Medicare 101

Are you turning 65 soon? It's time to learn about Medicare and how it can help you stay healthy. Medicare beneficiaries have seven months to sign up, starting three months before their birthday month and ending three months after. Don't worry if you miss this window - if you already have coverage, you may be able to sign up later. Talk to your agent for advice.

Watch the Medicare video

Check out the video below from Florida Blue for an overview of how Medicare works.

Original Medicare

You may have heard the term "Original Medicare", which refers to Medicare parts A and B. For Medicare Parts A and B, coverage is provided directly from Medicare and covers 80% after deductibles and coinsurance. The remaining 20% out of pocket costs can be covered by additional supplemental coverage.

Medicare Part A

Part A is Medicare covers hospital-related expenses. In most cases, Medicare Part A doesn’t require a monthly premium as it was funded through you paying a minimum of 10 years of Social Security taxes through payroll. Consequently, most people earn Medicare Part A. In the event you don’t qualify for Medicare Part A, it can be purchased. Talk to your insurance agent if you need to purchase Medicare Part A coverage.

Medicare Part A covers the following services:

• Blood
• Home health services
• Hospice care
• In patient hospital care
• Skilled nursing facility care

Medicare Part B

Medicare Part B covers medical related expenses. Part B has a monthly premium which is typically deducted from your Social Security each month. Part B premiums can range in price from the low end $164.50 to as high as $428.60. The variability of pricing is directly related to your Adjusted Gross Income that you filed on your taxes. 

It’s very important to elect into Part B on time, otherwise you will be subject to a late enrollment penalty of 10% for every full 12 months delay in enrollment. Medicare Part B enrollment penalties may be waived if you already have credible coverage. For example, you may have existing health insurance coverage through your employer, so your penalty is waived as long as the coverage remains in force.

Medicare Part B covers the following services:

• Doctor’s visits
• Ambulance services
• Ambulatory surgical centers
• Blood
• Bone density tests
• Breast cancer screening
• Cardiac rehabilitation
• Cardiovascular disease
• Cervical screenings
• Diabetes screening
• Chronic care management
• Colorectal cancer screenings
• CPAP

As of 2024, Medicare Part B has an annual deductible of $226. This deductible must be paid before Medicare starts paying. Once the deductible is met, you will be responsible for 20% of the Medicare-approved costs.

What Medicare Does NOT Cover

Unfortunately, Medicare part A & B does not cover the full spectrum of health related services. Medicare coverage gaps can expose you to financial risk, so it’s important to consider supplemental coverage to cover out of pocket expenses like co-pays and co-insurance. 

Services listed below are NOT covered by Medicare and may incur out of pocket expenses:

• Dentures
• Acupuncture
• Hearing aids
• Cosmetic surgery
• Eye glasses or vision screenings other than after cataract surgery
• Long Term Care
• Preventative dental care
• Silver Sneakers (health & wellness benefit offered through Medicare Advantage)

If you will need these services, talk to your agent to purchase additional coverage through a Medicare supplement plan. Talk to your agent about Medicare Supplement Plans.

Medicare Part C - Medicare Advantage Plans

Medicare Part C is called Medicare Advantage. Parts A and B are required to enroll in a Medicare Advantage plan. With Medicare Advantage, a private insurance company (like Florida Blue) is designated as the primary payor instead of Medicare and pays Part A and Part B services covered under your plan. Florida Blue Medicare Advantage plans utilize a massive network of physicians, one of the largest in the US. Florida Blue Medicare Advantage plans are accepted anywhere Medicare is accepted. 

Medicare Advantage plans are offered as either HMO or PPO plans. The main difference is that for HMOs, if you need to see a specialist, it requires a referral from your Primary Care Physician (PCP). However, referrals are not required in PPO plans.

What Medicare Advantage Covers

• Medicare Part A and B deductibles
• Additional services such as hearing aids, wellness discounts and limited dental work.
• Some plans include prescription drug coverage, further reducing out of pocket expenses.

Medicare Part D

Medicare Part D offers prescription drug coverage, and Part D requires a monthly premium. It is important to enroll in Part D on time, as penalties are incurred for not enrolling when you are eligible. However, these penalties may be waived if you have existing credible coverage.

Part D plans follow the annual election period (AEP) schedule. Part D coverage can be changed each year between October 15th and December 7th. Part D coverage copays vary from year to year, so make sure to review your plan thoroughly every year to understand your plan’s coverage and costs. For Part D plans, basic copays and deductibles are published in the Medicare Handbook. 

Learn More

For more detailed information about Medicare, download or get a copy of the "Medicare and You 2024" handbook.