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An Overview of Medicare

Medicare Overview

Getting started with Medicare or Medicare Advantage and want to learn about the basics?

What is Medicare?

Medicare is a federal health insurance program for people aged 65 and older, and people with certain disabilities.

The ABCDs of Medicare Benefits

At a basic level, Medicare is broken into four parts: A, B, C and D as outlined below:

 

Part

A

Hospital Insurance

Covers

Inpatient hospital stays

Care in skilled nursing facility

Hospital care

Some home health care

It does NOT cover regular doctor visits or prescription drugs

Part

B

Medical Insurance

Covers

Certain doctors’ services

Outpatient care

Medical supplies

Preventative services

Part

C

Medical Insurance

Covers

Everything you get with Original Medicare (Parts A and B)

An “all in one” alternative to original Medicare, with bundled plans that include Part A and Part B, and sometimes Part D.

Sometimes Covers

Dental care

Vision benefits

Over-the-counter items

and more...

Part

D

Medicare Advantage

Covers

Prescription drugs

Part D plans are offered by private companies approved by Medicare

Original Medicare

Part A and Part B are together referred to as “Original Medicare.” Original Medicare only includes hospital and medical insurance, so if you need prescription drug coverage, you’ll need to enroll in a separate Part D plan.

Medicare Supplement

Medicare Supplement Insurance plans (also called Medigap) are only available to people who already have Medicare Part A and Medicare Part B. Medigap can help pay for some of the out-of-pocket costs under Original Medicare. These plans may be associated with additional costs and some health services are not covered such as vision or dental care, hearing aids and eyeglasses.

Medicare Advantage

Medicare Advantage is an alternative to Original Medicare offered by private health insurance companies. These plans combine everything you get in Part A (hospital insurance) and Part B (medical insurance), typically with added benefits, such as prescription drug coverage (Part D), dental, vision, wellness perks, and more.

If you join a Medicare Advantage plan, you’ll still have Medicare plus supplemental health benefits—but the Medicare Advantage plan is your primary insurer.

Eligibility and Enrollment

  • If you’re not already getting benefits, you should contact Social Security about three months before your 65th birthday to sign up for Medicare. You should sign up for Medicare even if you don’t plan to retire at age 65. If you’re already getting Social Security benefits or Railroad Retirement Board benefits, we’ll contact you a few months before you become eligible for Medicare and send you information
  • You should receive this red, white, and blue Medicare ID card in the mail
*If you have another insurance card, you likely may be part of another plan
  • If you haven’t received your card, connect with your local SS office.
  • If you were not automatically enrolled, you can sign up for Original Medicare during your Initial Enrollment Period (IEP) - the seven-month period of time when you can enroll for the first time in a Medicare plan - online at www.ssa.gov/medicare, visit your local Social Security office, or call 1-800-772-1213.

How to Choose the Right Option for You

There are some key differences to consider when choosing which option is best for you:

Part A and Part B

Original Medicare

Typically charges 20% coinsurance

Responsible for paying 20% of total bill with no limit on how much you could spend in a single year

Does not cover prescription drugs or offer extra benefits such as coverage for routine dental, vision, or hearing exams

Additional Medicare Supplement Insurance (Medigap) plans do not cover additional health services such as vision care, dental care, hearing aids and eyeglasses

Part D

Medicare Advantage

Medicare Advantage plans have set maximum out-of-pocket limits

Once maximum out-of-pocket limit is reached, the plan will pay for 100% of costs

Many Medicare Advantage plans include prescription drug coverage and benefits like dental, vision, and hearing

Other extra benefits can include hearing aids, an allowance for over-the-counter items like pain relievers and personal care products, and membership to fitness facilities

Medicare Supplement Insurance plans may also have set out-of-pocket limits and those vary more by the type of plan you have