1. • Hospital stays, skilled nursing facility care, inpatient care in hospital, hospice care, and home healthcare.
2. • You get Part A benefits directly from the government.

1. • Doctor visits, outpatient care, labs, some preventive services, and durable medical equipment.
2. • You receive Part B benefits directly from the government.

1. • All the benefits and services covered under Part A and Part B. Part C plans are offered by Medicare-approved private insurance companies and usually include added benefits like prescription coverage, dental, vision, transportation, gym membership, acupuncture, chiropractic, insulin, and wellness perks.

1. • Prescription drugs both brand name and generic. Part D is offered by Medicare-approved private insurance companies. You can gain Part D coverage through a Medicare Advantage or enrolling in a Prescription drug plan that offers Part D coverage on its own. It may help lower your prescription drug costs and help protect against higher costs in the future.

1. • Are a U.S. citizen or permanent legal resident and
2. • You or your spouse worked and paid Medicare taxes for at least 10 years

1. • Have received Social Security disability benefits for at least 24 months, or
2. • Have a qualifying disability or special condition

1. • Online at https://secure.ssa.gov/iClaim/rib
2. • By calling Social Security at 1-800-772-1213 | TTY users can call 1-800-325-0778
3. • In person at your local Social Security office

1. • Have received Social Security disability benefits for at least 24 months, or
2. • Have a qualifying disability or special condition

1. • Health Maintenance Organization (HMO) plans: These plans offer a network of doctors and hospitals that members are generally required to use to be covered. Because of this, HMOs tend to have strict guidelines, meaning that any visits and prescriptions are subject to the plan approval. If you use providers outside of the plan network, you may need to pay the full cost out of pocket (with the exception of emergency or urgent care). You generally need to get a referral from your primary care doctor to see a specialist.
2. • Preferred Provider Organization (PPO) plans: Medicare Advantage PPO plans offer a network of doctors and hospitals for beneficiaries to choose from. Unlike an HMO, you have the option to receive care from healthcare providers outside of the plan’s network, but you’ll pay higher out-of-pocket costs. Medicare Advantage PPOs don’t require you to have a primary care doctor, and you don’t need referrals for specialist care.
3. • Private Fee-for-Service (PFFS) plans: This type of plan allows visits to any Medicare-approved doctor or hospital, as long as the plan’s terms and conditions of payment are accepted by the provider. Keep in mind that you’ll need to find providers that contract with the plan each time you are receiving treatment.
4. • Special Needs Plans (SNPs): These plans limit enrollment to beneficiaries who have certain chronic conditions, are institutionalized, or qualify for both Medicare and state Medicaid (also known as dual eligibles). Benefits, provider options, and prescription drugs are tailored to meet the needs of the plan’s enrollees.
5. • Medicare Medical Savings Account (MSA) plans: These plans combine a high-deductible Medicare Advantage plan with a medical savings account. Every year, your MSA plan deposits money into a savings account that you can use to pay for medical expenses before you’ve reached the deductible. After your reach the deductible, your plan will begin to pay for Medicare-covered services. These plans don’t cover prescription drugs; if you want Medicare Part D coverage, you may enroll in a stand-alone Medicare Prescription drug plan.

1. • Currently have Medicare Parts A and B
2. • Live in a service area where a Medicare Advantage plan is available

1. • Annual Enrollment Period (AEP): Is from October 15th to December 7th. During this time period, you can change plans or enroll in Medicare Advantage for the first time. If you decide to change Medicare plans, the new plan will be effective on January 1st of the upcoming year.
2. • Special Enrollment Period (SEP): If you have experienced specific life events or changes occur, you are able to make a one-time change during the year. Qualifying life events include losing employer-covered insurance, retirement, or moving out of your plan’s service area.
3. • Open Enrollment Period (OEP): If you’re currently enrolled in a Medicare Advantage plan, you have the option to change plans once beginning January 1st through March 31st.

1. • Switch from Original Medicare to a Medicare Advantage plan
2. • Join a Medicare drug plan if you’re in Original Medicare
3. • Switch from one Medicare drug plan to another if you’re in Original Medicare.

You can only make one change during this period, and any changes you make will be effective the first of the month after the plan gets your request. If you’re returning to Original Medicare and joining a drug plan, you don’t need to contact your Medicare Advantage plan to disenroll. The disenrollment will happen automatically when you join the drug plan. For additional questions on your eligibility for Medicare Advantage, visit medicare.gov

1. •Special Enrollment Period (SEP): If you wait to enroll in Part B because you or your spouse are working and have coverage through an employer, you can enroll during an SEP. Your SEP is either the 8-month period that begins the month after your employer coverage ends or when the employment ends (whichever comes first).
2. •Tip: Many individuals sign up for Part A, which covers hospital costs, as soon as they become eligible for Medicare because there is generally no premium for that coverage, whereas there is a premium associated with Part B.
3. •General Enrollment Period (GEP): If you don’t qualify for a Special Enrollment Period, you have to wait until the GEP (from January 1 to March 31) to enroll in Medicare Part A and/or Part B.

