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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:

Manage your prescription drug costs by switching to a generic drug when possible.

Apply for Extra Help, an assistance program for prescription drug coverage.

Apply for copay relief or financial aid help from the Patient Advocate Foundation.

Find out whether you qualify for Medicaid, a joint federal and state program that helps pay for medical costs.

In Missouri: Apply for Medicare Savings Programs like the Qualified Medicare Beneficiary (QMB) Program or the Specified Low-Income Medicare Beneficiary (SLMB) Program. These are state-level discount programs for people with Medicare who meet a certain income limit.

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:

Sign up for

Part A (Hospital Insurance)

and

Part B (Medical Insurance)

Choose which way you want to get your Medicare health coverage
You can choose either of these for your health coverage.

Original Medicare

Medicare Advantage (Part C)

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:

Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778), Monday through Friday, from 7 a.m. to 7 p.m.

In person:

Visit your local Social Security office.

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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Most recent revision July 12, 2025 08:38:09 AM

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