Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). It is administered by the Centers for Medicare and Medicaid Services. You can enroll through the Social Security Administration or Railroad Retirement Board.
Medicare covers certain services and supplies in hospitals, doctors’ offices and other healthcare settings. Services are either covered under Medicare Part A (Hospital Insurance) or Medicare Part B (Medical Insurance). Medicare Part A and B are commonly referred to as Original Medicare.
What does Medicare Part A (Hospital Insurance) Cover?
Inpatient care in hospitals
Inpatient stays in a skilled nursing facility
Hospice care services
Some home health services
What does Medicare Part B (Medical Insurance) Cover?
Durable Medical Equipment (DME)
Some home health services
Medicare Advantage Plans (Part C)
Medicare Advantage Plans are health plan options approved by Medicare and offered by private companies. These plans are sometimes called "Medicare Health Plans", Medicare Supplemental plans or "MA plans". Medicare Advantage Plans provide your Medicare health coverage and may provide Medicare drug coverage. They are not supplemental insurance.
Medicare Advantage Plans provide all of your Part A (Medicare Insurance) and Part B (Medicare Insurance) coverage. This means they must cover at least all of the services that Original Medicare covers. Some plans may offer extra coverage, such as vision, hearing, dental and/or health and wellness programs. Each Medicare Advantage Plan can charge different out-of-pocket costs. These are usually copayments but can also be coinsurance and deductibles. It is important to understand a plan’s rules before enrolling.
Medicare Prescription Drug Coverage (Part D)
Medicare offers prescription drug coverage (Part D) for everyone with Medicare. To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered. If you want Medicare drug coverage, you need to choose a plan that best meets your healthcare needs.
There are two ways to get Medicare prescription drug coverage:
Medicare Prescription Drug Plans. These plans (sometimes called "PDPs") add drug coverage to Original Medicare (Parts A and B) and some Medicare Advantage Plans (Part C).
Medicare Advantage Plans that offer prescription drug coverage. Medicare Advantage Plans with prescription drug coverage are sometimes called "MA-PDs." You get all of your Part A and Part B coverage, including prescription drug coverage (Part D), through these plans.
Even if you do not take a lot of prescription drugs, you should still consider joining a Medicare drug plan. If you do not sign up for Medicare Part D when you first become eligible or during a special enrollment period, you may pay a late enrollment penalty (1% penalty for each month you did not have creditable coverage after you were eligible to join a Medicare drug plan). If you have limited income and resources, you may qualify for extra help from Medicare and Medicaid to pay for your prescription drug coverage.