Medicare

Are You Taking Full Advantage of Your Medicare Plan?

October 15, 2020 • By

Reading Time: 2 Minutes

Last Updated: July 19, 2021

Medicare is our country’s health insurance program for people age 65 or older, and for younger people receiving Social Security disability benefits. It helps with the cost of health care, but doesn’t cover all medical expenses or the cost of most long-term care.

You have choices for Medicare:

  • Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
  • Medicare Advantage (also known as Part C).
  • Medicare Part D (prescription drug coverage).

If you have Original Medicare, the government pays for Medicare benefits when you get them. You can add prescription drug coverage to help pay for costs that Original Medicare doesn’t cover.

Medicare Advantage Plans are offered by private companies approved by Medicare. These “all in one” alternatives to Original Medicare include Part A, Part B, and usually Part D (prescription drug coverage). Medicare Advantage Plans may have lower out-of-pocket costs than Original Medicare. They may also offer extra benefits that Original Medicare doesn’t cover — like vision, hearing, dental, and more.

How you qualify

You can enroll in a Medicare Advantage Plan, if you have Part A and Part B and reside in the plan’s service area. Please be aware there are some restrictions if you have End-Stage Renal Disease. The most common types of plans are:

Before you join a Medicare Advantage Plan:

  • Find and compare Medicare health plans in your area using Medicare’s Plan Finder.
  • Visit the plan’s website to see if you can join online.
  • You can also call Medicare at 1-800-MEDICARE (1-800-633-4227). When you call, please have your Medicare number and the date your Part A or Part B coverage started. You can find this information on your Medicare card.

When can I join, switch, or un-enroll in a Medicare Advantage Plan?

  • Initial Enrollment Period. When you first become eligible for Medicare, you can join a Medicare Advantage Plan during your Initial Enrollment Period.
  • General Enrollment Period. If you have Part A coverage and you get Part B for the first time during the General Enrollment Period, you can also join a Medicare Advantage Plan at that time. Your coverage may not start until July 1.
  • Open Enrollment Period. From October 15 – December 7 you can join, switch, or un-enroll in a Medicare Advantage Plan. Your coverage will begin on January 1 (as long as the plan gets your request by December 7).

You can learn more about Medicare, including how to apply for Medicare and get a replacement Medicare card, by reading our publication Medicare. You can also visit our website.

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About the Author

Darlynda Bogle, Assistant Deputy Commissioner

Darlynda Bogle, Assistant Deputy Commissioner

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Comments

  1. Dan

    I will be 63 next month. I started collecting SSDI in April 2019. My actual start date of my disability was November 2018 and had to wait 5 months. I believe it’s a two year warning period. Yes the two year mark start for me in November 2018 or April 2019? Thank you.

    • Vonda V.

      Hi Dan, thank you for your question. You are automatically enrolled in Medicare Part A and B if you’ve been entitled to Social Security disability benefits for 24 months. An information packet will arrive in the mail a few months before you become eligible. Check out the Medicare brochure for more information.

  2. Joseph H.

    What is Blue Cross Blue Shield Medicare advantage plan. Compared to regular BC/BS that I have?

    • Vonda V.

      Hi Joseph, thank you for using our blog. If you need information about Medicare Advantage plans or how to enroll in a plan, call 1-800-MEDICARE (TTY 1-877-486-2048) or visit http://www.medicare.govhttp://www.medicare.gov. You also can request information from your State Health Insurance Counseling and Assistance Program (SHIP). The SHIP offers help with your Medicare questions.

    • BETTY G.

      joseph herman,

      you are paying extremely high rates for BC/BS!!

      look into HUMANA PPO or a similar plan they have!

      i pay $58/month PER PERSON.

      i’ve had several surgeries & they paid really well on that.

      i’m on tier 1 RX meds, i pay NOTHING for them. fyi only.

  3. Bill F.

    Surprisingly, no mention was made of Medicare’s Special Enrollment Period. You can read al about that at https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/special-circumstances-special-enrollment-periods

    There are 25 different reasons why you might qualify for the Special Enrollment Period. Common ones are you leave your job and lost employer healthcare coverage, you had COBRA coverage that has expired, you moved to a different county, and others.

  4. Diane S.

    How do you add prescription coverage and how much is it I have A & B already My coverage starts 1/1/21

    • Kay

      Go to medicare.gov and look for Part D drug plans. You can look at Part D plans in your area. You can type in your zip code and any medications you are on, add your favorite pharmacies, and the plans and prices will come up. Look at the details of each plan and even the individual pharmacies listed, because it’s amazing how prices change depending on the pharmacy.

