What is Medicare?

Medicare can be complicated. InsuranceProfessor.net will help guide you to your decision on Medicare supplementary and health plans ­­ connect the dots, so to speak, from the mass of information. The Centers for Medicare and Medicaid Services, or CMS, is the federal government agency that is responsible for Medicare. Each year they publish a number of publications that will assist you with understanding Medicare. The keystone publication is called “Medicare and You”. You can get the current year electronic version by calling (1­800­MEDICARE) or go to www.medicare.gov to order a hard copy, customized to Colorado.

Watch the educational video series offered above to get a thorough understanding of Medicare.

What is Medicare?

Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, any age with End­Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant), or were residents of Libby, MT prior to 1990. A history of Medicare can be found in Appendix A. Medicare recipients are termed beneficiaries. Determination of eligibility and enrollment for Medicare is administered by Social Security.


Your eligibility will be the first of the month of your 65th birthday, unless you were born on the first, in which case you become eligible on the first of the preceding month. If you have been receiving social security disability, you become eligible following 24 months of having received these benefits. In the instance where you continue to work and are covered by a group health plan, you may enroll in Part A at age 65, but your eligibility to enroll in Parts B or D can be postponed until your group coverage is terminated. If you are covered under a small group plan (fewer than 20 employees), you will need to enroll in both Parts A & B in order to continue with the group plan. If the company employs more than 20 employees, you may enroll in Part A, you will not be required to enroll in Part B, until coverage ends.

How is Medicare Structured?

Medicare has four parts. Parts A & B together are referred to as Original Medicare. Part C is Medicare Advantage, and Part D is outpatient prescription Drug coverage.

Part A is commonly called Hospital or Inpatient insurance and provides for inpatient care, for medical and mental health care, as well as coverage for skilled nursing facility care for recuperation, and hospice. If you are Medicare ­eligible, there is no cost for participation in Part A.

Part B is called Medical or Outpatient insurance and covers doctors office visits and other outpatient types of care. Part B is optional and is available for the payment of a monthly premium as established annually by CMS. The Part B premium is “means tested.” (see table later in this pamphlet for amounts of

Part C of Medicare provides for Medicare Advantage plans. MA plans, as they are termed, are offered by a commercial insurance company, or carrier, and provide at least the same level of coverage as does Original Medicare.

Part D of Medicare provides help covering outpatient prescription drug coverage, and is provided through commercial carriers. Medicare stipulates minimum coverages, and most often available plans offer benefits above the minimums. Premiums for these plans vary based on benefit level from the various carriers. In addition, Part D imposes a 1%/month penalty if a beneficiary doesn’t enroll in Part D when eligible.

Enrollment in Parts A and/or B is necessary to enroll in a Part D plan, and enrollment in Part B is mandatory to have a Part C plan, or to apply for a Medicare Supplement plan.

Watch the video series offered above to get a thorough understanding of Medicare.