Part A: Hospital insurance
Inpatient stays in a hospital, a short stay in a skilled nursing facility after one, hospice and some care at home.
Most people pay no premium for it, because they or a spouse paid Medicare taxes long enough while working.
How Medicare works
The short version: four parts, two ways to receive them and a handful of dates. Read it here, then ask for a guide that applies it to you.
The four parts
Parts A and B together are Original Medicare. Part C is another way to get them. Part D covers prescriptions.
Part B: Medical insurance
Doctor visits, outpatient treatment, many screenings and vaccines, and equipment such as walkers or oxygen.
It has a monthly premium set each year. Once the yearly deductible is met you usually pay a share of each bill, often 20 percent.
Part C: Medicare Advantage
Another way to receive Parts A and B, through a private plan Medicare approves. Most include drug cover, and many add dental, vision or hearing.
Plans usually work through a network, and some ask for a referral before you see a specialist.
Part D: Drug coverage
Prescriptions you fill at a pharmacy. Sold by private plans, either on its own beside Original Medicare or inside a Medicare Advantage plan.
Each plan keeps its own list of covered drugs. Going without drug cover when you first can may bring a penalty that lasts.
Medigap
Medigap, also called Medicare Supplement Insurance, comes from private insurers and helps with the deductibles, coinsurance and copays Original Medicare leaves for you to pay.
It works only with Original Medicare, never with a Medicare Advantage plan, and it has no drug cover, so people who buy it usually add Part D. The simplest time to buy is the six months that begin once you are 65 and enrolled in Part B. Later on, insurers in most states may ask health questions before they sell you a policy.
Key dates
Most changes can only happen inside one of these windows. That is why your guide opens with your own dates.
Around your 65th birthday
Initial Enrollment Period
Seven months long: three months before the month you turn 65, that month, and three months after. Signing up in the first three lets cover begin without a gap.
October 15 to December 7
Open Enrollment
Every year, anyone with Medicare can join, leave or change a Medicare Advantage or Part D plan. What you choose takes effect on January 1.
January 1 to March 31
Medicare Advantage Open Enrollment
Already in a Medicare Advantage plan? You get one change in these months: another Advantage plan, or back to Original Medicare.
When something changes
Special Enrollment Periods
Moving house, losing cover from a job or a plan leaving your area can each open a window outside the usual dates.
Covered through a current job at 65? You may be able to delay Part B without a penalty. Check with Social Security or your employer's plan before deciding.
Original Medicare or Medicare Advantage
A general picture. Every Advantage plan sets its own rules, so read the plan's own papers too.
| Topic | Original Medicare | Medicare Advantage |
|---|---|---|
| Who runs it | The federal government. | A private company approved by Medicare. |
| Choice of doctors | Any doctor or hospital in the U.S. that accepts Medicare. | Usually a network. Care outside it may cost more or not be covered, emergencies aside. |
| Seeing a specialist | No referral needed. | Some plans ask for a referral first. |
| Prescriptions | Not included. You add a Part D plan. | Included in most plans. |
| Dental, vision and hearing | Mostly not covered. | Often some cover, which varies by plan. |
| Yearly limit on costs | None, unless a Medigap policy helps with the gaps. | Yes, each plan sets a cap on what you pay for covered care in a year. |
| Away from home | Works the same in every state. | Routine care is mostly tied to the plan's area; emergencies are covered across the U.S. |
| Medigap | Can be added. | Cannot be used with these plans. |
Eight questions to put to any plan
Your guide repeats these with room to note each plan's answer.
- Do my doctors take this plan, or Medicare?
- Is every medicine I take on its drug list, and at what tier?
- Which pharmacies near me charge the least under it?
- What is the most I could pay in a year, premium included?
- Does it cover me when I travel or spend winters away?
- Must I get a referral before I see a specialist?
- How does it work with any cover I have from work?
- What does it offer for teeth, eyes and hearing?
Free one-to-one help is available from your State Health Insurance Assistance Program (SHIP), at shiphelp.org. Its counsellors sell nothing.
Ready when you are
One short form, and a person writes back with your guide.