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.

  • Medicare enrollment periods are based on birthday month eligibility. Better known as the Initial Enrollment Period, or IEP, it begins three months prior to the first day of your birthday month as well as the three months following the last day of your birthday month.
      

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 parts A & B coverage that’s effective in July.

Annual Enrollment Period

The Annual Enrollment Period (AEP) runs from October 15 through December 7 each year.  During the AEP, Medicare beneficiaries may enroll in Medicare Part D (if they didn't sign up during their IEP), change a prescription drug plan, add or change Medicare plans, or return to Original Medicare.  Changes takes effect January 1.

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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 parts 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 private insurance carriers. Your costs will vary based on the plan you choose. 

donut hole

What is the Donut Hole?

The Donut Hole is a GAP in Medicare coverage.

The “donut hole” refers to a gap in prescription drug coverage under Medicare Part D. Once $3,820 in prescription drug costs is reached in 2019 (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 75% discount on brand name drugs and a 63% discount on generic drugs. If your total out-of-pocket costs reach $5,100 in 2019, 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: 10/01/2018.  Please call to confirm you have the most up to date information about our Medicare Cost plans.

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Important Disclaimers: RMHP is a Medicare-approved Cost plan. Enrollment in RMHP depends on contract renewal. This information is not a complete description of benefits.  Call RMHP Customer Service at 888-282-1420 (TTY: 711) for more information.  Other pharmacies, physicians, providers are available in our network. Medicare beneficiaries may also enroll in RMHP through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.  For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.   Every year, Medicare evaluates plans based on a 5-star rating system.  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.org.

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