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Medicare
What is Medicare
Medicare is a U.S. government health insurance program that
primarily covers people age 65 or older, but can cover
younger individuals with certain types of illnesses or
patients with end-stage renal disease (ERD) or amyotrophic
lateral sclerosis (ALS). Medicare covers particular
healthcare services. Some services covered by Medicare
require Medicare enrollees to share the costs. While this
arrangement can offer participants more healthcare options
and lower their costs, it can also create more complexity
when they seek services. It was created in 1965 to provide health
coverage for Americans aged 65 and older. Medicaid, on the other hand,
is both a federal and state-funded assistance program that helps
low-income people of every age with healthcare costs.
The History of the Medicare Program
In 1965, President Lyndon B. Johnson signed a bill that created the
Medicare and Medicaid programs. The original Medicare program included
Part A (Hospital Insurance) and Part B (Medical Insurance). Today, we
refer to Parts A and B as Original Medicare.
In the intervening years, Congress expanded Medicare by making more
people eligible for coverage and extending coverage for more medical
conditions. In 1972, Medicare expanded to cover the disabled, people
with end-stage renal disease who require dialysis or a kidney
transplant, and people aged 65 or older who select Medicare coverage.
Congress has since added new benefits like prescription drug coverage.
The Medicare Prescription Drug Improvement and Modernization Act (MMA)
of 2003 made the biggest changes to Medicare in 38 years. MMA
established the creation of private health plans approved by Medicare,
known as Medicare Advantage Plans. These plans are sometimes called Part
C or “MA Plans.” The MMA also expanded Medicare to include an optional
prescription drug benefit, Part D, which went into effect in 2006.
On March 27, 2020, in response to the COVID-19 pandemic, then-President
Donald Trump signed into law a $2 trillion package of relief measures,
called the Coronavirus Aid, Relief, and Economic Security (CARES)
Act. It expanded Medicare coverage for the treatment of COVID-19. The
CARES Act also improved telehealth service coverage and increased
Medicare payments for COVID-19-related hospital stays and durable
medical equipment.
In 2022, the Inflation Reduction Act was passed and included a redesign
of Medicare prescription drug coverage and other costs.
What health insurance programs are available
for aging and/or low-income people?
Medicare is a Federal health insurance program for
people 65 years or older, certain people with disabilities,
and people with end-stage renal disease (ESRD). When you
first enroll in Medicare, you'll have Original Medicare,
unless you make another choice. There are different ways you
can get Medicare coverage, including a Medicare Advantage
Plan (like HMO or PPO). In some types of plans that don't
offer drug coverage, you may be able to join a Medicare
Prescription Drug Plan.
Visit Medicare.gov to:
- Get detailed information about the Medicare health and
prescription drug plans in your area, including what
they cost and what services they provide.
- Find doctors or other health care providers and
suppliers who participate in Medicare.
- See what Medicare covers, including preventive services.
- Get Medicare appeals information and forms.
- Get information about the quality of care provided by
plans, nursing homes, hospitals, home health agencies,
and dialysis facilities.
- Look up helpful websites and phone numbers.
For information on Medicare, visit the https://www.medicare.gov/ or
call toll free 1-800-MEDICARE.
Medicare Prescription Drug Coverage: Since January
1, 2006, everyone with Medicare, regardless of income,
health status, or prescription drug usage has had access to
prescription drug coverage. For more information about this
program, visit: http://www.medicare.gov.
Medicare offers prescription drug coverage to everyone with
Medicare. If you decide not to join a Medicare Prescription
Drug Plan (Part D) when you're first eligible, and you don't
have other creditable prescription drug coverage, or you
don't get Extra Help, you'll likely pay a late enrollment
penalty.
To get Medicare drug coverage, you must join a plan run by
an insurance company or other private company approved by
Medicare. Each plan can vary in cost and drugs covered.
There are two ways to get drug coverage:
- A Medicare Prescription Drug Plan (Part D)
- A Medicare Advantage Plan (Part C), like an HMO or PPO,
or other Medicare health plan that offers Medicare
prescription drug coverage.
Visit https://www.medicare.gov for
more information on these two options, or call
1-800-MEDICARE. TTY users can call
1-877-486-2048.
