Medicare covers certain medical services and supplies in hospitals, doctors’ offices, and other health care settings. If you have both Part A (Hospital) and Part B (Medical), you can get all Medicare services covered under Part A or Part B, whether you have Original Medicare or a Medicare Advantage Plan (like an HMO or a PPO). To get Medicare-covered Part A and/or Part B services, you must be a U.S. citizen or be lawfully present in the U.S. To learn more about your options, call Health Care Express at: 786-237-7243. Learn More

When you are first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B.

For example, if you are eligible for Medicare when you turn 65, you can sign up during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

If you sign up for Part A and/or Part B during the first 3 months of your Initial Enrollment Period, in most cases, your coverage starts the first day of your birth month. However, if your birthday is on the first day of the month, your coverage will start the first day of the month prior.

If you enroll in Part A and/or Part B during the month you turn 65, or during the last 3 months of your Initial Enrollment Period, the effective start date for your Medicare coverage will be delayed.

If you did not sign up for Part A (or if you must buy it) and/or Part B (for which you must pay premiums) during your Initial Enrollment Period, you can sign up between January 1–March 31 each year. Your coverage will not start until July 1 of that year, and you may have to pay a higher Part A and/or Part B premium for late enrollment. Learn More

If you or your spouse are still working, and you did not sign up for Part A or Part B because you are covered under a group health plan based on current employment, (your own, your spouse’s, or if you are disabled – your family member’s), you may still have a chance to sign up for Medicare during a Special Enrollment Period.

You can sign up for Part A and/or Part B at any time in which you are covered by the group health plan or during the 8-month period beginning the month after the employment ends or the coverage ends, whichever happens first.

Usually, you do not pay a late enrollment penalty if you sign up during a Special Enrollment Period. This Special Enrollment Period does not apply to people with End-Stage Renal Disease (ESRD). Note: If you are disabled, the employer offering the group health plan must have 100 or more employees.

COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage and retiree health plans are not considered coverage based on current employment. You are not eligible for a Special Enrollment Period when that coverage ends. To avoid paying a higher premium, make sure you sign up for Medicare when you are first eligible.Learn More

A Medicare Advantage Plan (like an HMO or PPO) is another way to get your Medicare coverage. A Medicare Advantage Plan, sometimes called “Part C” or “MA Plan,” is a Medicare health plan offered by a private Insurance company that contracts with Medicare to provide you with all your Part A and Part B benefits. If you join a Medicare Advantage Plan, you will still have Medicare, but you will get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from your Medicare Advantage Plan, not Original Medicare. You will generally get your services from a plan’s network of providers. Remember, in most cases, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your Original Medicare card in a safe place because you will need it if you ever switch back to Original Medicare.

Make sure you understand how a plan works before you join. Providers can join or leave a plan’s provider network anytime during the year. Your plan can also change the providers in the network anytime during the year. If this happens, you may need to choose a new provider. Learn More

Medicare Advantage Plans cover all Medicare Part A and Part B services except hospice care and some costs in qualifying research studies. They also cover emergency and urgent care. Original Medicare will cover hospice care and some costs for clinical research studies, even if you are in a Medicare Advantage Plan.

Medicare Advantage Plans may offer extra coverage such as vision, hearing, dental, and other health, and wellness programs such as a gym membership. Most plans include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you might pay a monthly premium for the Medicare Advantage Plan, however some plans offer a Part B premium reduction or “buy down” as a benefit.

Medicare pays a fixed, monthly amount for your coverage to the companies offering Medicare Advantage Plans, so these companies must follow the rules set by Medicare. Each Medicare Advantage Plan can charge different out‑of‑pocket costs and have different rules regarding your services. These rules can change each year. The plan must notify you about any changes before the start of the next enrollment year.

Note: You have the option to keep your current plan, choose a different plan or switch to Original Medicare each year during the Annual Enrollment Period. Medicare Annual Enrollment begins on October 7th and ends on December 7th.

Make sure you understand how a plan works before you join. Providers can join or leave a plan’s provider network anytime during the year. If this happens, you may need to choose a new provider. Learn More

Health Maintenance Organization (HMO) Plans – With most HMO plans, you can only go to doctors, other health care providers or hospitals in the plan’s network except in an urgent or emergency. You may also need to get a referral from your primary care doctor for tests or to see other doctors and specialists.

Preferred Provider Organization (PPO) Plans – With a PPO plan, you pay less if you use doctors, hospitals and other health care providers that belong to the plan’s network. You usually pay more if you use doctors, hospitals, and providers outside of the network.

Special Needs Plans (SNPs) – SNPs provide focused and specialized health care for specific groups of people, such as those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions.

HMO Point-of-Service (HMOPOS) Plans – these are HMO plans that may allow you to get some out-of-network services for a higher copayment or coinsurance.

Private Fee-for-Service (PFFS) Plans – PFFS plans are like Original Medicare in that you can generally go to any doctor, other health care provider or hospital as long as they accept the plan’s payment terms. The plan determines how much it will pay doctors, other health care providers and hospitals, as well as how much you must pay when you receive care.

Medical Savings Account (MSA) Plans – These plans combine a high-deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year. MSA plans do not offer Medicare drug coverage. If you want drug coverage, you must join a Medicare Prescription Drug Plan.

Note: It is important to check with the plan for information about your rights and responsibilities. You must follow plan rules. If you go to a doctor, other health care provider, facility or supplier that does not belong to the plan’s network, your services may not be covered, or your costs could be higher. In most cases, this applies to Medicare Advantage HMOs and PPOs.

You can join a Medicare Advantage Plan even if you have a preexisting condition, except for End-Stage Renal Disease (ESRD), for which there are special rules. Learn More

Medicare offers prescription drug coverage to everyone with Medicare. You must join a prescription drug plan approved by Medicare to receive the drug coverage. Each plan can vary in cost and cover specific drugs. Even if you do not take many prescriptions now, you should consider joining a Medicare drug plan. If you decide not to join a Medicare drug plan when you are first eligible, you don’t have other creditable prescription drug coverage and you don’t get Extra Help, you will likely pay a late enrollment penalty if you join a plan later. Generally, you will pay this penalty for as long as you have Medicare prescription drug coverage.

If you have a higher income, you might pay more for your Part D coverage. If your income is above a certain limit ($85,000 if you file individually or $170,000 if you are married and file jointly), you will pay an extra amount in addition to your plan premium. This does not affect everyone, so most people will not have to pay a higher amount.

Usually, the extra amount will be deducted from your Social Security check. If you get benefits from the Railroad Retirement Board (RRB), the extra amount will be deducted from your RRB check. If you are billed the amount by Medicare or the RRB, you must pay the extra amount to Medicare or the RRB and not your plan. If you do not pay the extra amount to Medicare (or RRB), you could lose your Part D coverage. You may not be able to enroll in another plan right away and you may have to pay a late enrollment penalty for as long as you have Part D. If you must pay an extra amount and you disagree (for example, you have a life event that lowers your income.

Yearly deductible is the amount you must pay before your drug plan begins to pay its share of your covered drugs. Some drug plans do not have a deductible.

Copayments or coinsurance are the amounts you pay for your covered prescriptions after the deductible (if the plan has one). You pay your share, and your drug plan pays its share for covered drugs. These amounts may vary. Learn More