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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.

 

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.

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 is the part of Original Medicare that provides benefits for care while you are an inpatient in the hospital, a skilled nursing facility, or hospice. Part A also covers some home health care services. Part A doesn’t cover custodial or long-term care if it’s the only type of care you need while you are an inpatient. To be eligible for this coverage, the hospital or other medical facilities must accept Medicare assignment.

Medicare Part A doesn’t carry a monthly premium for most beneficiaries. If you or your spouse has worked for at least 40 quarters (approximately 10 years) and paid Medicare taxes, Part A is premium-free. There is, however, a deductible that applies to every benefit period that you receive inpatient care. And depending on the number of days you are an inpatient, you may pay coinsurance.

Part B (Medical Insurance)

Part B is the second part of Original Medicare. It covers a portion of physicians’ services and your outpatient care. Part B also provides coverage for some services that Part A doesn’t cover, even if you receive them during inpatient treatment. These can include physical, occupational, and speech therapy, and certain home health care services.

To be eligible for coverage through Medicare Part B, the services or supplies you receive must be considered medically necessary, and the health care provider or supplier must accept Medicare assignment.

There is a monthly premium for Medicare Part B, as well as an annual deductible, and coinsurance or co-payments. For most covered services, Medicare pays 80 percent of the final approved cost, and you are responsible for the remaining 20 percent after covering your annual deductible.

Medicare Advantage (also known as Part C)

Medicare Advantage plans are offered to eligible Medicare beneficiaries as an alternative way to get Medicare Part A and Part B benefits. These plans are sold by private insurance companies that must provide the same coverage as Parts A and B do. 

Part C plans also typically offer additional coverage such as prescription drugs; and extra benefits like dental, vision, and hearing care that Original Medicare doesn’t cover. In some cases, these benefits are all bundled into one plan with one monthly premium, while others may have separate plans with multiple premiums.

Part D (Drug coverage)

Part D is prescription drug coverage. You can purchase a stand-alone Part D plan from a private insurance company that works with Medicare, or you can get prescription drug coverage bundled with your Medicare Advantage plan.

Because these plans are provided by private insurers, they have the option to create their own list of covered drugs, for the most part.

Medicare Prescription Drug Plans and Medicare Advantage plans with prescription drug coverage usually may have a monthly premium, deductible, and co-payments.

Plan F  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.

 

Part A (Hospital Insurance) costs

Part A costs: What you pay in 2025:
Premium

$0 for most people (because they or a spouse paid Medicare taxes long enough while working — generally at least 10 years). If you get Medicare earlier than age 65, you won’t pay a Part A premium. This is sometimes called “premium-free Part A.”

If you don’t qualify for premium-free Part A: You might be able to buy it. You’ll pay either $285 or $518 ($311 or $565 in 2026) each month for Part A, depending on how long you or your spouse worked and paid Medicare taxes.

Remember:

  • 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. 
Deductible

$1,676 ($1,736 in 2026) for each inpatient hospital benefit period, before Original Medicare starts to pay. 

There’s no limit to the number of benefit periods you can have in a year. This means you may pay the deductible more than once in a year. 
Inpatient stay
  • Days 1-60: $0 after you pay your Part A deductible.
  • Days 61-90: $419 each day ($434 in 2026).
  • Days 91-150: $838 each day while using your 60 lifetime reserve days ($868 in 2026).
  • After day 150: You pay all costs.
Skilled nursing facility stay 
  • Days 1-20: $0.
  • Days 21-100: $209.50 ($217 in 2026) each day.
  • Days 101 and beyond: You pay all costs.
Home health care 

$0 for covered home health care services.

20% of the Medicare-approved amount for durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment) 
Hospice care 

$0 for covered hospice care services.

You may also pay:

  • A co-payment of up to $5 for each prescription drug and other similar products for pain relief and symptom control while you're at home.
  • 5% of the  Medicare-approved amount for inpatient respite care .

 

Part B (Medical Insurance) costs

Part B costs: What you pay in 2025:
Premium

$185 each month ($202.90 in 2026) (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 monthly penalty if you don’t sign up for Part B when you’re first eligible for Medicare (usually when you turn 65). You’ll pay the penalty for as long as you have Part B. The penalty goes up the longer you wait to sign up. 
Deductible $257 ($283 in 2026) before Original Medicare starts to pay. You pay this deductible once each year.
General costs for services (coinsurance)

Usually 20% of the cost for each Medicare-covered service or item after you’ve paid your deductible (and as long as your doctor or health care provider accepts the  Medicare-approved amount  as full payment – called “accepting assignment”). 
Clinical laboratory services

$0 for covered clinical laboratory services.
Home health care
  • $0 for covered home health care services.
  • 20% of the  Medicare-approved amount  for durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment).
Inpatient hospital care

20% of the  Medicare-approved amount  for most doctor services while you’re a hospital inpatient.
Outpatient mental health care
  • $0 for your yearly depression screening.
  • 20% of the  Medicare-approved amount  for visits to your doctor or other health care provider to diagnose or treat your condition.
  • If you get your services in a hospital outpatient clinic or hospital outpatient department, you may have to pay an additional amount to the hospital.
Partial hospitalization mental health care

After you meet the Part B deductible:

  • 20% of the  Medicare-approved amount  for each service you get from a doctor or certain other qualified mental health professional
  • Coinsurance for each day of partial hospitalization services you get in a hospital outpatient setting or community mental health center
Outpatient hospital care
  • Usually 20% of the  Medicare-approved amount for doctor and other health care providers’ services.
  • You’ll also pay a co-payment to the hospital for each service you get in a hospital outpatient setting (except for certain preventive services). In most cases, your co-payment won’t be more than the Part A hospital stay deductible amount.
  • This additional hospital co-payment means you may pay more for an outpatient service you get in a hospital than you’d pay if you got the same service in a doctor’s office.