Parts of Medicare
When you first sign up for Medicare and during certain times of the
year, you can choose which way to get your Medicare coverage.
There are
2 main ways:
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.
- You can also shop for and buy
supplemental coverage that helps pay your out-of-pocket costs (like
your 20% coinsurance).
Part A (Hospital Insurance)
Part A helps cover inpatient care
in hospitals, skilled nursing facility care, hospice care, and home
health care.
Part B (Medical Insurance)
Part B 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)
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 many cases, you can only use
doctors who are in the plan’s network.
- Plans often have different
out-of-pocket costs than Original Medicare or supplemental coverage
like Medigap. You may also have an additional premium.
- Plans may offer some extra
benefits that Original Medicare doesn’t.
Part D (Drug coverage)
Part D 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.
What’s the difference between Medicare & Medicaid?
Medicare and Medicaid are government-funded health insurance
programs. Medicare eligibility is typically determined by
age or medical history, while Medicaid eligibility is based
on income level. Medicaid and Medicare are often confused or used
interchangeably. Although they sound similar, these two programs
are actually very different.
Each is regulated by its own set of laws and policies, and the
programs are usually designed for different sets of people.
However, it’s possible to be eligible for both programs.
Different agencies administer each program
The federal government provides Original
Medicare (Parts A and B). Private insurance companies
contract with the federal government to offer Medicare
Advantage (Part C) and stand-alone prescription
drug (Part D) plans. Medicare is financially supported by two dedicated trust funds
held by the U.S. Treasury. Workers pay
into these funds through payroll taxes. The Hospital Insurance Trust Fund supports Part A, while the
Supplementary Medical Insurance Trust Fund supports Part B, Part
D, and the overall administration of Medicare.
Part C is funded through a combination of government payments to
private insurers and premiums paid by beneficiaries.
Medicaid is a joint federal and state program. State governments
establish and administer the program according to federal
requirements, securing federal funding.
The federal government pays states for a specific percentage of
program expenses, called the Federal Medical Assistance
Percentage (FMAP).
The federal government also provides “disproportionate share
hospital (DSH)” payments to hospitals that support many Medicaid
beneficiaries.
Eligibility requirements are different for each program
In most cases, Medicare eligibility is based on age. All U.S.
citizens and permanent
residents of at least 5 years are eligible for Medicare at
age 65.
You may
qualify for Medicare before age 65 if you have:
- received Social Security or Railroad Retirement Board (RRB)
disability benefits for at least 2 years
- end stage renal disease (ESRD)
- amyotrophic lateral sclerosis (ALS), also known as Lou
Gehrig’s disease
Eligibility for Medicaid in each state is based primarily on
income.
The Affordable Care Act established a
minimum income threshold based on Modified
Adjusted Gross Income (MAGI) that’s used to
determine financial eligibility for:
- Medicaid
- Children’s Health Insurance Program (CHIP)
- premium tax credits and cost-sharing reductions through the health
insurance marketplace
MAGI is a combination of:
- adjusted gross income (AGI)
- tax-exempt interest
- Social Security benefits not included in gross income
- excluded foreign income
To determine eligibility, MAGI is compared to the federal
poverty level (FPL) for the household
size claimed on your taxes.
Forty states and Washington, D.C., have
expanded Medicaid to cover people under 65 with incomes at
or below 133% of the FPL.
The 2024
FPL for most people is:
- $15,060 for an individual
- $20,440 for a household of two
- $25,820 for a household of three
- $31,200 for a household of four
FPL amounts are higher in Alaska and Hawaii.
Some states have also expanded Medicaid eligibility to better
cover specific groups. For example, all
but four states have extended Medicaid coverage to pregnant
people with incomes above the currently required level.
According to the Centers
for Medicare & Medicaid Services (CMS), Medicaid typically
covers:
- children and adolescents
- parents and caregivers of minor children
- people with certain disabilities or blindness
- adolescents who are no longer eligible for foster care due
to age
- pregnant people
- adults ages 65 or older
What does Medicare cost?
Is Medicare Free?
