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Medicare Basics

Let’s talk about Medicare
Medicare is a national health insurance program backed by the U.S. government
There are four different parts to Medicare – A, B, C, and D – plus Medicare Supplement (or MediGap plans)
Medicare Part

A

Covers hospital-related services and emergency care.
Medicare Part

B

Covers doctor’s visits and outpatient hospital stays.
Medicare Part

C

Covers both Part A and Part B with additional coverage.
Medicare Part

D

Covers prescription drugs.
Medicare Supplement

Private supplement insurance of Medicare’s coverage gaps.

What You Need to Know

Medicare (Part A & Part B): Part A & Part B is also known as Original Medicare. Original Medicare serves as the foundation for private Medicare Advantage and Medicare Supplement plans.

  • Medicare Part A: Covers inpatient hospital care. Some people call Part A “hospital insurance.” Part A covers:
    • Inpatient hospital care
    • Stays in hospitals and skilled nursing facilities (with limits on time)
    • Home services like home health visits
    • Hospice care
  • Medicare Part B: Covers outpatient doctor visits or outpatient care. Some people call Part B “medical insurance.” Part B covers:
    • Outpatient medical services, including routine doctor visits
    • Preventive services, like flu shots and mammograms
    • Equipment or tests administered during outpatient services
    • Medication administered during outpatient visits

With Original Medicare, you’ll still have to pay for prescription drugs, emergency care in foreign countries and your first three pints of medically necessary blood per year. You are also responsible for deductibles and co-payments of up 20 percent on Part B costs. That’s why supplementary plans are a very important and affordable way to cover these additional out of pocket costs.

  • Medicare Part C (Medicare Advantage):
    • Is a type of Medicare health plan offered by a private insurance company that contracts with Medicare to provide all your Part A and Part B benefits.
    • These plans are required to cover everything that Original Medicare does. Many plans are $0 per month and most include prescription drug coverage.
    • These plans have an annual out-of-pocket maximum and can include additional benefits that aren’t part of Original Medicare (like hearing aids, routine dental and vision, fitness benefit).
  • Medicare Part D (Prescription Drug Plans):
    • Prescription drug payments generally aren’t covered by Original Medicare.
    • Medicare Part D plans add prescription drug coverage to your existing Medicare benefits. Many Part C plans are bundled with Part D coverage.
  • Medicare Supplement (Medigap):
    • Medicare Supplement plans fill the “gaps” in coverage that you would otherwise be see under Original Medicare.
    • All plans cover your Part A hospital costs, and give you extra time in the hospital.
    • Most plans cover your full Part B coinsurance.
    • Some plans even cover your Original Medicare deductibles and excess charges.

Frequently Asked Questions

  • When do I sign up?

    You become eligible for Medicare when you turn 65 or on your 25th month of collecting Social Security Disability. If you are drawing some form of Social Security benefit (retirement of disability) and become eligible for Medicare, you will be automatically enrolled in Part A and B. 

    If you are not collecting any Social Security benefit when you become eligible for Medicare, you must enroll through Social Security by doing one of the following:

    • Apply online at the Social Security website
    • Call Social Security at 1-800-772-1213 (Monday – Friday 7am – 7pm) If you are deaf or hard of hearing, you may call TTY 1-800-325-0778.

  • When Do I Get My Medicare Card?

    If you’re automatically enrolled in Medicare, then your official Medicare card will arrive in the mail 2 to 3 months before you’re eligible. Otherwise, your card will arrive about 3 weeks after you apply for Medicare coverage. The sooner you apply, the sooner your card will be ready. You can access benefits as soon as your coverage begins.

  • Is Medicare Free?

    Original Medicare isn’t free, but it’s a more affordable option than anything else.

    You don’t have to pay for Medicare Part A under most circumstances (the monthly premium for Part A is $0 for those who have worked long enough to quality for Social Security benefits). You’ll still need to pay a deductible for each hospital stay before Part A covers some of your hospital costs – but Medicare Supplement and most Medicare Advantage plans cover this.

    The premium for Medicare Part B is generally $144.60 (for 2020) per month, although the exact cost will depend on your tax returns from two years ago. Additionally, you’ll need to pay 20 percent of your medical costs on Part B – but Medicare Supplement and most Medicare Advantage plans pay this for you too.

  • Am I Eligible for Medicare?

    You must be a U.S. citizen or legal resident. Legal residents must live in the U.S. for at least 5 consecutive years, including the 5 years prior to applying for Medicare; AND, one of the following:

    • 65 years old or older
    • Under 65 with a qualifying disability
    • Someone with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD) or Amyotrophic Lateral Sclerosis (ALS)