Medicare 101 - Get the Info You Need | Health Insurance Basics

Health Insurance Basics

Medicare 101 – Get the Info You Need

You’ve probably heard of Medicare but if this is your first time choosing a plan, it can be confusing. It’s important to find the right mix of coverage that fits your health, your lifestyle and your budget. The first step is to determine if you are eligible for Medicare.

You must meet one of the following criteria:

  • Age 65 or older
  • Under age 65 but with certain disabilities
  • Any age with permanent kidney failure where dialysis or a kidney transplant is needed

Once you have determined that you’re eligible for Medicare, you’ll also need to decide what type of coverage you will need. Here’s a brief overview of each coverage plan:


Medicare Part A: Hospital Insurance

  • Part A covers the medical care you need for something like an overnight hospital stay. It also covers care in a skilled nursing facility, hospice care and some home healthcare, but it does not cover outpatient care.


Medicare Part B: Medical Insurance

  • Part B Covers doctors’ visits, outpatient care and diagnostic tests. It also covers home healthcare, durable medical equipment, and many preventive services and screenings.


Medicare Part C: Medicare Advantage Plans with extra benefits

  • Part C, also known as Medicare Advantage, offers extra benefits for medical and health needs not covered by Part A or B. These may include Part D drug coverage, and routine vision and hearing care, all in one single, easy-to manage plan. Medicare Advantage plans are Health Maintenance Organizations (HMOs) and Preferred-Provider Organizations (PPOs).


Medicare Part D: Prescription Drug Coverage

  • Part D covers prescription drugs you can get at a retail pharmacy or through a mail order program.


Here are some tips for picking the right Medicare package to fit your specific needs:

    • Enroll in Medicare Parts A and B as soon as you are eligible. You’ll be covered and avoid some penalties if you enroll too late.
    • If you want the benefits of a Medicare Advantage plan, you must still sign up for Medicare Parts A and B. Remember that you will still pay your Part B premium as well as your Part A premium (if you have one).
    • Decide which Medicare Advantage plan (Part C) is right for you—there are plenty of options with a range of benefits. Gateway Health has several tools to help you pick the just-right plan for your healthcare needs.
      • Get started using our plan finder to see available options based on where you live.
      • Once you see the options in your area, you’ll be able to use our easy plan comparison tool, which will lay out your options side-by-side in a helpful grid. This will show important considerations like deductibles, premiums and copays.

  • If you elect to not have a Medicare Advantage plan (Part C), you’ll need to decide if you need Medicare Supplement (Medigap) insurance to help cover deductibles, copays and coinsurance for Parts A and B.
  • Ask yourself if you’ll need prescription drug coverage. Certain Medicare Advantage plans have Part D drug coverage included. If you did not enroll in a Medicare Advantage plan, you can buy a stand-alone Part D plan along with your Medicare Supplement plan.
  • You’ll also need to determine if you will need help paying for your Medicare premiums. You may qualify for extra help from Medicare to pay the costs of Medicare prescription drug coverage (Part D) if you meet certain income and resource limits.


Finally, you’ll need to sign up. You may be automatically signed up for Medicare Parts A & B if you’re already getting social security benefits when you turn 65. If not, you can sign up through the Social Security Administration during the seven-month period that starts three months before the month of your 65th birthday and ends three months after the month of your 65th birthday. If you don’t enroll when you are first eligible, you can sign up between January 1 and March 31 each year. Also keep in mind that if you are covered by a health insurance plan through an employer or union, you may not need Medicare when you first become eligible.

For more information and to discuss your Medicare plan options, contact Gateway Health today.


Toll Free Numbers

Pennsylvania 1-800-685-5209

Ohio: 1-888-447-4505

North Carolina: 1-855-847-6430

TDD/TTY: 711

8:00 AM – 8:00 PM Eastern Time

7 Days a week from October 1 through March 31.

*From April 1 through September 30 our business hours are 8 a.m. – 8 p.m., Monday through Friday.



Now Reading: Medicare 101 – Get the Info You Need

6 min read