For most individuals, Medicare Part A premiums are free
based on past payroll tax payments under the Federal
Insurance Contributions Act (FICA). Individuals can also
qualify for free Medicare Part A based on the work
history of a spouse. Those who do not qualify have to
pay a premium for Medicare Part A. Other Medicare
components require a premium payment.
Is Medicare Insurance?
Medicare covers healthcare costs for eligible
individuals in the same way that health insurance does.
Oftentimes, there is no premium for Medicare Part A, but
coverage is more limited than private health
insurance—no free preventive care or ongoing care for
chronic diseases, for example. Private health insurance
often allows you to extend coverage to dependents, such
as a spouse and children. Medicare participants, on the
other hand, must qualify based on their age or
disability.
Generally, you pay a monthly premium for Medicare coverage and part of
the costs each time you get a covered service. There’s no yearly limit
on what you pay out-of-pocket, unless you have supplemental coverage,
like a Medicare Supplement Insurance (Medigap) policy, or you join
a Medicare Advantage Plan.
Costs for Part A (Hospital Insurance)
Costs: |
What you pay in 2025: |
Part A Premium |
$0 for most people (because they paid Medicare
taxes long enough while working - generally at least 10
years). This is sometimes called “premium-free Part A.”
If you don’t qualify for a premium-free Part A, you might be
able to buy it. In 2025, the premium is either $285 or $518
each month, depending on how long you or your spouse worked
and paid Medicare taxes.
- You also have to
sign up for Part B to buy Part A.
- If you don’t buy
Part A when you’re first eligible for Medicare (usually
when you turn 65), you might pay a penalty.
|
Part A Deductible |
$1,676 for each time you’re admitted to the
hospital per benefit period, before Original Medicare
starts to pay.
There's no limit to the number of benefit periods you can
have.
|
Inpatient stays
(co-payments) |
Days 1-60: $0 after you pay your Part A deductible
Days 61-90: $419 each day
Days 91-150: $838 each day
After day 150: You pay all costs
|
Skilled Nursing Facility
(co-payments) |
Days 1-20: $0 after you pay your Part A deductible
Days 21-100: $209.50 each day
After day 100: You pay all costs
|
Costs for Part B (Medical Insurance)
Costs: |
What you pay in 2025: |
Part B Premium |
$185 each month (or higher depending on your
income). The amount can change each year.
You’ll pay the premium each month, even if you don’t get any
Part B-covered services.
You might pay a penalty if you don’t sign up for Part B when
you’re first eligible for Medicare (usually when you turn
65).
How much is the Part B late enrollment penalty?
- You’ll pay an extra
10% for each year you could have signed up for Part B,
but didn’t.
- This penalty is
added to your monthly Part B premium. (You may also pay
a higher premium depending on your income.)
- It’s not a one-time
late fee — you’ll pay the penalty for as long as you
have Part B.
- Generally, you won’t have
to pay a penalty if you qualify for a Special Enrollment
Period
- To qualify, you (or your spouse) must still be
working and you must have health coverage based on that
job.
|
Part B Deductible |
You’ll pay $257, before Original Medicare starts to pay. You
pay this deductible once each year.
|
Costs for services
(coinsurance) |
You’ll usually pay 20% of the cost for each
Medicare-covered service or item after you’ve paid your
deductible.
|
Get help with Part A & Part B costs
If you have limited income and resources, you may be able to get help
from your state to pay your premiums and other costs, like deductibles,
coinsurance, and copays.
Costs for plans & supplemental coverage
Drug coverage (Part D):
Costs: |
What you pay in 2025: |
Part D Premium |
Monthly premiums vary based on which plan you join. The
amount can change each year. The average basic Part D
premium for 2025 is $36.78 per month, a 6% increase over
last year.
You may also have to pay an extra amount each month based on
your income.
You might pay a penalty if you:
- Don’t join a
Medicare drug plan when you first get Medicare, and
- Go 63 days or more
without
creditable drug coverage
(coverage that’s similar in value to Part D).
How much is the Part D penalty?
- You’ll pay an extra
1% for each month (that’s 12% a year) you could have
signed up for Part D, but didn’t.
- The penalty is added
to your monthly premium.
