Benefit & Health Promotion
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Medicare
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Medicare is federal health insurance primarily for people 65 or older and certain younger people with disabilities or specific conditions. Medicare has four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage).
First, enroll in Medicare Part A and Part B. Depending on your situation, you may be enrolled automatically or need to sign up through the Social Security Administration (SSA). Once you have Part A and Part B, you generally have two main coverage options:
Option 1 : Original Medicare + Part D + Medigap
Original Medicare (Parts A & B) covers hospitals, medical, and other health care services. You can generally see any doctor or hospital that accepts Medicare. You can enroll in a stand-alone Part D plan through Medicare.gov to help cover prescription drug costs and may purchase Medigap (Medicare Supplement Insurance) from a private insurance company to help pay some out-of-pocket costs that Original Medicare does not cover.
Option 2: Medicare Advantage (Part C)
Medicare Advantage is an alternative to Original Medicare offered by Medicare-approved private insurance companies. Plans provide Part A and Part B coverage and most include Part D prescription drug coverage. Many plans also offer additional benefits, such as dental, vision, hearing, or fitness benefits. You can compare and enroll in Medicare Advantage plans through Medicare.gov.
Where to Enroll
Enroll in Part A and Part B through Social Security Administration (SSA), and compare and enroll in Part D, Medicare Advantage through Medicare.gov, and find and compare Medigap policies through Medicare.gov and purchase them directly from private insurance companies licensed to sell Medigap in your state.
Not sure where to start?
Our Multilingual Helpline can help.
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(English) 1-800-336-2722
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(Korean) 1-800-582-4259,
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(Chinese Mandarin) 1-800-683-7427
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(Cantonese) 1-800-582-4218,
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(Vietnamese) 1-800-582-4336
Medicare Enrollment Periods: Important Deadlines & Why It Matters
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Enrolling in Medicare on time is essential to ensure uninterrupted healthcare coverage and avoid potential late penalties. Each year, there are specific enrollment periods to keep in mind:
Initial Enrollment Period (IEP)
Your first opportunity to enroll in Medicare. It begins three months before you turn 65, includes the month you turn 65, and ends three months after your 65th birthday month
General Enrollment Period (GEP)
Runs from January 1 to March 31 for those who missed their initial enrollment. Coverage starts on the 1st day of the following month after you sign up.
Annual Medicare Open Enrollment Period (Medicare OEP)
Every year, Medicare Open Enrollment Period allows beneficiaries to make changes to their Medicare health and prescription drug coverage for the following year:
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October 15 - Medicare Open Enrollment begins
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December 7 - Medicare Open Enrollment ends
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January 1 - Changes made during OEP generally take effect.
Medicare Advantage Open Enrollment Period
MA OEP (Medicare Advantage Open Enrollment Period): From January 1 to March 31, those already enrolled in a Medicare Advantage plan are allowed to make one change - switch to another Medicare Advantage plan or return to Original Medicare. The effective date is the first date of the following month after the change are made.
Staying informed about these deadlines ensures you receive the healthcare benefits you need without delays or penalties. For assistance with navigating Medicare, NAPCA’s Multilingual Helpline is here to help!
MSPs(Medicare Savings Programs) & LIS(Low-Income Subsidy, Extra Help) – Medicare cost assistance
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These programs help people who meet income and resource limits pay Medicare costs. Medicare Savings Programs (MSPs) can help pay Medicare Part A and/or Part B premiums and, depending on the program, other Medicare cost-sharing such as deductibles, coinsurance, and copayments. MSP eligibility requirements and income and resource limits may vary by state and program. LIS (Low-Income Subsidy), also called Extra Help, helps eligible people pay Medicare Part D prescription drug costs, including premiums, deductibles, and prescription copayments or coinsurance. People with full-benefit Medicaid, including ABD Medicaid, or who receive help from an MSP generally qualify for Extra Help. Income and resource limits for MSPs and Extra Help may change each year.
Where to Apply
Apply for MSPs through your state Medicaid office. Apply for Extra Help through Social Security. You can apply for both programs at the same time.
Questions? Call our Multilingual Helpline for assistance.
Medicaid
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MAGI Medicaid
Medicaid coverage for certain children, pregnant people, parents, and adults whose financial eligibility is determined using Modified Adjusted Gross Income (MAGI). Eligibility generally depends on household income and size, along with other requirements such as state residency, citizenship or immigration status, and eligibility for a specific Medicaid category.
ABD Medicaid
Medicaid for people who are 65 or older, blind, or disabled. When you become eligible for Medicare, your Medicaid eligibility may be reassessed. Eligibility generally considers income and resources, as well as other state-specific requirements. If you continue to meet your state’s Medicaid eligibility requirements, you may qualify for both Medicare and Medicaid.
Important
Medicaid programs are administered by individual states, so eligibility rules and requirements can vary. Check with your state Medicaid agency to find out whether you qualify or how your eligibility may change when you become eligible for Medicare. Find your state Medicaid agency
When to Enroll
Medicaid applications are generally accepted year-round. You can apply at any time if you think you may qualify based on factors such as income, household size, age, pregnancy, disability, or other eligibility requirements. Eligibility is reviewed periodically to determine whether you continue to qualify for coverage.
Beginning in 2027, adults enrolled through the ACA Medicaid expansion will generally have their eligibility redetermined every 6 months. This requirement applies to states that have adopted the ACA Medicaid expansion.
Have questions or need help understanding recent changes to Medicaid?
Contact our Multilingual Helpline for assistance.
Affordable Care Act (ACA) Health Insurance Marketplace
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ACA Health Insurance Marketplace is a health insurance marketplace where eligible individuals and families can compare and enroll in private health plans. Eligible enrollees may qualify for financial assistance, including premium tax credits and cost-sharing reductions, based on household income, household size, and other eligibility requirements. The Marketplace also screens applicants for Medicaid or CHIP eligibility and can direct eligible applicants to those programs. Find your state’s Marketplace.
People who are eligible for Medicare generally should not enroll in a Marketplace plan instead of Medicare. If you are approaching age 65, it is important to understand when to enroll in Medicare and how Medicare eligibility may affect your Marketplace coverage and financial assistance.
ACA Health Insurance Marketplace Important Deadlines
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November 1 - Open Enrollment begins; you can enroll in, renew, or change a Marketplace plan.
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December 15 - Last day to enroll in or change a plan for coverage starting January 1 of the following year
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January 15 - Open Enrollment ends. Plans selected or changed by this date generally start coverage on February 1 of the following year.
If you need further assistance and guidance,
contact our Multilingual Helpline for help.
