Most people think Medicare is a federal health program, but it's a very complex system of private, state, and federal insurance options. Making the right choice can be confusing with the plethora of available options. If you or someone you know is considering Medicare, the Open Enrollment period closes on December 7th. In this article, we'll briefly break down what Medicare is, what it covers, who qualifies, and where to find help before open enrollment closes.

What Is Medicare and Who Qualifies?

At its most basic form, Medicare is a federal health program for all individuals 65 and older, people under 65 with certain disabilities, and any person diagnosed with End-Stage Renal Disease or Amyotrophic Lateral Sclerosis (ALS, aka Lou Gehrig’s disease). Many state and private insurance providers also offer Medicare plans that cover some expenses that base Medicare does not.

To be eligible for Medicare based on a disability, you generally need to qualify and be on Social Security Disability Insurance (SSDI) for 24 months. To qualify for SSDI, you must have been injured or have another medical condition that inhibits your ability to work. Once you've been on SSDI for 24 months, you will automatically be enrolled in Medicare.

What Does Medicare Cover?

Medicare has three different parts to it and it's critical to understand the differences in coverage. Part A is hospital insurance, Part B is medical insurance, and Part D is prescription drug coverage. In most cases, you will need to elect Part D yourself and pay an additional premium. Medicare plans can vary widely, but here is a quick breakdown of the three parts and what is covered in each.

• Medicare Part A. Part A is the hospital insurance portion. It covers inpatient care, skilled nursing facilities, hospice, and other health care needs, but does not cover long-term care. Most people do not pay a premium for Part A because it is already paid for through payroll tax deductions. If an individual has never worked, they may have a premium.
• Medicare Part B. Part B is the insurance portion of Medicare and covers the bill for doctors' services, outpatient services, physical and occupational therapists, and other medically necessary services that Part A does not cover. Most people will have a premium for Part B.
• Medicare Part D. Part D covers prescription drugs and is available to everyone who has Medicare Part A and B. You must have a Medicare-approved plan that offers Medicare drug coverage to apply for Part D, and it comes with an additional premium.

Where Do I Sign Up For Medicare?

There are two ways you can sign up for Medicare yourself. The first and most convenient is to sign up online at the official Medicare website. There you can find and compare available plans based on your zip code. The website also contains information about Medicare if you want to read more about the program.

The second option is to go in person to the Social Security office closest to you. Your local Social Security office will be able to help you sign up for Medicare, Disability, and more but will likely not be able to offer individual guidance.

How Can I Get Help Choosing Medicare Coverage?

Like other health insurance options, there are Medicare brokers that can help explain your options. They can discuss the pros and cons of each plan and important things to consider. They are especially helpful if you become overwhelmed or confused with the options. Medicare brokers cannot charge fees and they cannot change the pricing on any policy. They are paid by insurance companies to help you find the policy that fits your needs and budget.

If you want help navigating your Medicare options and understanding the pros and cons of different policies, we have partnered with a handful of Medicare brokers. Email us here and we can send you our recommendations directly.

Will Medicare Coverage Change?

Medicare coverage could change if the Senate passes the Build Back Better bill. The House passed the $1.7 trillion package in November and it's waiting for deliberation in the Senate. Should it pass as is, the federal government would be able to negotiate prescription drug prices for the first time, which could result in lower drug prices.

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