Medicare Defined: Medicare is a federal program that offers health insurance to American
citizens and other eligible individuals. The program is often called Original Medicare. It has two
parts—Part A and Part B.
How Medicare Works
Medicare Defined: Medicare is a federal program that offers health insurance to
American citizens and other eligible individuals. The program is often called Original Medicare. It has two parts — Part A and Part B.
U.S. citizens and legal residents.
Legal residents must live in the U.S. for at least 5 years in a row, including the 5 years just before applying for Medicare.
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).
Part A covers inpatient hospital and skilled nursing care.
Part B covers doctor visits and outpatient care.
Medicare Advantage plans are optional and provide more coverage.
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.
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) helps pay some or all costs not paid by Original Medicare (deductibles, copays and coinsurance).
You can add coverage to Original Medicare or choose a Medicare Advantage plan instead.
You may add a standalone Part D plan, a Medicare supplement plan or both to Original Medicare (Parts A & B).
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 plan
You may choose to get your benefits through a Medicare Advantage plan (Part C). Many plans come with
built-in prescription drug coverage.
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
Medicare and many Medicare Health plans charge premiums—a fixed amount that you pay each month for your coverage.
You also pay a share of the cost for health care services you receive. There are three types of payments you may have:
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 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.
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.
Think about your needs so you can see how different coverage options might work for you.
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?
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