Learn the Basics of Medicare

Learn the Basics of Medicare

To make an informed decision about your benefits, you need to know the basics. We’ve outlined some essential information below to help you get started on your Medicare journey.


Let's Start by Defining Medicare

Medicare is the federal health insurance program for individuals age 65 and older and for certain younger people with disabilities. It provides coverage for care received in the hospital and medical services, such as going to see your primary care doctor. About 55 million Americans are covered under Medicare.


There are four parts to Medicare: Parts A and B (referred to as Original Medicare), Part C (optional coverage that you purchase separately to get benefits beyond Original Medicare), and Part D (prescription drug insurance).

Am I Eligible?

If you are an American citizen, and you or your spouse worked for 10 years, paid in to Social Security and Medicare, and reached the age of 65, you’re eligible. You are also eligible for Medicare if you have been receiving Social Security Disability benefits for 24 months and are under age 65.


When Can I Enroll?

There are different Medicare enrollment periods based on your circumstances, and your enrollment options depend on which part of Medicare you need.

Enroll in Original Medicare when:

  • You turn 65
  • If you've been getting Social Security benefits, you're automatically enrolled in Parts A & B beginning the first day of your birthday month (if your birthday is on the 1st, your benefits will start the month prior). You will receive your card in the mail automatically.
  • If you don't yet receive Social Security, you will need to contact the Social Security Office to enroll in Parts A & B. The Initial Enrollment Period (IEP) begins three months before the month you turn 65 and three months after. You can apply online at any time during this seven month period.

What if I’m still working?

If you (or your spouse) work beyond your 65th birthday and you have employer coverage, you can wait to enroll in Medicare until after you retire.

Once you retire, you qualify for a Special Enrollment Period (SEP). You can sign up for Original Medicare during the eight month period that begins the month after you stop working or your group health insurance is cancelled (whichever happens first).

When are the Enrollment Periods?

General Enrollment Period

The General Enrollment Period applies to Parts A & B and is for anyone who did not enroll during their IEP and didn’t qualify for the SEP. This period is also applicable for those who previously had Medicare coverage and cancelled it. Enroll from January 1 through March 31 for A & B coverage that’s effective in July.

Annual Enrollment Period

The Annual Enrollment Period is for Part D, your prescription coverage. Again, if you did not enroll during your IEP and did not qualify for the SEP, or if you canceled previous Medicare coverage, you are eligible to enroll in Part D from October 15 to December 7. In this case, your drug coverage would be available on January 1 of the following year.

3-Months-Before-Birthday-3-Months-After-Graphic

Placeholder image

What does Medicare Cost?

Part A is paid for from the Medicare tax deduction from you paycheck. No additional premium payment is needed.
There is a monthly premium for Part B, but it is typically deducted from your monthly Social Security check.

If you decide you want coverage beyond what Original Medicare A & B offers, you can purchase a Part C plan from a private insurance company like RMHP. Benefits and premiums vary. Many people choose to purchase Medicare supplements, Cost plans, or Part C plans to help offset the costs that aren’t covered by Parts A & B.

Part D covers your prescriptions and is also available for purchase from carriers like RMHP. Your costs will vary based on the plan you choose. 

Placeholder image

What is the Doughnut Hole?

The Doughnut Hole is a GAP in Medicare coverage.

The “doughnut hole” refers to a gap in prescription drug coverage under Medicare Part D. Once $3,700 in prescription drug costs is reached in 2017 (including both your share of covered drugs and the amount paid by your insurance), you will be in the coverage gap. You then receive a 60% discount on brand name drugs and a 49% discount on generic drugs. If your total out-of-pocket costs reach $4,950, you qualify for "catastrophic coverage," and you are responsible for only small copays on generic and brand name drugs, or 5% of your prescription drug costs for the remainder of the year. Specific details may be found in the Summary of Benefits document.

See What's Next

Now that we've examined the basics, it's time to take an in-depth look at each Medicare part. 

Learn about the Medicare Parts

Medicare Disclaimer

This page was last updated: 10/29/2016.  Please call to confirm you have the most up to date information about our Medicare Cost plans.

H0602_MS_MC500WEB_RMHP2 Pending CMS Review

Important Disclaimers: RMHP is a Medicare-approved Cost plan. Enrollment in RMHP depends on contract renewal. This information is available for free in other languages. Please call our Customer Service number at 888-282-1420 (TTY dial 711). Hours are 8am - 8pm, 7 days/week, Oct. 1–Feb.14, and 8am - 8pm, M-F, Feb.15–Sept.30. Esta información está disponible gratuitamente en otros idiomas. Por favor llame a la línea de Atención a Clientes, al 888-282-1420 (TTY marque 711). Horario  de 8am - 8pm, 7 días a la semana, del 1 de octubre al 14 de febrero; y de 8am - 8pm, de lunes a viernes, del 15 de febrero al 30 de septiembre.  RMHP has a 3.5 rating for the 2017 plan year. View the details about our Star Rating . Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. RMHP’s contract with Medicare is renewed annually. The availability of coverage beyond the end of the current contract year is not guaranteed.  However, RMHP has contracted with Medicare to provide benefits since 1977. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change each year on January 1. The benefit information provided is a brief summary, not a complete description of benefits.  For more information, contact the plan. Optional supplemental benefit packages may change each year on January 1. Benefits may be subject to copayments, limitations and/or restrictions. See the Evidence of Coverage or contact customer Service for details.  Eligible beneficiaries can enroll in RMHP medical-only Cost plans at any time but can only enroll in plans that include Part D drug coverage during specific times of the year. For enrollment guidelines and full information on RMHP benefits, please call Customer Service. Medicare beneficiaries may be enrolled in only one Part D plan at a time. Individuals are able to enroll in RMHP if they are enrolled under Medicare Parts A and B or B only and reside in our service area. In addition to the applicable RMHP plan premium, members continue to pay the Original Medicare Part B premium. If you decide to switch to premium withhold through Social Security or the Railroad Retirement Board, or move from premium withhold to direct bill, it could take up to three months for it take effect, and you will continue to be responsible for direct payment of premiums until the change takes effect. Information is available in alternative formats such as large print and Braille. For more information, call Customer Service. You can use any doctor who is part of the Rocky Mountain Health Plans’ network. You may also go to doctors outside of our network.  We may not pay for services you receive outside of our network, but Medicare will pay for its share of charges it approves. You will be responsible for paying the Medicare deductible and coinsurance for those services, unless they were authorized in advance by RMHP. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. If you need help finding a network provider, please call 888-282-1420 (TTY 711) or visit www.rmhpMedicare.org to access our online searchable directory. If you would like a provider directory mailed to you, you may call the number above, request one at the website link provided above, or email customer_service@RMHP.orgOther Medicare Disclaimers

Let's Find A Medicare Plan That's Right For You