Medicare: What It Covers, What It Doesn't and How to Enroll

Medicare is a federal health insurance program for people aged 65 or older. The Social Security Administration handles Medicare eligibility and enrollment. You can contact the Social Security Administration at 800-772-1213 to enroll in Medicare or to ask questions about whether you are eligible.

Medicare Supplement Insurance

Medicare supplement insurance can help you fill in some of the "gaps" that Medicare won't pay. There are 12 standardized Medicare supplement insurance plans, labeled "A" through "L." Each plan offers a different combination of benefits. Four plans - F, J, K and L offer high deductible options.

Not everyone needs Medicare supplement insurance. You probably don't need a Medicare supplement plan if:

. You have group health insurance through an employer or former employer, including government or military retiree plans

. You belong to a Medicare Advantage plan

. Medicaid or the Qualified Medicare Beneficiary (QMB) Program pays your Medicare premiums and other out-of-pocket costs

Medicare Parts A and B

You must participate in Medicare Parts A and B to participate in a Medicare supplement insurance plan.

Medicare Part A (hospital) pays for in-patient hospital services, skilled nursing facility care after a hospital stay, home health care and hospice care. Medicare Part A also pays for all but the first three pints of blood in a calendar year.

Medicare Part B (medical) pays for medical expenses, clinical laboratory services and outpatient hospital treatment. In most cases, Medicare pays 80 % of the cost of covered services.

Medicare Part D - Prescription Drug Coverage

Medicare Part D pays for prescription drugs, both generic and brand name. You must join a prescription drug plan to have this coverage. The initial enrollment period to join a Medicare drug plan is three months before your 65th birthday to three months after you turn age 65. Each year between November 15 - December 31 you can switch to a different Medicare drug plan if your needs change.

Services Not Covered By Medicare

The following services are not covered by Medicare:

. Long-term care services

. Private nursing care

. Most dental care and dentures

. Health care received while traveling outside the United States, except under limited circumstances

. Cosmetic surgery and routine foot care

. Routine eye care, eyeglasses (except after cataract surgery) and hearing aids

Medicaid

Medicaid is a federal program administered by the states that pays for health coverage for people with low incomes. If you qualify for Medicaid, the state will pay your Medicare premiums and other Medicare out-of-pocket costs. Medicaid will also pay for some services not covered by Medicare. If you receive Medicaid, you likely won't need Medicare supplement insurance.

Medicare Supplement Plan Open Enrollment Period

You may apply for a Medicare supplement plan within six months after enrolling in Medicare Part B. These six months are called the open enrollment period. During open enrollment, you are eligible to apply for any Medicare supplement plan, even if you have health problems. Your right to open enrollment is absolute, even if you wait several years after you become 65 to enroll in Medicare Part B because of continued employment or other reasons.

Content provided by medicare.gov.

This information is provided for InsWeb users' general information. InsWeb makes no representation as to the information's completeness or accuracy. We urge you to contact your insurance professional directly for specific information and instructions.