Medicare Basics
Medicare offers different options for you to get health care coverage. Start here to get the basics and find out how Medicare works before you look at your coverage options.
Parts of Medicare
Learn the parts of Medicare and what they cover. Get familiar with other terms and the difference between Medicare and Medicaid.
How Medicare Works
Working Past 65
Find out what to do if you’re still working & how to get Medicare when you retire.
Parts of Medicare
Learn the parts of Medicare and what they cover. Get familiar with other terms and the difference between Original Medicare and Medicare Advantage.
How Medicare Works
Parts of Medicare
Part A (Hospital Insurance)
Helps cover:
- Inpatient care in hospitals
- Skilled nursing facility care
- Hospice care
- Home health care
Part B (Medical Insurance)
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)
Part D (Drug Coverage)
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.
Your Medicare Options
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.
- To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also buy supplemental coverage, like Medicare Supplement Insurance (Medigap), or have coverage from a former employer or union, or Medicaid.
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 most cases, you’ll need to use doctors who are in the plan’s network.
- Plans may have lower out-of-pocket costs than Original Medicare.
- Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.
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)
You can sign up at certain times. Contact us to find out when and how to sign up. - Choose which way you want to get your Medicare health coverage
You can choose either Original Medicare or Medicare Advantage (Part C) for your health 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) and 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, or employee or union coverage). Contact us to get details on cost saving programs.
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. Contact us to find providers that work with Medicare.
- 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 have other insurance, contact us to learn how Original Medicare works with your other coverage.
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 or use 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).
Working Past 65
If you (or your spouse) are still working when you turn 65, Medicare works a little differently. Contact us to get more details.