- It’s not a one-time
late fee — you’ll pay the penalty each month for as long
as you have Part D coverage (even if you change plans).
- If you have
creditable drug coverage or if you qualify for Extra
Help, you won’t have
to pay a penalty.
|
When you get prescription drugs |
Most plans charge a deductible, an amount you pay before the
plan starts to pay, for prescriptions you fill. The
deductible amount varies based on which plan you join.
Your actual costs vary depending on the medicines you take,
if they are on your plan’s list of covered drugs, and which
pharmacy you use. |
Getting help with Medicare costs
Enrolling in Medicare during your initial enrollment period
can help you avoid late enrollment penalties, which may
raise your monthly costs.
When possible, you can lower your Medicare costs with
one of the following programs:
Medicare Advantage Plan (Part C):
- Monthly premiums vary based on
which plan you join. The amount can change each year.
- You must keep paying your Part B
premium to stay in your plan.
- Deductibles, coinsurance, and
co-payments vary based on which plan you join.
- Plans also have a yearly limit
on what you pay out-of-pocket. Once you pay the plan’s limit, the
plan pays 100% for covered health services for the rest of the year.
Medicare Supplement Insurance (Medigap):
- Monthly premiums vary based on
which policy you buy, where you live, and other factors. The amount
can change each year. Premiums generally range from about $100 to
over $300 per month. Plans with higher premiums, like
Plan G, typically have fewer out-of-pocket costs, while
cost-sharing options like Plan K or L have lower
premiums but require more expenses during care.
- You must keep paying your Part B
premium to keep your supplement insurance.
- Helps lower your share of costs
for Part A and Part B services in Original Medicare.
- Some Medigap policies include
extra benefits to lower your costs, like coverage when you travel
out of the country.
Assistance for Medicare participants who have lower income
Those with limited income can get help
paying for Original Medicare and Part D. Medicare savings
programs help pay premiums, deductibles, coinsurance, and other
costs. Medicare savings programs
Learn the four types of Medicare
savings programs in detail in the following sections.
Qualified Medicare Beneficiary (QMB) program
You can qualify for the QMB
program if you have a monthly income of less than $1,325 and
total resources of less than $9,660.
For married couples, the limit is less than $1,783 monthly and less
than $14,470 in total.
You are not responsible for the costs of premiums, deductibles,
copayments, or coinsurance amounts under a QMB plan.
Specified Low-Income Medicare Beneficiary (SLMB) program
If you make less than $1,585 a month and have less than $9,660 in
resources, you can qualify for SLMB.
Married couples need to make less than $2,135 and have less than
$14,470 in resources to qualify.
This program covers your Part B premiums.
Qualifying Individual (QI) program
The QI
program also covers Part B costs and is run by each U.S. state.
You’ll need to reapply yearly. Applications are approved on a
first-come, first-served basis. You can’t qualify for the QI program
if you have Medicaid.
If you have a monthly income of less than $1,781 or a joint monthly
income of less than $2,400, you are eligible to apply for the QI
program. You’ll need to have less than $9,660 in resources. Married
couples need to have less than $14,470 in resources.
Income limits are higher in Alaska and Hawaii for all programs.
Additionally, if your income is from employment and benefits, you
could qualify for these programs even if you make slightly above the
limit.
You can contact
your state Medicaid office if you think you might qualify.
Qualifying Disabled & Working Individual (QDWI) program
The QDWI
program helps pay the Medicare Part A premium for certain
individuals under age 65 who don’t qualify for premium-free Part A.
You must meet the following income requirements to enroll in your
state’s QDWI program:
- an individual monthly income of $5,302 or less
- an individual resources limit of $4,000
- a married couple monthly income of $7,135 or less
- a married couple resources limit of $6,000
Can I get help with Part D costs?
The Extra Help program, also known as the Part D Low-Income
Subsidy, provides financial help for prescription drugs
based on income and level of financial need. Extra Help is a federal program, set up specifically for helping
with prescription medications only.
It’s different from the state-sponsored Medicare savings
programs.
What does Extra Help pay for?
If you have limited income and resources, the Extra Help program can
cover your Part
D prescription drug plan premiums, deductibles, and copayments.