 

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 co-pays.

 

Medicare Advantage Plan (Part C) costs

Medicare Advantage Plan costs: What you pay in 2025:
Premiums & other costs (like deductibles, co-payments, & coinsurance)

Varies by plan. These amounts can change each year.

You must have Part B and keep paying your Part B premium to stay in your plan.
Out-of-pocket limit

Varies by plan. Once you pay the plan’s limit, the plan pays 100% of your covered health services for the rest of the calendar year.

 

Costs for plans & supplemental coverage

 

Part D (Drug Coverage) costs:

Part D costs: What you pay in 2025:
Premium

Varies by plan. You may have to pay more, depending on your income.

Avoid paying a penalty:

  • Join a Medicare drug plan when you first get Medicare Part A and/or Part B, and
  • Don’t go 63 days or more without  creditable drug coverage  (coverage that’s similar in value to Part D).
Deductibles, co-payments, & coinsurance Varies by plan and pharmacy. Find Medicare drug plans in your area, and compare their costs and coverage.

 

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 Supplement Insurance (Medigap):

Medigap costs: What you pay in 2025:
Premium

Varies based on which Medigap policy you buy, where you live, and other factors. The amount can change each year. 

You must have Part B and keep paying your Part B premium to keep your Medigap policy.
Other costs
  • Medigap usually helps pay your portion of the costs (like deductibles and coinsurance) for services that Part A and Part B cover in Original Medicare. The amount you’ll pay for Part A and Part B services if you have a Medigap policy varies depending on the policy you buy.
  • 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, co-payments, 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 co-payments.

Your typical costs with Extra Help in 2026 are:

  • Premium: $0
  • Deductible: $0
  • Generic drugs: up to $5.10 for each prescription
  • Brand-name drugs: up to $12.65 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.

Income and resource limits in 2025:

Your situation: Income limit: Resource limit:
Individual $23,475 $17,600
Joint (married) $31,725 $35,130

The income limits are higher for people who live in Alaska and Hawaii than for those in the rest of the United States.

What counts in income limits?

  • Alimony
  • Annuities
  • Earnings from self-employment
  • Pensions
  • Railroad Retirement Board (RRB) benefits
  • Rental income
  • Social Security benefits
  • Veterans benefits
  • Wages
  • Worker’s compensation  

States don't count:

  • Assistance from others to pay for household expenses
  • Disaster assistance
  • Earned income tax credit payments
  • Home energy assistance
  • Housing assistance
  • Medical treatment and drugs
  • Scholarships and education grants
  • Supplemental Nutrition Assistance Program (SNAP)
  • Victim compensation payments

There’s also a limit on the value of your individual or combined resources.

Resources can include things like:

  • Money in a checking, savings, or retirement account
  • stocks
  • bonds

States don’t count:

  • Your home
  • One car
  • Burial plot
  • Up to $1,500 for burial expenses if you have put that money aside
  • Furniture
  • Other household and personal items

2025 income and resource limits for Alaska:

Your situation: Income limit Resource limit
Individual $29,325 $17,600
Joint (married) $39,645 $35,130

 

2025 income and resource limits for Hawaii:

Your situation: Income limit Resource limit
Individual $26,985 $17,600
Joint (married) $36,480 $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 2026?

 

Most people will pay the standard amount for their Medicare Part B premium. However, you’ll owe an IRMAA if you make more than $109,000 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 2026 (based on your 2024 tax return):

Yearly income in 2024
single		 Yearly income in 2024
married, joint filing		 Yearly income in 2024
married, Seperate filing		 2026 Medicare Part B
monthly premium		 2026 Medicare Part D
monthly premium
$109,000 or less $218,000 or less $109,000 or less $202.90 just your plan’s premium
$109,001 to $137,000 $218,001 to $274,000 not applicable $284.10 your plan’s premium plus $14.50
$137,001 to $171,000 $274,001 to $342,000 not applicable $405.80 your plan’s premium plus $37.50
$171,001 to $205,000 $342,001 to $410,000 not applicable $527.50 your plan’s premium plus $60.40
$205,001 to $500,000 $410,001 to $750,000 $109,001 to $391,000 $649.20 your plan’s premium plus $83.30
$500,000 or more $750,000 or more $391,000 or more $689.90 your plan’s premium plus $91.00

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.

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.

 

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.

The Bottom Line

Medicare supports adults ages 65 and older, as well as younger individuals with certain health conditions and disabilities. Medicaid primarily supports children, adolescents, and adults with limited income or resources.

If you have questions about your eligibility or enrollment, contact your local State Health Insurance Assistance Program (SHIP) for free personalized health insurance counseling.

Call the SHIP National Technical Assistance Center at 1-877-839-2675 to find a program near you.

 

 

 

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Most recent revision November 19, 2025 10:55:35 AM

 

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