Elderly Woman at Gym

MEDICARE

Medicare Insurance

Medicare is health insurance for people 65 or older. You’re first eligible to sign up for Medicare 3 months before you turn 65. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease).

 

Original Medicare is a fee-for-service health insurance program that has 2 parts: Part A and Part B. You typically pay a portion of the costs for covered services as you get them. Under Original Medicare, you don’t have coverage through a Medicare Advantage Plan or another type of Medicare health plan.

Generally, you only need to sign up for Part A and Part B once. Each year, you can choose which way you get your health coverage (and add or switch drug coverage).

 

Medicare is different from private insurance — it doesn’t offer plans for couples or families. You don’t have to make the same choice as your spouse.

Medicare Part A (Hospital Insurance)

Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home healthcare.

Medicare Part B (Medical Insurance)

Helps cover Helps cover: services from doctors and other health care providers, outpatient care, home health care, durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment), and many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits).

Medicare Part D (Drug Coverage)

Helps cover the cost of prescription drugs (including many recommended shots or vaccines). You join a Medicare drug plan in addition to Original Medicare, or you get it by joining a Medicare Advantage Plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare.

Medicare Supplemental Insurance (Medigap)

Extra insurance you can buy from a private company that helps pay your share of costs in Original Medicare. Policies are standardized, and in most states named by letters, like Plan G or Plan K. The benefits in each lettered plan are the same, no matter which insurance company sells it.

Your Medicare Options

Original Medicare

  • Original Medicare includes Part A and Part B.

  • You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).

  • You can use any doctor or hospital that takes Medicare, anywhere in the U.S.

  • To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also buy supplemental coverage, like Medicare Supplement Insurance (Medigap), or have coverage from a former employer or union, or Medicaid.

Medicare Advantage (also known as Part C)

  • Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.

  • In most cases, you’ll need to use doctors who are in the plan’s network.

  • Plans may have lower out-of-pocket costs than Original Medicare.

  • Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.