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Understanding Medicare

Your complete Medicare 101 introduction

With Medicare, it can be difficult to know where to start. It’s complex, and you want to gather as much information as possible to feel confident in selecting the right coverage for you. We make finding out Medicare details as simple as possible.

On this page, you can find information about:
Get to know Original Medicare

Medicare is a federal health insurance program that helps cover health care costs for those who qualify. The basic coverage you can receive directly from the U.S. government is called Original Medicare – also known as Medicare Parts A and B.

Medicare Part A

Medicare Part A covers certain hospital-related expenses you may be charged during a traditional hospital stay, through home health care or in a skilled nursing facility. These can include costs like room fees, meals and more. Part A also covers necessary medical supplies and drugs that are provided at these facilities.

Medicare Part A does not cover doctor fees, or hospital fees considered medically unnecessary, such as private duty nursing, the television or telephone in your room (if separate charges apply), or personal care items such as razors and slippers.

Medicare Part B

Medicare Part B covers medical expenses like routine doctor visits, outpatient services and some diagnostic screenings. Part B may cover some medication administered during your visit but not drugs that are prescribed for you to take after the visit.

Premiums and out-of-pocket expenses

Most people don’t pay a monthly premium for Part A. However, everyone pays a monthly premium for Part B. And when you need care, you’re also responsible for deductibles, copays and coinsurance.

Medicare eligibility

To be eligible for Medicare, you must be a United States citizen or lawfully present in the United States. You must also:

  • Be age 65 or over,OR
  • Be under age 65 with certain disabilities,OR
  • Have end-stage renal disease
How to enroll in Original Medicare

Many people are automatically enrolled in Original Medicare (Part A and Part B) once they're eligible. But not everyone is.

You'll be automatically enrolled in Original Medicare if:

  • You're receiving Social Security benefits or Railroad Retirement Board benefits when you turn 65, OR
  • You're eligible for Medicare because of a disability or medical condition

You must enroll yourself if you're not receiving Social Security benefits when you become eligible for Medicare.

There are three ways you can enroll yourself in Original Medicare:

  1. Enroll online through the Social Security Administration
  2. Call the Social Security Administration at 800-772-1213 (TTY 800-325-0778), 8 a.m. to 7 p.m., Monday - Friday
  3. Enroll in person at your local Social Security office
When you can enroll in Original Medicare

Starting when you turn 65, you’ll have an opportunity to enroll in Original Medicare. But if you wait until after your first enrollment window around your 65th birthday, you may have to pay a late-enrollment penalty for Part B.

It’s a good idea to learn about all enrollment windows so you can take action when the time is best for you.

Your Initial Enrollment Period is your opportunity to enroll in Original Medicare (Parts A and B).

Your IEP is a seven-month window around your 65th birthday:

  • The three months before the month you turn 65
  • The month of your birthday
  • The three months after the month you turn 65

For example, if your birthday falls on June 10, your IEP would start on March 1 and end on September 30. For coverage to start the month you turn 65, you must sign up in the three months before the month of your birthday.

If you don’t enroll in Original Medicare Part B during your IEP, you may have a late-enrollment penalty if you enroll later. The late-enrollment penalty takes the form of higher premiums and lasts for as long as you have Part B.

If you don’t sign up for Medicare Part A and/or Part B when you’re eligible, you can apply for Medicare for the first time using the General Enrollment Period from January 1 through March 31 every year.

This enrollment period is only available to people who didn’t sign up during their Initial Enrollment Period and who aren’t eligible for a Special Enrollment Period (see below). Coverage would begin July 1 of the same year. You may have to pay a higher premium for Part A and/or Part B due to late enrollment.

A Special Enrollment Period lets you enroll in Original Medicare outside of your IEP and the GEP due to certain circumstances, such as losing your employer coverage after the age of 65.

If you qualify for an SEP, you have a certain amount of time to enroll in Original Medicare. The length of time is determined by the type of SEP you are qualified for, but it’s generally between two and three months.