Your typical
costs with Extra Help in 2025 are:
-
Premium: $0
-
Deductible: $0
-
Generic drugs: up to $4.90 for each prescription
-
Brand-name drugs: up to $12.15 for each prescription
According to the Social Security Administration (SSA), the Extra
Help program may provide up to $6,200 worth
of annual assistance for each beneficiary.
Extra Help does not apply to Original
Medicare (parts A and B), Medicare Advantage (Part
C), or Medicare supplement (Medigap)
plans.
What are the income limits for the Extra Help program?
To qualify, you’ll need to meet the income
requirements, which are based on the annual federal poverty
level. The income limits are higher for people who live in
Alaska and Hawaii than for those in the rest of the United
States.
There’s also a limit on the value of your individual or combined
resources. Resources can include things like:
- checking, savings, or retirement accounts
- stocks
- bonds
2025 income and resource limits for Alaska:
|
Income limit |
Resource limit |
Individual |
$29,325 |
$17,600 |
Joint (married) |
$39,645 |
$35,130 |
2025 income and resource limits for Hawaii:
|
Income limit |
Resource limit |
Individual |
$26,985 |
$17,600 |
Joint (married) |
$36,480 |
$35,130 |
2025 income and resource limits for the rest of the United
States:
|
Income limit |
Resource limit |
Individual |
$23,475 |
$17,600 |
Joint (married) |
$31,725 |
$35,130 |
How do you apply for the Extra Help program?
It might seem like applying for a program such as Medicare Extra
Help would require a lot of paperwork. But the application
process might be easier than you think.
Here are some tips:
- You can submit the form through the mail or through the SSA’s
website. If you’re sending your application by mail,
make sure to use an original form, not a photocopy.
- You don’t have to submit documents proving your income or
assets, and you don’t have to give the government access to
your bank account to complete the application.
- You don’t have to list public assistance, foster care
payments, interest, or dividends from investments on this
application.
- You don’t have to list the value of your home, car, or
farmland property on the application.
- Listing children or grandchildren who live with you on your
application could make you eligible for Extra Help.
Call Medicare at
800-633-4227 (TTY:
877-486-2048) to have
someone guide you through the process or fill out the form for
you. Help is available 24 hours per day, 7 days per week, except
for some federal holidays.
What resources are available to help with other Medicare
costs?
There are four kinds of Medicare
savings programs to help you with the costs of Part
A and Part
B if you need assistance. Rules for these programs vary
according to the state you live in.
These programs, each of which has its own criteria, can help you
pay for Medicare in different ways:
- Qualified Medicare Beneficiary (QMB) program
- Specified Low-Income Medicare Beneficiary (SLMB) program
- Qualifying Individuals (QI) program
- Qualified Disabled and Working Individuals (QDWI) program
You can call Social
Security at 800-772-1213 (TTY:800-325-0778) to find out which
benefits you’re eligible to receive. Help is available from
8 a.m. to 7 p.m. local time on weekdays. What about Medicaid?
If you qualify for Medicaid,
your costs will be covered. You won’t be responsible for premiums or
other plan costs.
Each state has different rules for Medicaid eligibility. You can use
this tool from the Health
Insurance Marketplace to see whether you might qualify for
Medicaid in your state.
How much will I pay for premiums in 2025?
Most people will pay the standard amount for their Medicare Part B
premium. However, you’ll owe an IRMAA if you make more than $106,000 in
a given year.
For Part D, you’ll pay the premium for the plan you select.
Depending on your income, you’ll also pay an additional amount to
Medicare.