    • BETTY G.

      look into HUMANA PPO. i’m on TIER 1 RX meds; i pay ZERO for them!!

      this year i have paid NOTHING for my RX meds. fyi only.

      depends on what specific meds you are on and the TIER LEVEL they are!! good luck.

      bettyg, ames, iowa

  5. Jacques V.

    What can I change in my ? I have part Aand B. I don’t have prescription ,therefore I’m not sick…never sick…no lie
    I paid $ 135.00 from my Social Security each month. Again ,what change do you have in mind?

  6. Juan N.

    I only have part A medicare because my wife has her job insurance. It it right or would I and wife save somehow in another wsy?

    • Vonda V.

      Thanks for using our blog, Juan. If you have medical insurance coverage under a group health plan based on your or your spouse’s current employment, you may not need to apply for Medicare Part B at age 65. You may qualify for a “Special Enrollment Period” (SEP) that will let you sign up for Part B during:
      •Any month you remain covered under the group health plan and you, or your spouse’s, employment continues.
      •The 8-month period that begins with the month after your group health plan coverage or the employment it is based on ends, whichever comes first.

      We always suggest that individuals speak to their personnel office, health benefits advisor, or health plan representative to see what’s best for them, and to prevent any penalties or delayed enrollment in the future.

  7. Donald G.

    Do I have Medicare Part D? If not, how do I get enrolled into it? I have Medicare Parts A & B, plus Tricare For Life, which pays for most of my medical expenses, but I still have to pay for prescriptions.

    • Vonda V.

      Hi Donald, thank you for using our blog. In your personal, my Social Security account, you can check your Medicare entitlement information. In the Benefit and Payment Details section, you will see Medicare details including what you are enrolled in.

      If you need information about Medicare Prescription Drug plans or how to enroll in a plan, call 1-800-MEDICARE (TTY 1-877-486-2048) or visit http://www.medicare.gov. You also can request information from your State Health Insurance Counseling and Assistance Program (SHIP). The SHIP offers help with your Medicare questions.

    • BETTY G.

      donald gilleland,

      god bless you for your years of sacrifice and service in whatever branch of the military you served in.

      again, look into HUMANA PPO or a similar plan.

      depending on how many & specific prescription meds you are on, they may BE tier 1 like me, and FREE!!!

      i’ve not paid for any RX meds this year!!
      fyi only…hope this info might help you/family.

      betty gordon, ames, iowa

    • paul

      That is not correct, Tricare For Life pays for prescriptions, all you pay is your copay with is very low compared to other plans especially if you do the mail order scripts. You also have a maximum you will have to pay out in an year of $3,000 for a family of 2 for both medical care and prescriptions. Tricare For Life is a GREAT entitlement for retired military families!

  8. Valente f.

    . Rept. 116-247 – PROVIDING FOR CONSIDERATION OF THE BILL (H.R. 2513) TO ENSURE THAT PERSONS WHO FORM CORPORATIONS OR LIMITED LIABILITY COMPANIES IN THE UNITED STATES DISCLOSE THE BENEFICIAL OWNERS I am the overriding Royalty and CEO chairman leader king and this is my Royal bill in Congress department from beneficial owners liability as overriding Royalty king CEO I need your help I want to get my teeth screwed in a.s.a.p. before 21 Center 12/30/2020 is my release date and who I am and i need to get my special security Department going for my new Justice Department for UN.DEPARTMENT.OF.ROYALJUSTICE i need your help on this will you help me king Valente

  9. Donna C.

    What about American citizens living abroad?

    • Kay

      It is my understanding that Medicare does not cover citizens living abroad. Some Medigap plans have limited coverage. You probably need to look into health plans in the country in which you reside.

  10. BETTY G.

    for us SENIORS, look into HUMANA PPO, etc.

    it’s a combo OF MEDICARE/SECONDARY INSURANCE vs. 2 separate policies!

    i have been paying only $58/month for a single POLICY.

    my late husband, jack, and I were on a FAMILY PLAN with BCBS.

    it was $1200/MONTH; plus another 300/mo. when we dropped policy for HUMANA!

    when i joined around 6-7 yrs. ago, it was $31 / month for 1 PERSON so $62/month for a couple.

    i pay now $58/month single policy.

    all my RX meds are TIER 1; so they are free to me!! HUGE SAVINGS for 12+ prescriptions.
    betty gordon, iowa

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