New to Medicare
Whether you're eligible for Medicare insurance coverage now or will be soon, Dean Health Plan is here to help you understand your Medicare coverage options.
You are Medicare-eligible if you are a legal U.S. resident and one of the following applies to you:
- You are age 65 or older
- You are any age and have a qualifying permanent disability
- You are any age and have been diagnosed with end-stage renal disease (ESRD)
The ABCDs of Medicare
Once you decide to join Medicare, you have a few different options you can choose. The federal government refers to these Medicare benefits and options as Parts A, B, C and D.
No matter which option you choose, the first step is the same: Enroll in Original Medicare, also known as Parts A and B.
Original Medicare is Parts A and B
To those enrolled in Medicare, the federal government provides hospital insurance/coverage for inpatient care (Part A) and medical insurance/coverage for outpatient care (Part B). For example, Part A covers hospital room stays and home health services, and Part B covers doctor visits and durable medical equipment.
Take Advantage with Parts C and D
Original Medicare doesn’t cover everything. Many Medicare recipients elect to buy additional coverage from private insurance companies like Dean Health Plan, and many choose Medicare Advantage plans, also known as Part C.
Members often find that these plans cover deductibles, set an annual out-of-pocket maximum, provide additional benefits not covered by Original Medicare and provide coverage for prescription drugs, also known as Part D.
Medicare enrollment periods
Initial Enrollment Period (IEP)
This is the seven-month period in which you may enroll in Medicare for the first time. If you are enrolling for the first time due to disability, your IEP timing is based on your disability date.
Annual Enrollment Period (AEP)
October 15–December 7 of every year is the period in which you may make changes to your medical and prescription drug coverage, for a January 1 effective date.
Special Enrollment Period (SEP)
This is a period in which Medicare recipients may change medical and prescription drug coverage outside of AEP, if they meet certain requirements and have a qualifying event, such as moving to a new service area or leaving an employer-based plan.
For more information about Medicare eligibility and enrollment policies and limitations, please visit medicare.gov or call 1-800-MEDICARE (1-800-633-4227).
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Information provided by Medicare.gov
(The Official U.S. Government Site for Medicare)
What is Medicare?
Medicare is a Health Insurance Program for:
- People age 65 or older.
- People under age 65 with certain disabilities.
- People of all ages with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant).
You can choose different ways to get the services covered by Medicare. Depending on where you live, you may have different choices. In most cases, when you first get Medicare, you are in Original Medicare. You may want to consider a Medicare Prescription Drug Plan to add drug coverage. Or, you may want to consider a Medicare Advantage Plan (like an HMO or PPO) that provides all your Part A, Part B, and often Part D coverage. You make a choice when you are first eligible for Medicare. Each year you can review your health and prescription needs and switch to a different plan in the fall.
As long as you have both Part A and Part B, items covered by Part A and Part B are covered whether you have Original Medicare, or you belong to a Medicare Advantage Plan (like an HMO or PPO). For more information see the Your Medicare Coverage database.
Who is eligible?
Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years or older and a citizen or permanent resident of the United States. If you aren't yet 65, you might also qualify for coverage if you have a disability or with end-stage renal disease (permanent kidney failure requiring dialysis or transplant).
Here are some simple guidelines. You can get Part A at age 65 without having to pay premiums if:
- You already get retirement benefits from Social Security or the Railroad Retirement Board.
- You are eligible to get Social Security or Railroad benefits but haven't yet filed for them.
- You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay premiums if you have:
- Received Social Security or Railroad Retirement Board disability benefits for 24 months.
- End-stage renal disease and meet certain requirements.
While you don't have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it. The standard Part B premium amount is $134 (or higher depending on your income). However, most people who get Social Security benefits will pay less than this amount ($109 on average). This is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don't get any of the above payments, Medicare sends you a bill for your Part B premium every 3 months.
Note: You will be eligible for Medicare when you turn 65 even if you are not eligible for Social Security retirement benefits.
What are the parts of Medicare?
The following phone numbers and contact agencies are for Wisconsin residents. If you live outside of Wisconsin and are looking for contact information, or the agency you are looking for is not listed, please see the Government Medicare site for more information.