Understanding Medicare
Medicare is the federal health insurance program for:
- Most people age 65 and over
- Certain people younger than 65 who qualify for Social Security disability benefits
- People with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease
- People with end-stage renal disease
Generally, you only need to sign up for Part A and Part B once. Each year, you can choose which way you get your health coverage (and add or switch drug coverage).
Medicare is different from private insurance — it doesn’t offer plans for couples or families. You don’t have to make the same choice as your spouse.
Two steps to set up your Medicare coverage:
- Sign up for Part A (Hospital Insurance) and Part B (Medical Insurance) You can sign up at certain times. Check when and how to sign up.
- Choose which way you want to get your Medicare health coverage You can choose either Original Medicare or Medicare Advantage (Part C) for your health coverage. If you choose Original Medicare, you’ll also decide if you want drug coverage (Part D) and supplemental coverage, like Medigap.
You’ll have Original Medicare unless you join a Medicare Advantage Plan.
You must have both Part A and Part B to join a Medicare Advantage Plan.
Medicare Advantage bundles your Part A, Part B, and usually Part D coverage into one plan. Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.
You join a plan offered by Medicare-approved private companies that follow rules set by Medicare. Each plan can have different rules for how you get services, like needing referrals to see a specialist. Costs for monthly premiums and services you get vary depending on which plan you join.
Plans must cover all emergency and urgent care, and almost all medically necessary services Original Medicare covers. Some plans tailor their benefit packages to offer additional benefits to treat specific conditions.
With Medicare Advantage, you:
- Need to use doctors who are in the plan’s network (for non-emergency or non-urgent care).
- May pay a premium for the plan in addition to the monthly Part B premium. Plans may have a $0 premium or may help pay all or part of your Part B premiums.
- Can’t buy separate supplemental coverage (like Medigap).
When you have Medicare and other health insurance (like from your job), one will pay first (called a “primary payer”) and the other second (called a “secondary payer”).
If you have other insurance, who pays first depends on a number of items, like if you’re still working, the type of insurance you have, and if you have a special situation, like End-Stage Renal Disease (ESRD). ↗Find out who pays first in your situation.
↗ Get details if you’re working past 65 or getting ready to retire.
Speak with a SHINE Counselor: Email Bea Scafidi at bscafidi@aaapbtc.org
Check when & how to sign up: ↗Check Now
Estimate my eligibility: ↗Get My Sign-up Date
Compare benefits side-by-side: ↗Compare Options
SHINE (Serving the Health Care Needs of the Elderly) is a free program offered by the Florida Department of Elder Affairs (DOEA) and the Area Agency on Aging of Palm Beach / Treasure Coast, Inc. Specially trained volunteers in the 5-County service area (Palm Beach, Martin, Okeechobee, St. Lucie, and Indian River) can assist you with your Medicare, Medicaid and health insurance questions by providing one-on-one counseling and information.
SHINE services are free, unbiased and confidential. To find out more information about this program, please contact the Area Agency on Aging of Palm Beach / Treasure Coast at 1-866-684-5885 or email us at info@aaapbtc.org or click here to reach out to us.
The link to the Florida SHINE (called SHIP in other states) website is ↗here.
The SHINE program supports the Florida DOEA’s mission by providing free and unbiased health insurance counseling through a dedicated network of volunteers, empowering Florida seniors to make informed health care choices.
Find enrollment events in your area ↗SHINE Community Events