What You Need to Know About Medicare
What is Medicare?
Medicare is a federal health insurance program primarily for people age 65 and older, though it also covers certain younger individuals with disabilities or specific medical conditions. Understanding how Medicare works is the first step toward making informed healthcare decisions as you approach retirement or explore your coverage options.
Medicare is divided into several parts, each covering different services:
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Part A (Hospital Insurance) - helps cover inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. Most people don’t pay a premium for Part A if they paid Medicare taxes while working.
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Part B (Medical Insurance) - covers outpatient care like doctor visits, preventive services, lab tests, and durable medical equipment. Part B usually comes with a monthly premium.
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Part C (Medicare Advantage Plans) - are offered by private insurance companies approved by Medicare. These plans include all the benefits of Part A and Part B and often include additional coverage such as dental, vision, hearing, and prescription drugs.
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Part D (Prescription Drug Coverage) - helps cover the cost of prescription medications and is also offered through private insurance companies.
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Medigap (Medicare Supplement Plans) - additional coverage offered by private insurance companies that helps pay for the "gaps" in coverage left by Original Medicare (Parts A and B).
Choosing the right Medicare coverage depends on your healthcare needs, lifestyle, and budget. That’s where we come in. At Mountaineer Health and Life Insurance, we help you compare options, understand enrollment timelines, and find a plan that fits your unique situation. We’re here to make Medicare less confusing and more personal.
When Can I Sign Up for Medicare?
Most people become eligible for Medicare when they turn 65, and their Initial Enrollment Period begins three months before their 65th birthday, includes their birthday month, and continues for three months after. However, if you’re under 65 and have a qualifying disability, you may be eligible for Medicare after receiving Social Security Disability Insurance (SSDI) for 24 months. If you have ALS (Lou Gehrig’s disease), you automatically qualify for Medicare the same month your SSDI benefits begin. Those with End-Stage Renal Disease (ESRD) may also qualify, though different rules apply depending on treatment.
If you miss your Initial Enrollment Period, you may need to wait for the General Enrollment Period (January 1 to March 31), which could result in late penalties. If you're still working and have employer coverage, you might qualify for a Special Enrollment Period when that coverage ends. Every situation is unique, and we’re here to help you understand your options and enroll at the right time—without the stress.
How Do I Enroll in Medicare?
You have a few different options for enrolling in Medicare Part A and Part B—each comes with its own benefits and things to watch out for:
Automatic Enrollment: If you're turning 65 and already receiving Social Security or Railroad Retirement benefits, you’ll be automatically enrolled in Medicare Parts A and B.
Pros: Enrolling in Original Medicare (Parts A & B) happens on it's own.
Cons: You are still left with finding, understanding, and enrolling in additional options such as a Medicare Prescription Drug Plan, Medicare Advantage Plan, or a Medicare Supplement Plan.
Online: You can enroll in Parts A and B, or Part A only, through the Social Security website - www.ssa.gov.
Pros: You can avoid long wait times while enrolling from the comfort of your home.
Cons: This is not ideal for those who aren't comfortable using technology, and if you make a mistake it could delay your coverage.
In Person: You can schedule an appointment with your local Social Security office to enroll in person.
Cons: Walk in's are no longer accepted and appointments can take up to 8 weeks due to most offices being understaffed.
Over-the-Phone: You can call Social Security directly at 1-800-772-1213.
Cons: Appointments can sometimes take up to 8 weeks to set. On top of that, hold times are often hours long. If you are disconnected then you could be waiting even longer.
Let Us Help at No Cost!
We’re here to walk you through the process step by step, answer your questions along the way, and help you understand all of your options in a way that actually makes sense. Our goal is to make things simple, clear, and stress-free—so you can feel confident about the choices you’re making.