Medicare Basics

What’s Medicare?
Medicare is health insurance for people 65 or older, certain people who are under 65 with
disabilities, and people of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).  The different parts of Medicare help cover specific services.

Part A (Hospital Insurance)
Helps cover:
• Inpatient care in hospitals
• Skilled nursing facility care
• Hospice care
• Home health care

Part B (Medical Insurance)
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)
• Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)

Part D (Drug coverage)
Helps cover:
Cost of prescription drugs (including many recommended shots or vaccines)
Plans that offer Medicare drug coverage (Part D) are run by private insurance companies that follow rules set by Medicare.

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Your Medicare coverage options
When you first sign up for Medicare, and during certain times of the year, you can choose how you get your Medicare coverage. There are 2 main ways to get Medicare.

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Original Medicare
• Includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
• 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 shop for and buy supplemental coverage.

Supplemental coverage
This includes Medicare Supplement Insurance (Medigap). Or, you can use coverage from a former
employer or union, or Medicaid.

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Medicare Advantage (also known as Part C)
• 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 can only use doctors who are in the plan’s network.
• In many cases, you may need to get approval from your plan before it covers certain drugs or services.
• 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.

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Medicare and the Health Insurance Marketplace®
Even if you have Marketplace coverage, you should generally sign up for Medicare when you're first eligible to avoid the risk of a delay in Medicare coverage and the possibility of a Medicare late enrollment penalty. Once you're eligible for Medicare, you'll have an Initial Enrollment period to sign up for Medicare. For most people, this is the 7-month period that starts 3 months before the month they turn 65, includes the month they turn 65, and ends 3 months after the month they turn 65. You can keep your Marketplace plan without penalty until your Medicare coverage starts. Once you’re considered eligible for premium-free Part A or enrolled in Part A with a premium, you won’t qualify for help from the Marketplace to pay your Marketplace plan premiums or other medical costs. If you continue to get help paying your Marketplace plan premium after you're considered eligible for premium-free Part A or enrolled in Part A with a premium, you may have to pay back some or all of the help you got when you file your federal income taxes. Visit HealthCare.gov to connect to the Marketplace in your state, or learn how to end your Marketplace plan when you become eligible for Medicare to avoid a gap in coverage. You can also call the Marketplace Call Center at 1-800-318-2596. TTY users can call 1-855-889-4325.
Note: Medicare isn’t part of the Marketplace. The Marketplace doesn’t offer Medicare Supplement Insurance (Medigap) policies, Medicare Advantage Plans, or Medicare drug coverage (Part D). Find more information about Medicare
To learn more about Medicare:
• Visit Medicare.gov.
• Read your “Medicare & You” handbook.
• Get free, personalized counseling from your State Health Insurance Assistance Program (SHIP). (Go to pages 47– 48.)
• Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
• Find and compare health and drug plans at Medicare.gov/plan-compare and compare Medigap policies, too.

 

Health Insurance Marketplace® is a registered service mark of the U.S. Department of Health & Human Services.