Turning 65?

Your 65th birthday is a milestone event, and one of the reasons you're probably hearing a lot about Medicare. We created this resource to walk you through the basics, and if you still have questions, we’re here to help.

We understand that Medicare is tricky to navigate

The options can seem overwhelming, and even confusing. At Oscar, we like to keep things simple. We hope this information helps you in your decision-making process.

Your journey starts with some important questions

    • Medicare is a federal health insurance program for people who are 65 and older, and people with certain disabilities.

    • Medicare is broken into four parts: A,B,C, and D.
      • Part A (Hospital insurance) covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. It does not cover regular doctor visits or prescription drugs.
      • Part B (Medical insurance) covers certain doctors' services, outpatient care, medical supplies, and preventive services.
      Part A and Part B are together referred to as "Original Medicare". The two parts complement each other to provide coverage both in and out of the hospital.
      • Part C (Medicare Advantage) is an “all in one” alternative to Original Medicare, with bundled plans that include Part A, Part B, and sometimes Part D. It combines everything you get with Original Medicare while sometimes offering extra benefits such as dental, vision, and hearing services, as well as prescription drug coverage.
      • Part D (Prescription coverage) covers prescription drugs. Part D plans are offered by private companies approved by Medicare.
    • If you're age 65 or older, you're eligilbe for Medicare if you’re a U.S. citizen, and you or your spouse worked and paid Medicare taxes for at least 10 years.

      If you're under age 65, you're eligible for Medicare if you have received Social Security disability benefits for at least 24 months, or you have a qualifying disability or special condition.

    • You are automatically enrolled in Original Medicare (Part A and Part B) when you turn 65 if you’re receiving Social Security retirement or Railroad Retirement benefits. If you haven’t yet received your red, white, and blue Medicare ID card in the mail, contact Social Security for your card and number.If you’re not automatically enrolled, you can sign up during your Initial Enrollment Period (IEP). The IEP is the seven-month period of time when you can enroll for the first time in Medicare Parts A and B. It begins three months before your 65th birthday, lasts the entire month of your birthday and then continues for three months after your birthday. For example, if your birthday is April 5, you would be eligible from January to July. For questions on when you are eligible to sign up for Medicare visit www.medicare.gov.
    • If you want additional coverage, you have some options:Add a Medicare Supplement plan. Medicare Supplement (also called Medigap) can help pay for some of the out-of-pocket costs under Original Medicare. It’s only offered by private insurance companies.Add a Medicare Part D plan. Medicare Part D covers prescription drugs and is offered through private insurance companies—either through Medicare Advantage plans that include prescription drug coverage (like Oscar), or Prescription Drug Plans that offer Part D coverage on its own.Choose a Medicare Advantage (Part C) plan. (The plans Oscar offers fall into this category.) Medicare Advantage is an alternative to Original Medicare offered by health insurance companies, like Oscar. These plans combine everything you get in Part A (hospital insurance) and Part B (medical insurance), typically with added benefits, such as prescription drug coverage (Part D), dental, vision, and wellness perks. If you join a Medicare Advantage plan, you’ll still have Medicare plus supplemental health benefits—but the Medicare Advantage plan is your primary insurer. Note: You cannot enroll in a Medicare Advantage plan or purchase a Medicare Supplement plan unless you’re enrolled in both Part A and Part B.
    • With Original Medicare, you receive coverage for hospital and medical expenses, and you usually pay 20% of the cost of the service. There is no maximum-out-of-pocket cost limit, so you won't know how much you'll spend on health care for the year. Original Medicare alone does not cover prescription drugs. You'll have to purchase a stand alone Part D plan to cover the costs.Medicare Advantage plans have set maximum out-of-pocket expense limits. Once you've reached that amount for the year, your insurance company will pay for 100% of covered medical services. A Medicare Advantage plan covers all Original Medicare covered services, plus most cover prescription drugs and offer supplemental benefits like dental, vision, hearing and fitness benefits.For more information on the differences between Original Medicare and Medicare Advantage visit our blog post here.
    • To enroll in a Medicare Advantage (Part C) plan, you must:
      • Have Medicare Parts A and B
      • Live in the Medicare Advantage plan’s service area
      • Not have End-Stage Renal Disease
      You can enroll in a plan during your Initial Coverage Election Period (ICEP)—the period in which individuals who are newly eligible for Medicare can enroll in a Medicare Advantage plan. For many people, the ICEP occurs simultaneously with the Initial Enrollment Period (IEP)—the seven-month period that begins three months before (and ends three months after) your 65th birthday. For example, if your birthday is April 5, your IEP is from January to July. If you enroll in Part A and Part B during your IEP, then your ICEP is the same 7-month duration as your IEP, from January to July. However, if you delay Part B enrollment because you already have health coverage, such as through an employer’s plan, your Initial Coverage Election Period will not take place until you’re enrolled in Part B.Learn more about other opportunities to enroll in a Medicare Advantage plan.

Still have questions?

Call us at 1-855-672-2710 (TTY: 711). We can walk you through the basics of Medicare, help you understand our plans and benefits, check if your doctor is in our network, find out your prescription costs, or enroll in a plan.We’re here to help you every step of the way.
Contact your Concierge Team