Who is eligible for Medicare?
U.S. citizens and legal residents.
You must also meet one of the following requirements:
- Age 65 or older
- Younger than 65 with a qualifying disability
- Any age with a diagnosis of end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).
What benefits does Medicare provide?
Each part of Medicare provides different benefits.
- Part A covers inpatient hospital and skilled nursing care.
- Part B covers doctor visits and outpatient care.
- Optional alternative to Original Medicare, also referred to as “Part C.”
- Medicare Advantage plans (Part C) combine Part A and Part B coverage. They often include drug coverage and other benefits you don’t get with Original Medicare but can have differences in physician networks.
Medicare Prescription Drug
- Medicare prescription drug plans (Part D) help pay for medications. You can get a standalone Part D plan or get a Medicare Advantage plan that includes drug coverage.
Medicare Supplement Insurance (Medigap)
- Medicare Supplement Insurance (Medigap) helps pay some or all costs not paid by Original Medicare (deductibles, copays and coinsurance).
What are my coverage options?
- Parts A + B
- Parts A + B plus Part D prescription coverage
- Parts A + B plus a Medicare supplement plan
- Parts A + B plus both Part D prescription coverage and a Medicare Supplement Insurance plan
- Part C with no drug coverage
- Part C with built-in Part D prescription coverage
- Part C plus a standalone Part D prescription coverage plan in limited circumstances
If you choose Medicare Advantage, you cannot also purchase a Medicare Supplement Insurance plan.
What does Medicare cost?
- Deductible: A set amount you pay out of pocket for covered services each year before Medicare or your plan begins to pay.
- Copay: A fixed amount determined by the plan that you pay at the time you receive a covered service. For example, you might pay $20 when you visit the doctor or $12 when you fill a prescription.
- Coinsurance: A percentage of the cost for a covered service that you pay when you receive it. For example, Medicare might pay 80% of the covered service and the remaining 20% would be paid by you.
When can I enroll?
- Your Initial Enrollment Period (IEP) is 7 months long. It includes your 65th birthday month plus the 3 months before and the 3 months after.
- Your IEP begins and ends one month earlier if your birthday is on the first of the month.
- Your IEP is based on your 25th month of receiving benefits if you become eligible for Medicare due to a qualifying disability.
- If you’re getting these benefits, in most cases, you’ll automatically get Part A and Part B starting the first day of the month you turn 65. If your birthday is on the first day of the month, Part A and Part B will start the first day of the prior month.
How should I choose my coverage?
- How often do you go to the doctor?
- What health problems do you have?
- What medications do you take regularly?
- What are you able to pay each month in premiums?
- How comfortable are you covering copays or coinsurance for services?
- How willing are you to accept the risk of high out-of-pocket costs?
- Which doctors, hospitals and pharmacies do you like to go to?
- How important is it for you to have access to health care while traveling?
- What other coverage do you have, such as an employer or retiree plan?