Whether you are signing up for Medicare for the first time in the Initial Enrollment Period IEP (the month you turn 65 plus 3 months before and 3 months after) or you are reviewing your current Medicare plan, now is the time to pay attention and do your research. The 2025 Medicare Enrollment period is October 15th to December 7th.  

It is not necessary to sign up for Medicare at age 65 or ever. But that should think carefully and research your decision. If you decide to sign up later that your initial enrollment period, the penalties for late enrollment are as much as 10% for as long as you have Medicare. 

Medicare is the federal health insurance program for people who are 65 and over. If you are under 65, you still may be eligible to get Medicare before you turn 65 if you have a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig’s Disease). 

Medicare insurance is comprised of four parts: 

  • Medicare Part A is insurance for hospitalization, home or skilled nursing, and hospice. 
  • Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice. 
  • Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best. 

You pay nothing for most preventive services if you get the services from a health care provider who accepts ‘assignment’, that is your doctor, provider or supplier agrees to be paid directly by Medicare and accept the payment amount that Medicare has approved for that service, and not to bill you for costs that exceed the Medicare deductible and coinsurance. It is important to ask all your providers if they accept this assignment or you could end up with a big, unexpected bill. Don’t just ask if they take Medicare 

 

  • Medicare Part C (Medicare Advantage Plans) is a Medicare-approved health plan from a private company that you can choose to cover most of your Part A and Part B benefits in place of Original Medicare. It usually also includes Part D prescription drug coverage. 
  • Medicare Part D covers prescription medications. People who chiise original Medicare  Parts A and B will usually use Part D also. 

 

Medicare coverage is based on 4 main factors  

  1. Federal and state laws. 
  2. National coverage decisions made by Medicare about whether something is covered. 
  3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area. 
  4. Your own choice of Medicare coverage plan. 

 

Although the commercials you see for Medicare say that it covers 80% of your health care costs, in truth it usually covers 80% of the Medicare approved reimbursement (assignment) for the service or procedure. It is important that you confirm that your doctor and any health provider does accept the Medicare assignment, or you may be paying higher bills. If you intend to move, you should research where each state falls in a listing of the percentage of Medicare costs covered. Maryland is at the top of the list at over 91%. 

Medicare premiums are listed by monthly cost, but they are billed quarterly. If you are receiving Social Security, your Medicare premiums will be deducted from your monthly Social Security payment. 

If you have questions about Medicare and the different plans, go to Medicare.gov or sign up for the SHIP presentation at 1:00 pm on 12/12 at the Maggie Nightingale Library.