You can only make one change during this period, and any changes you make will be effective the first of the month after the plan gets your request. If you’re returning to Original Medicare and joining a drug plan, you don’t need to contact your Medicare Advantage plan to disenroll. The disenrollment will happen automatically when you join the drug plan. For additional questions on your eligibility for Medicare Advantage, visit medicare.gov

After your IEP, if you go without any of the following for 63 days or more without prescription drug coverage, you may incur a penalty. Make sure you are enrolled in one of the following during your IEP:

• 1.- Standalone Prescription drug plan (PDP)
• 2.- Medicare Advantage Prescription drug plan (MA-PD)
• 3.- Other creditable prescription drug coverage*

*Prescription drug coverage that’s generally as good as or better than the basic Part D prescription drug coverage (for example, from an employer or the Department of Veteran Affairs).

The late enrollment penalty is an amount that’s permanently added to your Medicare drug coverage (Part D) premium. You may owe a late enrollment penalty if at any time after your Initial Enrollment Period is over, there’s a period of 63 or more days in a row when you don’t have Medicare drug coverage or other creditable prescription drug coverage. You’ll generally have to pay the penalty for as long as you have Medicare drug coverage.

• 1. Enroll in Medicare drug coverage when you’re first eligible. Even if you don’t take drugs now, you should consider joining a Medicare drug plan or a Medicare Advantage plan with drug coverage to avoid a penalty. You may be able to find a plan that meets your needs with little to no monthly premiums.
• 2. Enroll in Medicare drug coverage if you lose other creditable coverage. Creditable prescription drug coverage could include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, the Department of Veterans Affairs, or individual health insurance coverage. Your plan must tell you each year if your non-Medicare drug coverage is creditable coverage. If you go 63 days or more in a row without Medicare drug coverage or other creditable prescription drug coverage, you may have to pay a penalty if you sign up for Medicare drug coverage later.
• 3. Keep records showing when you had other creditable drug coverage and tell your plan when they ask about it. If you don’t tell your Medicare plan about your previous creditable prescription drug coverage, you may have to pay a penalty for as long as you have Medicare drug coverage.

The cost of the late enrollment penalty depends on how long you didn’t have creditable prescription drug coverage. Currently, the late enrollment penalty is calculated by multiplying 1% of the “national base beneficiary premium” ($32.74 in 2020) by the number of full, uncovered months that you were eligible but didn’t enroll in Medicare drug coverage and went without other creditable prescription drug coverage. The final amount is rounded to the nearest $.10 and added to your monthly premium. Since the “national base beneficiary premium” may increase each year, the penalty amount may also increase each year. After you enroll in Medicare drug coverage, the plan will tell you if you owe a penalty and what your premium will be. Visit medicare.gov later this fall to find out how much the 2024 “national base beneficiary premium” will be.

Mrs. Martinez is currently eligible for Medicare, and her Initial Enrollment Period ended on May 31, 2016. She didn’t join Medicare drug coverage by May 31, 2016, and didn’t have other creditable prescription drug coverage. Mrs. Martinez joined a Medicare drug plan during the Annual Enrollment Period that ended December 7, 2018. Her Medicare drug coverage was effective January 1, 2019.

Since Mrs. Martinez didn’t have Medicare drug coverage and was without creditable prescription drug coverage from June 2016–December 2018, her penalty in 2019 was 31% (1% for each of the 31 months) of $33.19 (the national base beneficiary premium for 2019), or $10.29. Since the monthly penalty is always rounded to the nearest $0.10, she paid $10.30 each month in addition to her plan’s monthly premium.

.31 (31% penalty) × $33.19 (2019 base beneficiary premium) =

$10.29 rounded to the nearest $0.10 = $10.30 (Mrs. Martinez’s monthly late enrollment penalty for 2019)

$10.29 $33.19 + $10.30 = $43.49 The total amount Mrs. Martinez will pay for the premium and late enrollment penalty for 2019 is $43.49.

In 2020, Medicare recalculated Mrs. Martinez’s penalty using the 2020 base beneficiary premium ($32.74). So, Mrs. Martinez’s new monthly penalty in 2020 is 31% of $32.74, or $10.15 each month. Since the monthly penalty is always rounded to the nearest $0.10, she pays $10.20 each month in addition to her plan’s monthly premium.

.31 (31% penalty) × $32.74 (2020 base beneficiary premium) = $10.15

$10.15 rounded to the nearest $0.10 = $10.20 (Mrs. Martinez’s monthly late enrollment penalty for 2020)

$32.74 + $10.20 = $42.94 The total amount Mrs. Martinez will pay for the premium and late enrollment penalty for 2020 is $42.94.