October 6, 2016
If you’re looking into Medicare, then you may wish to familiarize yourself with every available option. The federally funded Medicare program is sometimes called Original Medicare, and includes both Medicare Part A and Part B.
But there are alternatives to government-administered Medicare, and these plans are offered by private insurance companies contracted with Medicare. Medicare Advantage plans provide at least the same coverage as Part A and Part B (except hospice care, which remains covered by Part A) and many of these plans feature additional benefits as well.
Other Medicare plans function as complements to your Original Medicare, Part A and Part B, coverage. For example, prescriptions are not generally covered by Original Medicare (except while you’re in the hospital). You can enroll in a Medicare Part D Prescription Drug Plan to receive this benefit. Medigap (Medicare Supplement) plans are also offered by private insurance companies and can help you pay your out-of-pocket costs for services covered under Original Medicare. The availability of Medicare plan options in North Carolina may vary depending on your location.
Original Medicare, Part A and Part B, is administered by the federal government. Part A covers inpatient hospital care, skilled nursing facility and nursing home care, home health care, and hospice care. Part B covers physician services, preventive screenings, durable medical equipment, and outpatient services.
To be eligible for Original Medicare, you must be 65 or older and a U.S. citizen or legal permanent resident of at least five continuous years. People who are younger than 65 may be eligible for Medicare if they have certain health conditions such as amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease) or if they’ve collected disability benefits for 24 continuous months or more from the Social Security Administration (SSA) or the Railroad Retirement Board.
Most people enroll in Original Medicare during the Initial Enrollment Period. This seven-month period begins three months before the month you turn 65, includes your birthday month, and ends three months after your birthday month. You’re also allowed to enroll in Medicare during the annual General Enrollment Period, which runs from January 1 to March 31, but if you miss your seven-month Initial Enrollment Period, you may have to pay a late-enrollment penalty in the form of higher monthly premiums.
In some situations you might qualify for a Special Enrollment Period, during which you can enroll in Part A or Part B outside the Initial Enrollment Period without incurring a penalty. For example, a person over the age of 65 might have delayed enrollment in Part B because the individual was covered under an employer-sponsored group health plan. When the group health plan coverage ends, the person qualifies for an eight month Special Enrollment Period to enroll in Medicare Part B (without a late enrollment penalty).
If you’re not automatically enrolled in Medicare, you may sign up by visiting your local SSA office or by registering online. You can also do so over the phone:
There are plans offered by private insurance companies that contract with Medicare to provide Medicare coverage to beneficiaries. These Medicare options may be available from plan providers in your area. Pricing and availability can vary depending on your zip code. You can sign up for any of these plans during your Initial Enrollment Period.
Medicare.gov is a valuable educational resource for additional information about Medicare and health organizations. You may also contact the organizations listed below for assistance.
Learn more about how Medicare plans work in North Carolina including:
The product and service descriptions, if any, provided on these PlanPrescriber Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.