Medicare 101: Start with the basics.
Medicare has a few different parts, but you do not need to learn everything at once. Start with who it covers, what each part does, and how the pieces fit together.
What is Medicare, and who is eligible?
Medicare is the federal health insurance program primarily for people age 65 and older. Some people qualify earlier because of a disability, End-Stage Renal Disease (ESRD), or ALS. Eligibility, enrollment and coverage start dates depend on your circumstances; Medicare and Social Security can confirm the rules that apply to you.
Medicare is different from Medicaid, called Medi-Cal in California. These programs have different eligibility rules, and some people qualify for both.
The four parts of Medicare
Part A: Hospital insurance
Part A helps cover inpatient hospital care, certain skilled nursing facility care, hospice and some home health care. Coverage conditions apply. Many people qualify for premium-free Part A based on their own or a spouse’s work history; not everyone does.
Part B: Medical insurance
Part B helps cover doctor visits, outpatient care, preventive services and other medically necessary services. Most people pay a monthly premium. Original Medicare is Parts A and B together, and it generally lets you use any doctor or hospital in the U.S. that accepts Medicare.
Part C: Medicare Advantage
Medicare Advantage is an alternative way to receive your Part A and Part B benefits through a private plan approved by Medicare. You must have Parts A and B to join and generally continue paying your Part B premium. Plans often include prescription drug coverage; provider networks, coverage rules and costs vary.
Part D: Prescription drug coverage
Part D is offered by private plans approved by Medicare. You can add a stand-alone Part D plan to Original Medicare, or get drug coverage through a Medicare Advantage plan that includes it. Each plan has its own covered-drug list and pharmacy network. Not every Medicare Advantage plan includes Part D.
How the coverage pieces fit together
You generally choose between Original Medicare and Medicare Advantage. With Original Medicare, you may add Part D and a Medicare Supplement (Medigap) policy to help pay certain out-of-pocket costs. Medigap is not another part of Medicare and does not work with Medicare Advantage.
Medicare does not pay every health expense. Deductibles, coinsurance, covered services and provider access depend on your coverage. Review current official documents and your circumstances before making a decision.
Understand your Medicare options
When do you get started?
Some people are enrolled automatically, while others need to sign up. Enrollment periods depend on your situation, including whether you have coverage through current employment. If you are approaching 65, the next step is to map your birthday-month timeline and check how your current insurance coordinates with Medicare.
Official information
Have Questions About Your Coverage?
Talk with Scott about your situation. There’s no obligation, and you can also get information on all of your options from Medicare.gov or 1-800-MEDICARE.