All what Medicare covers;
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) Helps cover the cost of prescription drugs (including many recommended shots or vaccines). Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare.
When you first enroll in Medicare and during certain times of the year, you
can choose how you get your Medicare coverage. There are 2 main ways to
get Medicare:
Original Medicare (Option 1)
• Original Medicare includes Medicare
Part A (Hospital Insurance) and
Part B (Medical Insurance).
• If you want drug coverage, you can join a separate Medicare drug plan
(Part D).
• To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also shop for and buy supplemental coverage.
• Can use any doctor or hospital that takes Medicare, anywhere in the U.S.
Medicare Advantage (Option 2)
(also known as Part C)
• Medicare Advantage is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.
• Plans may have lower out-of-pocket costs than Original Medicare.
• In many cases, you’ll need to use doctors who are in the plan’s network.
• Most plans offer extra benefits that Original Medicare doesn’t cover—like
vision, hearing, dental, and more.
You usually don’t pay a monthly premium for Part A coverage if you or your
spouse paid Medicare taxes while working for a certain amount of time.
Copayments, coinsurance, and deductibles may apply for each of the services covered by Part A.
The amounts you pay for each service covered by Part A or Part B will depend on whether you have just Original Medicare, a Medicare Advantage Plan or a Medicare Supplement Plan.
The standard Part B premium amount in in 2024 is $174.70 ( $185 in 2025). Most people pay the standard Part B premium amount.
If your modified adjusted gross income is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.
To determine if you’ll pay the IRMAA, Medicare uses the modified adjusted gross income reported on your IRS tax return from 2 years ago.
In addition to your monthly premium, you may pay deductibles, copayments and coinsurance.
The amounts you pay for each service covered by Part A or Part B will depend on whether you have just Original Medicare, a Medicare Advantage Plan or a Medicare Supplement Plan.
If you have Part D coverage, you will pay a premium, deductibles, and copayments and/or coinsurance for your covered prescriptions.
If you’re already getting benefits from Social Security or the Railroad Retirement Board (RRB), you’ll automatically get Part A and Part B starting the first day of the month you turn 65. (If your birthday is on the first day of the month, Part A and Part B will start the first day of the prior month.)
If you’re under 65 and have a disability, you’ll automatically get Part A and Part B after you receive disability benefits from Social Security or certain disability benefits from the RRB for 24 months.
If you’re automatically enrolled, you’ll receive your red, white, and blue Medicare card in the mail 3 months before your 65th birthday or the 25th month of disability benefits. In most cases, You don’t need to pay a premium for Part A . If you don’t want Part B, inform Social security office before the coverage start date on your Medicare card. If you do nothing, you’ll keep Part B and will have to pay Part B premiums through your Social Security benefits. If you choose not to keep Part B but decide you want it later, you may have to wait to enroll and pay a penalty for as long as you have Part B.
If you’re close to 65 but NOT getting Social Security or Railroad Retirement Board (RRB) benefits, you’ll need to sign up for Medicare. Contact Social Security 3 months before you turn 65. You can also apply for Part A and Part B at https://www.ssa.gov/medicare. If you worked for a railroad, contact the RRB.
In most cases, if you don’t sign up for Part B when you’re first eligible, you may experience a delay in getting Medicare coverage in the future, and you may have to pay a late enrollment penalty for as long as you have Part B.
A Medicare Advantage Plan is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D).
In many cases, you’ll need to use health care providers who participate in the plan’s network and service area for the lowest costs. These plans set a limit on what you’ll have to pay out-of-pocket each year for covered services to help protect you from unexpected costs. Some plans offer out-of-network coverage, but sometimes at a higher cost.
Remember, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your red, white, and blue Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare.
If you join a Medicare Advantage Plan, you’ll still have Medicare, but you’ll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare.
Most Medicare Advantage Plans offer coverage for things that Original Medicare doesn’t cover, such as some vision, hearing, dental, and fitness programs (like gym memberships or discounts).
Plans can also choose to cover additional benefits. For example, some plans may offer coverage for services such as transportation to doctor visits, over-the-counter drugs, and services that promote your health and wellness.
Plans can also tailor their benefit packages to offer these benefits to certain chronically-ill enrollees. These packages provide benefits customized to treat specific conditions. Check with the plan before you enroll to see what benefits it offers, if you might qualify, and if there are any limitations.
Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. Medicare Supplement Insurance (Medigap) policies, sold by private companies, can help pay some of the remaining health care costs for covered services and supplies, such as copayments, coinsurance, and deductibles.
Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, such as medical care when you travel outside the U.S. Generally, Medigap doesn’t cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
Medicare drug coverage helps pay for the prescription drugs you need. Even if you don’t take prescription drugs now, you should consider getting Medicare drug coverage. Medicare drug coverage is optional and is offered to everyone with Medicare. If you decide not to get it when you’re first eligible, and you don’t have other creditable prescription drug coverage (such as drug coverage from an employer or union) or receive Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later.
There are two ways to get Medicare drug coverage:
1. Medicare drug plans: These plans add drug coverage to Original Medicare, some Medicare Cost Plans, some Private Fee-for-Service plans, and Medical Savings Account plans. You must have Part A and/or Part B to join a separate Medicare drug plan.
2. Medicare Advantage Plans or other Medicare health plans with drug coverage: You get all of your Part A, Part B, and drug coverage through these plans. Remember, you must have Part A and Part B to join a Medicare Advantage Plan, and not all of these plans offer drug coverage.
