And D. and F and G and K, L, M, and N. Seriously, these are all types of Medicare plans.
But let’s start at the beginning.
Understanding Medicare was surprisingly difficult. And I have a Master’s in Health Policy and we studied Medicare a lot. But I was in my late 20s then and didn’t need to rely on it for my health insurance. Maybe I should have paid more attention. Fortunately my former workplace occasionally brought in experts to discuss various topics, including Medicare. I began to learn about it in the few years before I retired. That said I still hired a health care consultant to help me sign up.
I’m not an expert on Medicare (far from it) so I’ll only go into the basics. There are just so many complicated rules about coverage, gaps in coverage, costs, etc. You can find more information from the Medicare site. I also find that AARP (formerly the American Association of Retired Persons) is a good source of information. AARP’s answers to many common questions is found here. I strongly advise you to check out these or other sites that you trust.
Essentially Medicare is a federal health insurance program that you become eligible for when you turn 65. (There are certain groups who are eligible before 65, e.g. people with disabilities, but I won’t touch on that here.) It is not free. In fact there are lots of costs associated with Medicare including insurance premiums, co-pays, prescription drug costs (which can lead to something known as the “coverage gap”), etc.
How to enroll in Medicare
Enrollment in Part A is automatic (see next section about the different Medicare parts) when you turn 65 and you are already receiving your social security benefits. If you are not yet receiving your social security benefits when you turn 65, then you will need to take steps to do the enrollment yourself. You do this through the Social Security Administration.
The initial enrollment period starts 3 months before the month that you turn 65 and ends 3 months after that month. This is very important because there are potentially late enrollment penalties if you miss this enrollment period. You may have special enrollment periods outside of this enrollment period (including if you are working and covered in a group health plan) as outlined here, but make sure to find this out beforehand.
While enrollment in Medicare is not mandatory, I don’t know why anyone would opt out of Medicare altogether but there may be reasons for delaying it. This article from United Health Care discusses why someone may want to delay.
If you feel overwhelmed by all the decisions you need to make, free Medicare counseling and assistance is available through the State Health Insurance Assistance Program. There are also paid professionals who can help you navigate this process. I used one when I needed to enroll in the Affordable Care Act and used him again to enroll in Medicare.
Medicare Parts
There are several parts to Medicare (here’s where the letters come in). This is a simplified overview of the very basics. For more details see the links throughout this post (really I can’t stress this enough).
Medicare Part A is the part that covers stays in hospitals, skilled nursing facilities and hospice care.
Part B covers your doctor visits and other outpatient services.
Part C is also called Medicare Advantage. It is private insurance. It includes Parts A and B and often Part D (prescription drugs, see below). These plans also often include other benefits like dental and vision care, and more. Advantage plans are usually either Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs) which means you will generally need to see a doctor within the plan’s network.
Part D is the part that covers prescription drugs. It is optional. If you don’t have a Medicare Advantage plan that includes Part D then you may want to purchase this separately.
If you do not opt for a Part C plan, you can enroll in a Supplement plan which is also known as Medigap. These are private plans to help with the out-of-pocket costs from Parts A and B. There are different types of plans including F, G, K, L, M, and N. Regardless of the insurer, plans of the same letter should offer the same benefits. Here is a summary of what the different plans include. Some plans include extra benefits. For instance, my plan covers my gym membership which partially offsets the costs.
OK, still with me? Let’s move on.
Which parts do you need?
You can get Part A and Part B in one of two ways. Depending on what you chose will determine if you need any other plans to go with it.
Part A & B
You can opt for Part A & B through the government. This is often referred to as Original or Traditional Medicare.
You then have the option of adding on Part D (for prescriptions) and/or a supplement plan. You may also want to add on dental and vision plans.
Part C
You can enroll in a Medicare Advantage plan that includes Part A & Part B. Other benefits (e.g. prescriptions and even dental and vision) are often included so you will not need any other plans.
How do you know what’s right for you? There’s no easy answer. This Forbes article gives a helpful summary of the advantages and disadvantages of Original Medicare vs. Medicare Advantage. Factors like costs, choice of providers, medical history, services covered, etc. will all play a role in your decision. With Original Medicare you can go to any doctor in the U.S. that accepts Medicare whereas with an Advantage plan you most likely need to stay within a network. For this reason I ended up selecting Original Medicare with a Supplement Plan and a Part D plan. Keep in mind you can make different choices during the Open Enrollment season in the fall for the following year.
What about Dental and Vision?
Many Advantage plans include dental or vision. If you go the original Medicare route, you can opt for separate policies. After pricing vision and dental plans I decided against them. A bit of a gamble if I have an issue but one I’m willing to take for now. Before you decide it’s a good idea to check with your dental and vision providers to let them know you won’t have insurance and what to expect in terms of costs for your visits.
Costs of Medicare
| Medicare Part | Monthly Premium costs in 2024 | Notes and other costs |
| Part A (hospitalizations & inpatient care) | Free if you qualify | There is usually no charge for Part A (provided you meet the requirements i.e. you or a spouse paid into Medicare for 10 years while working) There is a deductible and also a co-pay depending on length of stay. |
| Part B (doctors and outpatient care) | $174.40 | This is the 2024 premium if your income in 2022 was less than $103,000 if you filed individually, or were married but filed a separate tax return, or if your income was less than $206, 000 if you filed jointly. If your income is more than these amounts then your premium increases up to the maximum of $594/ month. The annual deductible is $240. There are also co-pays. If you are already receiving Social Security, your premium will be automatically deducted. If not then you will need to pay your premium yourself until you start Social Security. |
| Part C (Medicare Advantage) | Varies | According to the National Council on Aging the average Medicare Advantage premiums for 2024 is $18.50 /month but can range from $0-200. Remember you will also still be paying the Part B premium. |
| Part D (Prescription drugs) | Varies | My current prescription plan is about $5/ month. Costs of individual drugs vary. |
| Supplement Plan (Supplement to Original Medicare. Plan options currently include F, G, K, L, M, N) | Varies | Premiums vary by plan type, age, location, and other factors. I am currently paying about $120/month for a Plan G. |
More details about premiums and other costs can be found here. In terms of other costs, it’s important to understand what your Medicare plans do and do not cover so you know what you will need to pay yourself or what other insurance you might want e.g. for long -term care or catastrophic coverage.
For people who need help paying for their Medicare premiums, drug costs, and/ or health plan costs, there are programs that can help. Information about these programs are on the Medicare site. Find ways to get help with drug costs here.
Key takeaways
I went through this many times hoping to provide a simplified overview of Medicare. But bottom line–Medicare is complicated. Here are a few key takeaways:
- Everyone is eligible for Medicare when they turn 65.
- You can enroll in Parts A & B in one of two ways: Through a private Medicare Advantage plan that includes Part A and Part B, or you can enroll in Original Medicare and add on other plans e.g. part D, a supplement, dental, and/or vision plans.
- Other than Part A each Part has a premium. There are also co-pays, coverage limitations, etc.
- Do your homework. Figure out what plan(s) will best meet your needs. Learn what is and is not covered by your plans. There are many links in this post and a wealth of other information out there. Also take advantage of the free assistance mentioned above or a paid professional.
- Finally, information changes often (and it’s possible I didn’t get something right). Make sure that you have the most recent information when making your decisions.
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