The following table shows the income brackets and IRMAA amount
you’ll pay for Part B and Part D in 2025 (based on your 2023 tax
return):
Yearly income
in 2023
single |
Yearly income in 2023
married, joint filing |
2025 Medicare Part B
monthly premium |
2025 Medicare Part D
monthly premium |
$106,000 or less |
$212,000 or less |
$185 |
just your plan’s premium |
$106,001 to $133,000 |
$212,001 to $266,000 |
$259 |
your plan’s premium plus $13.70 |
$133,001 to $167,000 |
$266,001 to $334,000 |
$370 |
your plan’s premium plus $35.30 |
$167,001 to $200,000 |
$334,001 to $400,000 |
$480.90 |
your plan’s premium plus $57 |
$200,001 to
$500,000 |
$400,001 to $750,000 |
$591.90 |
your plan’s premium plus $78.60 |
$500,000 or more |
$750,000 or more |
$628.90 |
your plan’s premium plus $85.80 |
There are different brackets for married couples who file taxes
separately. If this is your filing situation, you’ll pay the
following amounts for Part B in 2025 (based
on your 2023 tax return):
- $185 per month if you made $106,000 or less
- $591.90 per month if you made more than $106,000 and less than
$394,000
- $628.90 per month if you made $394,000 or more
Your Part B premium costs will be deducted directly from your Social
Security or Railroad Retirement Board benefits. If you don’t receive
either benefit, you’ll get a bill from Medicare every 3 months.
Just like with Part B, there are different brackets for married
couples who file separately. In this case, you’ll pay the following
premiums for Part
D:
- only the plan premium if you made $106,000 or less
- your plan premium plus $78.60 if you made more than $106,000 and
less than $394,000
- your plan premium plus $85.80 if you made $394,000 or more
Medicare will bill you monthly for the additional Part D amount.
How does Medicare work?
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.
2 steps to set up your Medicare coverage:
If you choose Original Medicare, you’ll also decide if you want drug
coverage (Part D) and supplemental coverage, like Medigap
You’ll have Original Medicare unless you join a Medicare
Advantage Plan.
How does Original Medicare work?
Original Medicare includes two parts:
- Part A (Hospital Insurance)
- Part B (Medical Insurance)
Original Medicare covers most, but not all of the costs for
approved health care services and supplies. After you meet your
deductible, you pay your share of costs for services and supplies as you
get them. There’s no limit on what you’ll pay out-of-pocket in a year
unless you have other coverage (like Medigap, Medicaid, employer,
retiree, or union coverage).
Services covered by Medicare must be medically necessary. Medicare also
covers many preventive services, like shots and screenings. If you go to
a doctor or other health care provider that accepts
the Medicare-approved amount, your share of costs may be less. If you
get a service that Medicare doesn’t cover, you pay the full cost.
With Original Medicare, you can:
- Go to any doctor or
hospital that takes Medicare, anywhere in the U.S.
- Join a separate Medicare
drug plan (Part D) to get drug coverage.
- Buy a Medicare
Supplement Insurance (Medigap) policy to help lower your
share of costs for services you get.
If you're not lawfully present in the U.S., Medicare won't pay
for your Part A and Part B claims, and you can't enroll in a
Medicare Advantage Plan or a Medicare drug plan.
How does Medicare Advantage work?
Medicare Advantage bundles your Part A, Part B, and usually Part
D coverage into one plan. Plans may offer some extra benefits
that Original Medicare doesn’t cover — like vision, hearing, and
dental services.
You join a plan offered by Medicare-approved private companies
that follow rules set by Medicare. Each plan can have different
rules for how you get services, like needing referrals to see a
specialist. Costs for monthly premiums and services you get vary
depending on which plan you join.
Plans must cover all emergency and urgent care, and almost all
medically necessary services Original Medicare covers. Some
plans tailor their benefit packages to offer additional benefits
to treat specific conditions.
With Medicare Advantage, you:
- Need to use doctors who
are in the plan’s network (for non-emergency or non-urgent
care).
- May pay a premium for
the plan in addition to the monthly Part B premium. Plans
may have a $0 premium or may help pay all or part of your
Part B premiums.
- Can’t buy separate
supplemental coverage (like Medigap).
You must have both Part A and Part B to join a
Medicare Advantage Plan.
How does Medicare work with my other insurance?
When you have Medicare and other health insurance (like from
your job), one will pay first (called a “primary payer”) and the
other second (called a “secondary payer”).
If you have other insurance, who pays first depends on a number
of items, like if you’re still working, the type of insurance
you have, and if you have a special situation, like End-Stage
Renal Disease (ESRD).
What's not
covered?
