Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
The different parts of Medicare help cover specific services:
Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Medicare Part B (Medical Insurance)
Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
Medicare Part C (Medicare Advantage Plans)
A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.
Medicare Part D (prescription drug coverage)
Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.
Whether you’re new to Medicare, getting ready to turn 65, or preparing to retire, you’ll need to make several important decisions about your health coverage. If you wait to enroll, you may have to pay a penalty, and you may have a gap in coverage. Use these steps to gather information so you can make informed decisions about your Medicare:
Step 1: Learn about the different parts of Medicare
The different parts of Medicare help cover specific services. Medicare Part A (Hospital Insurance) covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Medicare Part B (Medical Insurance) covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
Step 2: Find out when you can get Medicare
There are only certain times when people can enroll in Medicare. Depending on the situation, some people may get Medicare automatically, and others need to apply for Medicare. The first time you can enroll is called your Initial Enrollment Period. Your 7-month Initial Enrollment Period usually:
- Begins 3 months before the month you turn 65
- Includes the month you turn 65
- Ends 3 months after the month you turn 65
If you don’t enroll when you’re first eligible, you may have to pay a Part B late enrollment penalty, and you may have a gap in coverage if you decide you want Part B later.
Step 3: Decide if you want Part A & Part B
Most people should enroll in Part A when they turn 65, even if they have health insurance from an employer. This is because most people paid Medicare taxes while they worked so they don’t pay a monthly premium for Part A. Certain people may choose to delay Part B. In most cases, it depends on the type of health coverage you may have. Everyone pays a monthly premium for Part B. The premium varies depending on your income and when you enroll in Part B. Most people will pay the standard premium amount of $134 in 2018.
Step 4: Choose your coverage
If you decide you want Part A and Part B, there are 2 main ways to get your Medicare coverage — Original Medicare or a Medicare Advantage Plan (like an HMO or PPO). Some people get additional coverage, like Medicare prescription drug coverage or Medicare Supplement Insurance (Medigap). Most people who are still working and have employer coverage don’t need additional coverage. Learn about these coverage choices.
Step 5: Sign up for Medicare (unless you’ll get it automatically)
Some people automatically get Part A and Part B. Find out if you’ll get Part A and B automatically. If you’re automatically enrolled, you’ll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday or your 25th month of disability. If you don’t get Medicare automatically, you’ll need to apply for Medicare online.
Step 6: Learn About 5 tasks for your first year with Medicare
- Fill out an Authorization Form if you want your family or friends to call Medicare on your behalf. Medicare can’t give personal health information about you to anyone unless you give permission in writing first.
- Make a “Welcome to Medicare” Preventive Visit appointment during the first 12 months you have Medicare. This free, one-time comprehensive “Welcome to Medicare” preventive visit puts you in control of your health and your Medicare from the start.
- Sign up for MyMedicare.gov, our secure online service where you can access your personal Medicare information 24 hours a day, every day. You can:
- Track your health care claims
- View your “Medicare Summary Notices” (MSNs)
- Order a replacement Medicare card
- Check your Medicare Part B deductible status
- View your eligibility information
- Track your preventive services
- Find information about your Medicare health plan or Medicare Prescription Drug Plan (Part D), or search for a new one
- Keep your Medicare information in one convenient place
- Learn what Medicare covers. You’ll get a list of tests, items, and services that are covered no matter where you live. If your test, item, or service isn’t listed, talk to your doctor or other health care provider about why you need certain tests, items, or services, and ask if Medicare will cover them.
- Decide if you want to go paperless, and get your next free copy of “Medicare & You” [PDF, 5.91 MB] electronically! Next October, you’ll get an email from Medicare linking you to “Medicare & You” onlineinstead of a paper copy in your mailbox.