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15 Things You Need to Know About Medicare

By Maurie Backman - Nov 7, 2021 at 8:00AM
Medicare written on a Post-it note on a pile of hundred dollar bills.

15 Things You Need to Know About Medicare

Know your Medicare facts

A lot of people have Medicare on the brain right now because open enrollment is in full swing. But how much do you really know about this key healthcare program? Here are some important things to be aware of.

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Medicare enrollment form.

1. Eligibility begins at age 65

Medicare coverage kicks in at 65, but your initial enrollment period starts three months before the month of your 65th birthday and ends three months after that month. All told, you get seven months to sign up for benefits for the first time.

ALSO READ: 4 Medicare Secrets That Could Ruin Your Retirement

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Two people in scrubs talking with patient in hospital bed.

2. The program has a few different parts

Medicare has several parts that come together to provide comprehensive coverage. Part A covers hospital care, Part B covers outpatient care, and Part D covers prescription drugs.

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Entrance to hospital with sign indicating emergency room and main entrance.

3. Part A is free for most enrollees

Most Medicare enrollees are entitled to Part A coverage at no cost. But that doesn't mean there's no cost sharing for hospital care -- it just means they're not charged a monthly premium for Part A.

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Doctor in scrubs taking heart rate of patient.

4. Part B charges a monthly premium

Though Medicare Part A is free, enrollees are charged a premium for Part B. Right now, the standard premium is $148.50 a month, but that number can change from year to year.

ALSO READ: Already on Medicare? You Should Still Shop Around During Open Enrollment

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Pills spilling out of prescription bottle.

5. You'll need a Part D plan if you're on original Medicare

Original Medicare (parts A and B) won't cover prescriptions, so to that end, you'll need to sign up for a Part D plan. The monthly premium you pay for Part D will hinge on the specific plan you choose.

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Dentist examining patient.

6. Medicare doesn't cover a number of key services

Many seniors are shocked to learn that original Medicare won't pay for a number of essential health services. These include dental care, eye exams, and hearing aids.

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The words Medicare Advantage are printed on a paper clipped to a clipboard.

7. Medicare Advantage could be a smart alternative to original Medicare

Medicare Advantage, also known as Part C, is an all-in-one health coverage option that's available as an alternative to original Medicare. One benefit to choosing an Advantage plan is that you'll generally be covered for a number of key services that original Medicare won't pay for, like dental, vision, and hearing services.

ALSO READ: Enrolling in Medicare Advantage for the First Time? 3 Things You Need to Know

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Person behind the wheel of a car and driving.

8. But Advantage plans have their limitations, too

When you sign up for Medicare Advantage, you're limited to a specific network of providers. Depending on where you live and the plan you choose, you may have a hard time finding in-network doctors and pharmacies, or you may have to drive a longer distance to access them.

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Two people engaging with material they're reading on a laptop.

9. You can change your Part D or Advantage plan during fall open enrollment

Each fall, Medicare has an open enrollment period for existing beneficiaries that starts on Oct. 15 and runs through Dec. 7. During this time, you can make changes to your coverage for the upcoming year, like changing from one Part D plan to another.

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Person in glasses is using computer.

10. You can drop your new Advantage plan early on if you don't like it

You may decide to get a new Medicare Advantage plan during open enrollment. But if you wind up unhappy with your new plan, you're not stuck with it for a full year. That's because Medicare Advantage enrollees are entitled to a special period during which they can switch Advantage plans or drop Advantage altogether. That period runs from Jan. 1 through March 31.

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Person with serious expression at laptop.

11. Enrolling late in Medicare has its consequences

Signing up late for Medicare could mean going without coverage and risking costly medical bills. But that's not all. If you delay your Part B enrollment for too long, you'll face a 10% surcharge on those premiums for each 12-month period you were entitled to coverage but didn't sign up for it.

ALSO READ: 4 Things to Look For in a Medicare Advantage Plan This Year

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Person working and talking on phone.

12. You can sign up for Medicare if you're still working

Eligibility for Medicare is based on age, not financial need. Even if you're still earning a paycheck at work, you can still enroll in Medicare.

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Health insurance paperwork with stethoscope and money on top.

13. If you have an employer health plan, you won't be penalized for a late Medicare enrollment

The penalty we just talked about for signing up late for Part B? It won't apply as quickly if, come age 65, you're still covered by an employer health plan with 20 participants or more. If that's the case, you'll have eight months from the time your coverage under that plan ends to sign up for Part B without penalty.

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A Social Security card.

14. Medicare Part B premiums are paid out of Social Security

If you're collecting Social Security, your Part B premiums will be deducted automatically from the benefits you receive. You won't have to worry about writing out a check every month.

ALSO READ: Gear Up for These Big Social Security Changes in 2022

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A person filling out a Social Security benefits application form.

15. But you can sign up for Medicare before your Social Security benefits begin

Medicare eligibility starts before full retirement age for Social Security purposes kicks in. Full retirement age is when you can receive your monthly Social Security benefit in full. You're allowed to sign up for Social Security earlier, but that will reduce your benefits. Therefore, not only are you allowed to enroll in Medicare before Social Security but that could be a smart financial move.

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Person sitting at table in front of laptop is looking at receipts.

Learn more about Medicare

The more you know about Medicare, the better positioned you'll be to take care of your health during retirement. Keep reading up on the program so you can make the most of it once you're eligible for it.

The Motley Fool has a disclosure policy.

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