Understanding Medicare options and benefits
Medicare offers comprehensive health insurance coverage to millions of American seniors and people with disabilities.
What is Medicare?
Medicare is a federal government medical insurance program for seniors and disabled people and covers hospitalizations, outpatient care, and other health care services. Medicare beneficiaries typically pay a monthly premium and out-of-pocket costs when needing care. Medicare is also funded by taxes.
Who is eligible for Medicare?
Eligibility for Medicare includes:
- You’re 65 or older.
- You receive Social Security Disability benefits for at least 24 months.
- You receive Railroad Retirement Board benefits for at least two years.
- You have end-stage renal disease or amyotrophic lateral sclerosis (ALS), which is also called Lou Gehrig’s disease.
Your Medicare coverage options
You can choose between Original Medicare and Medicare Advantage when you first sign up for Medicare during the initial enrollment period and during open enrollment. Here are the differences.
Original Medicare
- Original Medicare includes Medicare Parts A and B and is administered by the Centers for Medicare and Medicaid Services. Part A covers hospital insurance and Medicare Part B covers medical insurance.
- Beneficiaries with Original Medicare can visit any doctor who takes Medicare.
- You can also add a Medicare Part D plan, which provides prescription drug benefits.
- People with Original Medicare can also get Medicare supplement insurance called Medigap, which helps pay out-of-pocket medical expenses.
Medicare Advantage
- A Medicare Advantage plan combines Part A and Part B and many plans also provide prescription drug benefits.
- Private insurance companies offer Medicare Advantage plans.
- Medicare Advantage plans have more restricted provider networks than Original Medicare.
- These private plans can offer supplemental coverage not found in Original Medicare, including other insurance coverage like vision and dental care.
What Medicare benefits cover
- Inpatient hospital care
- Doctor visits
- Outpatient care
- Skilled nursing facility
- Hospice
- Lab tests
- Surgery
- Durable medical equipment
- Preventive services
What Medicare does not cover
- Long-term care
- Dental care
- Eye exams for glasses and contacts
- Dentures
- Cosmetic surgery
- Hearing aids
- Acupuncture
- Routine foot care
Note: Medical Advantages plans may cover some of these services, but Original Medicare does not.
| Medicare Supplement Benefits | A | B | C | D | F* | G* | K | L | M | N |
|---|---|---|---|---|---|---|---|---|---|---|
| Part A Coinsurance and Hospital Costs (Up to an additional 365 days after Medicare benefits are used) | ||||||||||
| Part B Coinsurance or Copayment | 50% | 75% | ||||||||
| Blood (first 3 pints) | 50% | 75% | ||||||||
| Part A Hospice care coinsurance or copayment | 50% | 75% | ||||||||
| Skilled nursing facility care coinsurance | – | – | 50% | 75% | ||||||
| Part A Deductible | – | 50% | 75% | 50% | ||||||
| Part B Deductible | – | – | – | – | – | – | ||||
| Part B Excess Charges | – | – | – | – | – | – | ||||
| Foreign Travel Emergency Care (up to plan limits) | – | – | 80% | 80% | 80% | 80% | – | – | 80% | 80% |
Plan pays 100% of the benefit
Frequently asked questions
No, you don’t have to get Medicare coverage when you become 65. However, Part A (hospital coverage) is free for most Americans, so there isn’t an advantage in not accepting Part A coverage.
You may decide to delay Part B coverage, but you will likely have to pay more for that coverage when you eventually sign up. Medicare may charge a 10% for each year that you don’t sign up for Part B.
So, if you wait three years to sign up for Part B after becoming eligible, you’ll likely pay 30% higher premiums for Part B.
You may decide to delay Part B coverage, but you will likely have to pay more for that coverage when you eventually sign up. Medicare may charge a 10% for each year that you don’t sign up for Part B.
So, if you wait three years to sign up for Part B after becoming eligible, you’ll likely pay 30% higher premiums for Part B.
Turning 65 automatically makes you eligible for Medicare coverage.
Whether you decide to sign up for coverage is up to you.
Whether you decide to sign up for coverage is up to you.
If you have Original Medicare, you may switch Medicare supplement insurance plans (called Medigap) if you feel another Medigap policy fits your needs better.
There are 10 types of Medigap policies and all of them help with out-of-pocket costs. However, Medicare supplemental insurance plans differ in specifics and expanded coverage.
There are 10 types of Medigap policies and all of them help with out-of-pocket costs. However, Medicare supplemental insurance plans differ in specifics and expanded coverage.
You can typically change your Medicare coverage only during the initial enrollment period and the open enrollment period also called the general enrollment period.
However, you may qualify for a special enrollment period if you face a qualifying life event that may affect your coverage. A special enrollment period may be needed if you move to another state, lose other health coverage, a spouse dies, or you get divorced.
However, you may qualify for a special enrollment period if you face a qualifying life event that may affect your coverage. A special enrollment period may be needed if you move to another state, lose other health coverage, a spouse dies, or you get divorced.
People who turn 65 and are collecting Social Security benefits are automatically enrolled in Medicare Part B. If you’re not collecting Social Security benefits yet, you need to enroll online, over the phone, or in person.
Newly eligible Medicare beneficiaries can enroll from three months before the month of their 65th birthday to three months after the 65th birthday. This is called the initial enrollment period.
You should receive your Medicare card during the month before your 65th birthday.
Medicare offers comprehensive health insurance coverage to millions of American seniors and people with disabilities.
You should receive your Medicare card during the month before your 65th birthday.
Medicare offers comprehensive health insurance coverage to millions of American seniors and people with disabilities.
| Medicare Supplement Benefits | A | B | C | D | F* | G* | K | L | M | N |
|---|---|---|---|---|---|---|---|---|---|---|
| Part A Coinsurance and Hospital Costs (Up to an additional 365 days after Medicare benefits are used) | ||||||||||
