Medicare Overview

What is Medicare?

Medicare is health insurance for:

  • People 65 or older
  • People under 65 with certain disabilities
  • People of any age with end-stage renal disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant)

There are four Medicare parts:

  • Medicare Part A (Hospital Insurance)
  • Medicare Part B (Medical Insurance)
  • Medicare Part C (Medicare Advantage)
  • Medicare Part D (Medicare prescription drug coverage)

Beneficiaries may also choose to purchase a Medicare Supplement Insurance (Medigap) Policy, which is sold by private insurance companies and helps to pay some of the healthcare costs that Medicare doesn’t cover.

A Medigap policy is different from a Medicare Advantage Plan (Part C). Medicare Advantage plans are ways to get Medicare benefits (and often extra benefits, like vision and dental coverage), while a Medigap policy only pays some of the costs not covered by original Medicare.

Note:

If you join a Medicare Advantage Plan for the first time, and you aren’t happy with the plan, you’ll have special rights to buy a Medigap policy if you return to original Medicare within 12 months of joining.

  • If you had a Medigap policy before you joined, you may be able to get the same policy back if the company still sells it. If it isn’t available, you can buy another Medigap policy.
  • If you joined a Medicare Advantage Plan when you were first eligible for Medicare, you can choose from any Medigap policy.
  • The Medigap policy can no longer have prescription drug coverage even if you had it before, but you may be able to join a Medicare Prescription Drug Plan.

For more information, you can visit the Medicare website or call 1-800-MEDICARE 24 hours a day/7 days a week (1-800-633-4227). TTY users should call 1-877-486-2048.

Medicare Part A

Part A (Hospital Insurance) helps cover:

  • Inpatient care in hospitals
  • Inpatient care in a skilled nursing facility (not custodial or long term care)
  • Hospice care services
  • Home healthcare services
  • Inpatient care in a religious nonmedical healthcare institution

For more information, you can visit the Medicare website or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

Medicare Part B

Part B (Medical Insurance) helps cover;

  • Medically necessary doctors’ services
  • Outpatient care
  • Home health services
  • Durable medical equipment, and other medical services

Part B also covers many preventive services, like diabetes screenings and flu shots.

For more information, you can visit the Medicare web site or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

Medicare Part C

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.

If you join a Medicare Advantage Plan, you still have Medicare. You’ll get your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not original Medicare. Medicare Advantage Plans cover all Medicare services.

In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must cover all of the services that original Medicare covers except hospice care and some care in qualifying clinical research studies. Original Medicare covers hospice care and some costs for clinical research studies even if you’re in a Medicare Advantage Plan.

Medicare Advantage Plans may offer extra coverage, like vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan.

For more information, you can visit the Medicare web site or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

Medicare Part D

In original Medicare, if you don’t already have creditable prescription drug coverage (for example, from a current or former employer or union) and you would like Medicare prescription drug coverage, you must join a Medicare Prescription Drug Plan.

These plans are available through private companies under contract with Medicare. If you don’t currently have creditable prescription drug coverage, you should think about joining a Medicare Prescription Drug Plan as soon as you’re eligible. If you don’t join a Medicare Prescription Drug Plan when you’re first eligible and you decide to join later, you may have to pay a late enrollment penalty.

There are two ways to get prescription drug coverage:

  1. Medicare Prescription Drug Plan (Part D). These plans (sometimes called "PDPs") add drug coverage to original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
  2. Medicare Advantage Plan (Part C). You get all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.

For more information, you can visit the Medicare web site or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

What isn’t covered by Part A & Part B?

Medicare doesn’t cover all the services you may need. Some of the items and services that Medicare doesn’t cover include:

  • Long-term care (also called custodial care)
  • Routine dental, eye or foot care
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and exams for fitting them

Even if Medicare covers a service or item, you generally have to pay deductibles, coinsurance, and copayments.

If you need certain services that Medicare doesn’t cover, you’ll have to pay for them yourself unless:

  • You have other insurance (or Medicaid) to cover the costs.
  • You’re in a Medicare Advantage Plan (Part C) that covers these services.

For more information, you can visit the Medicare web site or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

Medicare Supplement (Medigap) Insurance

Medicare supplement (Medigap) insurance, sold by private companies, can help pay some of the healthcare costs that original Medicare doesn't cover, like co-payments, co-insurance, and deductibles. Some Medigap policies also offer coverage for services that original Medicare doesn't cover, like medical care when you travel outside the U.S. There are currently 10 standard Medigap policies to choose from, identified by letters A through N. 

If you have original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered healthcare costs. Then your Medigap policy pays its share.

A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your original Medicare benefits.

For more information, you can visit the Medicare web site or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.