Medicare Basics

Medicare is the federal health insurance program for people 65 and older. It also covers some younger people with certain disabilities or conditions.

It's run by the federal government, but the day-to-day pieces — like your plan, your card, and your network — can come from private insurance companies depending on which path you choose.

If you've had coverage through an employer or the marketplace, Medicare works a little differently:

• It's broken into parts (A, B, C, D) instead of one single plan.
• You usually pick from two main paths — Original Medicare or Medicare Advantage.
• There are specific windows when you can enroll or switch.
• Costs are spread across premiums, deductibles, and copays, not just one monthly bill.

Most people qualify when they turn 65. You may also qualify earlier if you:

• Have received Social Security Disability for 24 months
• Have End-Stage Renal Disease (ESRD)
• Have ALS (Lou Gehrig's disease)

You generally need to be a U.S. citizen or a legal resident who has lived in the country for at least five years.

Most people have a 7-month Initial Enrollment Period around their 65th birthday — the 3 months before, the month of, and the 3 months after.

You can enroll in a few ways:

• Automatically, if you're already getting Social Security
• Online through the Social Security Administration
• By phone or in person at a Social Security office

If you're still working and have employer coverage, you may be able to delay parts of Medicare without a penalty. The right move depends on:

• The size of your employer
• Whether your employer plan is considered "creditable" coverage
• Your spouse's coverage and prescription needs

This is one of the most common areas where people get tripped up. Birch can help you sort through it before you make a decision.