Original Medicare doesn't cover
everything. If you need items or
services Part A (Hospital Insurance)or
Part B (Medical Insurance)
don’t cover, you’ll have to pay
for them yourself unless:
- You have other health coverage that will help cover the costs.
- You’re in a
Medicare Advantage Plan (Part C)
or a
Medicare Cost Plan
or a
Program of All-inclusive Care
for the Elderly (PACE) plan that covers these services.
These plans may cover some extra
benefits that Original Medicare
doesn’t cover, like certain vision,
hearing, and dental services.
Some of the items and services Medicare doesn’t
cover include:
- Eye
exams (for prescription eyeglasses)
-
Long-term care
- Cosmetic
surgery
- Massage
therapy
- Routine
physical exams
- Hearing
aids and exams for fitting them
- Concierge care (also called concierge
medicine, retainer-based medicine, boutique
medicine, platinum practice, or direct care)
- Covered
items or services you get from a doctor or
other provider that has opted out of
participating in Medicare (except in the
case of an emergency or urgent need)
- Most
dental care: In most cases, Original
Medicare doesn't cover dental services like
routine cleanings, filings, tooth
extractions, or items like dentures.
However, in some cases, Original Medicare
may pay for some dental services closely
related to certain services like:
- A
heart valve repair or replacement
- An
organ transplant
- Cancer-related treatments
Find out if Medicare covers a test, item, or service you need
Enrollment occurs at different intervals
Unless you’re eligible for a special
enrollment period, you can only enroll
in Medicare at certain times of the year:
-
Initial Enrollment Period (IEP): This lasts for seven
months — three months before your 65th birthday, your birth
month, and three months after.
-
Open Enrollment Period (OEP): From October 15 to
December 7, you can enroll, switch plans, or drop coverage.
-
Medicare Advantage OEP: If you’re already enrolled in a
Medicare Advantage plan, you can make changes from January 1 to
March 31.
-
Medigap OEP: You have six months after turning 65 to
enroll in Medigap.
You can apply for Medicare online,
at your local
Social Security Office, or by calling Social Security at
1-800-772-1213 (TTY:
1-800-325-0778). Help is available from 8 a.m.
to 7 p.m. local time on weekdays.
You can enroll in Medicaid at any time. You can contact your state’s
Medicaid agency or complete a Health
Insurance Marketplace application to get started.
How do I get a new Medicare card if my card is lost,
stolen, or destroyed?
If your Medicare card was lost, stolen, or destroyed, you can ask for a
replacement card from Social Security in three ways:
- Online by using your personal my Social
Security account (note: you
can do this even if you don't yet receive Social Security
benefits). If you don’t already have a personal Social Security
account, you can create
one.
- Once you’re logged in, select the "Replace your Medicare card” link
under the Medicare Enrollment Detail section. Then select “Mail my
replacement Medicare Card.”
- Your Medicare card will arrive in the mail in about 30 days at the
address on file with Social Security. When you request your
replacement card, be sure to check your mailing address that’s in
your personal Social Security account and make any necessary
updates.
- By phone:
- In person:
You can also print an official copy of your card from your
secure Medicare account or call 1-800-MEDICARE. TTY
users can call 1-877-486-2048.
How do I report fraud, waste or abuse of Medicare?
To report suspected Medicare fraud, call toll free
1-800-HHS-TIPS. Medicare fraud happens when Medicare is billed for services or
supplies you never got. Medicare fraud costs Medicare a lot of
money each year.
One Final Note..
Medicare is a popular health insurance option for Americans who are
age 65 and older or have certain disabilities. Medicare Part A
covers hospital services, while Medicare Part B covers medical
services.
Medicare Part D helps cover prescription drug costs, and a Medigap
plan helps cover Medicare premium and coinsurance costs. Medicare
Advantage plans offer the convenience of all the coverage options in
one place.
To find and enroll in a Medicare plan in your area, visit
Medicare.gov and use the online
plan finder tool. Note that you may be eligible for both
Medicare and Medicaid coverage. If this happens, Medicare will
be your primary insurance coverage, and Medicaid will be your
secondary insurance coverage to help with costs and other services
not covered by Medicare.
Medicare plan options and costs are subject to change each year.
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