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United Healthcare

Medicare 101

When you’re new to Medicare, it may be a bit of a puzzle, so here’s an overview of the pieces:

What is Medicare?

Original Medicare Parts A and B are federal programs that offer health insurance to American citizens and legal residents who have lived in the United States for at least five years in a row and are at least 65 years old or qualify based on a disability or other special situation.

What does it cover?

There are many parts of Medicare. Parts A and B provide coverage for hospital stays and inpatient care, and some coverage for provider visits and outpatient care. With Parts A and B, you will have deductibles and coinsurance amounts to pay.

What are the coverage choices?

After you enroll in Medicare, you may decide you’d like more coverage or be eligible for additional coverage through your former employer. Here’s more on each of the different Medicare offerings:

Part A (hospital insurance) helps pay for hospital stays and inpatient care, including coverage for:1

  • A semi-private room and meals
  • Skilled nursing services
  • Care in special units, like Intensive Care
  • Drugs, medical supplies and equipment for your inpatient stay
  • Lab tests and x-rays you receive during a hospital stay
  • Operating room and recovery room services
  • Some blood transfusions
  • Rehabilitation services after an inpatient stay that qualifies
  • Part-time skilled care if you’re homebound
  • Hospice care

Part B (medical insurance) helps pay for provider visits and outpatient care. You will have a monthly premium for Part B that is typically paid out of your Social Security check. Part B benefits include:1

  • Annual wellness visits and preventive services like flu shots
  • Lab tests and x-rays not performed during a hospital stay
  • Physical therapy, occupational therapy and speech-language pathology services
  • Diabetes screenings and certain diabetic supplies
  • Mental health care
  • Durable medical equipment, like wheelchairs, for use at home
  • Part-time skilled care if you’re homebound
  • Ambulatory surgery center services
  • Ambulance and emergency room services

Part C (Medicare Advantage) combines all of the Part A and Part B benefits into one plan,* and in many cases also offers prescription drug coverage (Part D).

You must be enrolled in both Parts A and B to be eligible for Part C. Medicare Advantage plans are offered by private insurance companies like UnitedHealthcare and must be approved by Medicare. Coverage and costs that go beyond the standards set by Medicare may vary from plan to plan; for instance, additional benefits may include:1

  • Routine dental care
  • Vision care / eyewear
  • Hearing care / hearing aids
  • Fitness programs

*Note that even if you have a Medicare Advantage plan, hospice care is still covered under Medicare Part A.

Part D (Prescription Drug Coverage) helps with the cost of prescription drugs, and is optional. That means you will have to enroll in a plan to get part D coverage; you will not get it automatically. You can choose to enroll in a stand-alone part D plan, or get coverage as part of a Medicare Advantage (Part C) plan.

To be eligible for a Part D plan, you must be enrolled in Part A or Part B. Like Medicare Part C, Part D plans are offered by private insurance companies and must meet the same basic Medicare guidelines set by the federal government. But not all plans are alike. While every Part D plan has a drug list (called the “formulary”) that shows which brand-name and generic drugs are covered, those covered drugs and costs vary from plan to plan. Most formularies categorize drugs into tiers based on what they cost.

A little prep, a simpler process

Timing matters when you first enroll, so make note:

Your initial enrollment period (IEP) is your first chance to enroll in Medicare and choose the coverage you want. The IEP is seven months long, including the month of your 65th birthday OR the 25th month you have been getting disability benefits, PLUS the three months before and three months after.

We want your transition to be as easy as possible when the time comes; just follow the steps below before your 65th birthday:

  1. 3 months before you turn 65

    Apply for Medicare, then share your Medicare Beneficiary Identifier (MBI) number with your former employer or benefits team.

    • Note that you are automatically enrolled in Parts A and B if you are receiving Social Security or Railroad Retirement Board benefits when you become eligible for Medicare. Otherwise you must enroll yourself.
    • Medicare Part A, Part B and Part D may charge penalties if you sign up after your IEP ends, unless you qualify for a Special Enrollment Period.
    • Most people pay the standard Part B premium amount. If your modified adjusted gross income is above a certain amount, however, you may pay an Income Related Monthly Adjustment Amount (IRMAA), which is an extra charge added to your premium.
  2. 2 months before you turn 65

    Read through all the Medicare materials you get in the mail from your former employer or benefits team.

  3. 1 month before you turn 65

    Keep an eye out for your new member ID card in the mail, along with a Quick Start Guide from UnitedHealthcare.

  4. Happy birthday!

    You’re enrolled in Original Medicare.

    If you’re eligible for additional coverage through your former employer, please contact your benefits team.

Want an easy way to access these steps when you need them?

Just download and print our Turning 65 checklist

Prefer that we walk you through it?

Hear the details of Medicare, who’s eligible, and why it’s important to get started before you’re 65.