Original Medicare covers the basics, but not much more. There are many important services that Original Medicare doesn’t include, like prescription drug coverage, hearing exams and eye care.

When you need more coverage than you get with Original Medicare, consider enrolling in a plan with additional coverage from a private insurer like HealthPartners UnityPoint Health.

Here are some things to keep in mind about private Medicare plans:

  • Each plan has its own premium, deductible, copay and out-of-pocket maximum amounts.
  • Your choice of plans will depend on where you live – different plans are offered in different counties.
  • Once you enroll in a private Medicare plan, you don’t need to renew it each year, but you may have opportunities to switch plans if your needs change
Types of private Medicare plans

Most people who sign up for a private Medicare plan choose from these options during their initial enrollment period:

  • Medicare Advantage plans – Provide the same coverage as Original Medicare, and they often offer extra benefits like dental and Part D prescription drug coverage
  • Medicare Part D plans – Help cover the cost of your prescriptions
  • Medicare Supplement plans – Help bridge the gaps of Original Medicare

Medicare Advantage and Part D plans also have an Annual Enrollment Period (AEP), which gives you an annual opportunity to change your plan if your health care needs evolve.

Tips for comparing and choosing a plan

If you’re not sure which kind of Medicare plan will meet your needs, answering a few questions may help you compare plan details.

If yes: The more times you visit your doctor(s), the more coverage you may need. If you see your care team multiple times a year, it‘s worth looking for plans with lower deductibles and lower out-of-pocket maximums.

If you have a strong relationship with your current care team, you’ll want to make sure you choose a plan that includes them in its network. Also, make sure needed specialty care is covered by your plan and confirm whether you need a referral to see a specialist.

If no:You can be more flexible in the plans you choose.

If yes: Consider a Medicare plan that includes prescription drug coverage. When you find a plan you like, look through the plan’s drug list (formulary) to see if your medications are listed as preferred medicines.

If no:You can be more flexible in the plans you choose. But you may want to consider enrolling in Part D anyway during your Initial Enrollment Period – if you need coverage later, you’ll only be able to enroll at certain times, and you may have to pay a late-enrollment penalty.

If yes: Plans with low out-of-pocket maximums might be better for you. People in this situation tend to get care regularly – though your monthly premiums may be higher, your copays and coinsurance amounts may be lower when you visit the doctor.

If no: If you stay well under your deductible or out-of-pocket maximum each year, plans that have higher out-of-pocket maximums could be a good fit. People in this situation usually don’t get care very often – your monthly premiums will typically be lower, but your copays and coinsurance amounts may be higher when you visit the doctor.

If yes: You might be okay having separate plans for medical and prescription drug coverage. These plans usually come with separate member ID cards, additional paperwork and different service teams.

If no: You could find having all your Medicare benefits in one plan to be more convenient and less stressful.

HealthPartners and UnityPoint Health have combined their insurance and care expertise so you can get the most out of Medicare. Our Medicare Advantage plans combine medical and prescription drug coverage with extra perks and benefits.

Available in select counties
Plans available in these counties:
  • Benton
  • Black Hawk
  • Boone
  • Bremer
  • Buchanan
  • Butler
  • Cedar
  • Cherokee
  • Clarke
  • Clayton
  • Dallas
  • Delaware
  • Fayette
  • Greene
  • Grundy
  • Hamilton
  • Hardin
  • Humboldt
  • Ida
  • Iowa
  • Jackson
  • Jasper
  • Johnson
  • Jones
  • Linn
  • Madison
  • Marion
  • Marshall
  • Muscatine
  • Plymouth
  • Polk
  • Poweshiek
  • Scott
  • Sioux
  • Story
  • Tama
  • Warren
  • Washington
  • Webster
  • Woodbury
  • Wright
Available in select counties
Plans available in these counties:
  • Fulton
  • Jo Daviess
  • Peoria
  • Rock Island
  • Stark
  • Tazewell
  • Woodford
Legal information

Last updated August 2022
H3416_001602 Accepted