A and B, and provides all the benefits of Original Medicare, plus more.
How can a Medicare Advantage give you more?
- Provides a safety net that limits the amount of hospital and medical expenses paid each year
- Offers the convenience of an all-in-one plan
- May include additional benefits like dental and vision
- Usually includes Part D Prescription drug coverage
Working Past 65
You can delay taking Part B medical insurance from the government if you’re over 65 and have insurance through your employer. It’s important to evaluate your current coverage to make sure it’s the right fit and that your health insurance has creditable drug coverage. If you’re self-employed, you’ll need to sign up with the government for Original Medicare.
Options to Consider
- Compare Original Medicare with your current employer plan
- Talk to your employer about your plan, or call Blue KC to review your options
Social Security Eligibility
You can start taking Social Security benefits as early as age 62. If you're drawing from Social Security at least four months prior to your 65th birthday, you’ll be automatically enrolled in Medicare when you turn 65. If you receive benefits from Social Security or have end-stage renal disease (ESRD), you’ll be eligible for Medicare at any age.