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  • Writer's pictureMark Roberts

Medicare 101

On July 30, 1965, President Lyndon B. Johnson signed the Medicare and Medicaid Act, also known as the Social Security Amendments of 1965, into law. It established Medicare, a health insurance program for the elderly, and Medicaid, a health insurance program for people with limited income. It was funded by a tax on the earnings of employees, matched by contributions by employers, and was well received. In the first three years of the program, nearly 20 million beneficiaries enrolled in it. Needless to say, the Medicare program has been wildly popular since its inception.


Senior adults have the opportunity to join Medicare when they turn 65. Medicare is health insurance for people 65 or older. You’re first eligible to sign up for Medicare 3 months before you turn 65, and you also have the opportunity to join up to three months after you attain that age. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease).


As of October 2021, the total Medicare enrollment is 63,964,675 according to the Centers for Medicare & Medicaid Services (CMS). Original Medicare enrollment is 36,045,321, and Medicare Advantage and Other Health Plan enrollment is 27,919,354. This includes enrollment in Medicare Advantage plans with and without prescription drug coverage. Medicare Part D enrollment is 49,141,158, which includes enrollment in stand-alone prescription drug plans as well as Medicare Advantage plans that offer prescription drug coverage. At last count, there are about 12,000 people per day turning 65. That means a lot more men and women are aging into Medicare eligibility now more than ever.


There are several parts to Medicare:

Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

Part B (Medical Insurance): Helps cover:

  • Services from doctors and other health care providers

  • Outpatient care

  • Home health care

  • Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)

  • Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)

Medicare Supplemental Insurance (Medigap): Extra insurance you can buy from a private company that helps pay your share of costs in Original Medicare. Policies are standardized, and in most states named by letters, like Plan F, Plan G or Plan K or Plan N. The benefits in each lettered plan are the same, no matter which insurance company sells it. The government updated the law effective January 1, 2020 that anyone turning 65 after that date is no longer eligible to join Plan F. (MACRA was the revision to the law).


Medicare Advantage (also known as Part C):

  • Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.

  • In most cases, you’ll need to use doctors who are in the plan’s network

  • Plans may have lower out-of-pocket costs than Original Medicare.

  • Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.

Part D (Drug coverage): Helps cover the cost of prescription drugs (including many recommended shots or vaccines). You join a Medicare drug plan in addition to Original Medicare, or you get it by joining a Medicare Advantage Plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare. They are fairly inexpensive, but they are not guaranteed renewable.


Medigap is Medicare Supplement Insurance that helps fill "gaps" in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:


- Copayments

- Coinsurance

- Deductibles


When you turn 65, Medicare Parts A and B are essential to your healthcare. But what about the 20% that is your share? That's when a Medicare Supplement plan can help you save money. There are several very good insurance companies that offer Medigap policies, and I would encourage you to think about putting one in place to cover those medical costs not paid for by Original Medicare.


The best time to buy a Medigap policy (Medicare Supplement) is when you’re 65 (or older) and first get both Part A and Part B. You need both Part A and Part B to buy a Medigap policy. This is your Medigap Open Enrollment Period. You have 6 months after your Part B coverage starts to buy a policy. During this time, you can buy any Medigap policy sold in your state, even if you have health problems. After your Medigap Open Enrollment Period ends, you might not be able to buy a Medigap policy. If you’re able to buy one or want to switch policies later, it may cost more.


If you are brand new to Medicare, then you'll need to sign up for Parts A and B first. Go to the Social Security website as step 1: https://www.ssa.gov/medicare/sign-up


If you want a deeper dive into all things Medicare, more information is available about Medicare at this website: https://www.medicare.gov/basics/get-started-with-medicare


If you’re about to be Medicare eligible this year, interested in changing your current plan or just want to have a conversation about it, contact me to schedule a virtual or in person meeting. I’m here to help guide you through the process, help you find a plan, and answer your questions about getting Original Medicare and a Medicare plan. You only turn 65 once. Make sure that you get all the benefits to which you are entitled. Your Golden Years are worth enjoying with good health and great healthcare coverage.



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