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If you’re new to Medicare, you may not know exactly what you need to enroll in to get the coverage you want. Medicare has various “parts,” some of which you may be enrolled in automatically when you qualify and some which you have to elect to enroll in. Some parts of Medicare are administered by the federal government and other parts of Medicare are administered by private insurance companies approved by Medicare.

If you’re new to Medicare, learn how to get the coverage you need.

New to Medicare Tip 1: Do you need hospital insurance?

You can get hospital insurance through Medicare Part A. Most people are enrolled in Medicare Part A automatically and don’t pay a premium. As well as hospital care, Medicare Part A covers skilled nursing facility care, nursing home care in some circumstances, hospice, and home health services. You can apply for Medicare Part A online at the Social Security website.

New to Medicare Tip 2: Do you need medical insurance?

You can get medical insurance through Medicare Part B. Medicare covers doctor visits, durable medical equipment (such as walkers), ambulance services, and preventative services, such as vaccinations. Medicare Part B comes with a premium. Although you may be automatically enrolled, you can decline this coverage if you wish. You can apply for Medicare Part B online at the Social Security website. Together Medicare Part A and Part are Original Medicare.

New to Medicare Tip 3: Do you want prescription drug coverage?

Original Medicare doesn’t cover most prescription drugs you take at home. For coverage for most prescriptions, you will need Medicare Part D coverage. You can get a Medicare Part D Prescription Drug Plan from a private insurance company regulated by Medicare. You will generally have to pay a separate premium for your stand-alone Prescription Drug Plan. You can also get prescription drug coverage through a Medicare Advantage plan with prescription drug coverage. (See more about Medicare Advantage in tip 5.)

New to Medicare Tip 4: Do you want help paying for Medicare?

Keep in mind that Medicare is not free. You will generally still have to pay premiums, deductibles, copayments, and coinsurance and if you have a lot of doctor visits or extended hospital stays, the costs can add up. A Medicare Supplement (Medigap) insurance plan won’t help cover your Medicare premiums, but it can help pay copayments, coinsurance, and deductibles that you would otherwise have to pay out of pocket. Medicare Supplement helps with costs for Original Medicare (Part A and Part B) but doesn’t cover anything that Original Medicare doesn’t generally cover, such as prescription drugs, dental, or routine vision. Like stand-alone Medicare Prescription Drug Plans, Medicare Supplement plans are offered by private insurance companies approved by Medicare.

New to Medicare Tip 5: Do you want extra benefits?

You might be surprised to discover what it left out of Original Medicare coverage including:

  • Most prescription drugs
  • Most dental care and dentures
  • Eye exams related to prescribing glasses
  • Hearing aids and exams for fitting them
  • Routine foot care

To coverage for these extra benefits, you may consider enrolling in a Medicare Advantage plan offered by a private insurance company approved by Medicare. Some Medicare Advantage plans have premiums as low as $0, although you must continue to pay your Medicare Part B premium. Medicare Advantage plans must cover, at a minimum, everything Original Medicare covers but these plans are free to add additional benefits. Many Medicare Advantage plans have networks, meaning you could pay more if you see providers out of network.

New to Medicare Tip 6: Do you want an out-of-pocket maximum?

Original Medicare has no out-of-pocket limit, meaning you could have health insurance and still spend thousands and thousands out of pocket. Two types of plans offered by private insurance companies that contract with Medicare have out-of-pocket maximums. These are:

  • Medicare Advantage plans (all Medicare Advantage plans have out-of-pocket limits)
  • Medicare Supplement plans K and L. After you met your out-of-pocket yearly limit and pay your yearly Part B deductible, your plan can pay 100% of covered services for the rest of the calendar year.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

The provider network may change at any time. You will receive notice when necessary.

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