Medicare Insurance
Medicare is health insurance for people 65 or older. You’re first eligible to sign up for Medicare 3 months before you turn 65. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease).
Parts of Medicare
Part A (Hospital Insurance)
Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and 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). You join a Medicare drug plan in addition to
- Original Medicare
or you get it by joining a:
- Medicare Advantage Plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare.
When you first sign up for Medicare and during certain times of the year, you can choose which way to get your Medicare coverage.
There are 2 main ways:
Original Medicare
- Original Medicare includes Part A and Part B.
- You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).
- You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
- To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also buy supplemental coverage, like Medicare Supplement Insurance (Medigap), or have coverage from a former employer or union, or Medicaid.
Medicare Advantage
- Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.
- In most cases, you’ll need to use doctors who are in the plan’s network.
Plans may have lower out-of-pocket costs than Original Medicare.
Plans may offer some extra benefits that Original Medicare doesn’t/
Compare Original Medicare & Medicare Advantage
Consider these things when deciding between Original Medicare and a Medicare Advantage Plan for your health coverage:
Doctor & hospital choice
Original Medicare |
Medicare Advantage |
|---|---|
| You can go to any doctor or hospital that takes Medicare, anywhere in the U.S. | In most cases, you can only use doctors and other providers who are in the plan’s network and service area (for non-emergency care). |
| In most cases you don’t need a referral to see a specialist. | You may need to get a referral to see a specialist. |
Doctor & hospital choice
| Original Medicare |
| For Part B-covered services, you usually pay 20% of the Medicare-approved amount after you meet your deductible. This amount is called your coinsurance. |
| Medicare Advantage |
| Out-of-pocket costs vary – plans may have lower or higher out-of-pocket costs for certain services. |
| Original Medicare |
| You pay a premium (monthly payment) for Part B. If you choose to join a Medicare drug plan, you’ll pay a separate premium for your Medicare drug coverage (Part D). |
| Medicare Advantage |
| You pay the monthly Part B premium and may also have to pay the plan’s premium. Some plans may have a $0 premium and may help pay all or part of your Part B premium. Most plans include Medicare drug coverage (Part D). |
| Original Medicare |
| There’s no yearly limit on what you pay out-of-pocket, unless you have supplemental coverage – like Medicare Supplement Insurance (Medigap) |
| Medicare Advantage |
| Plans have a yearly limit on what you pay out of pocket for services Medicare Part A and Part B cover. Once you reach your plan’s limit, you’ll pay nothing for services Part A and Part B covers for the rest of the year. |
| Original Medicare |
| You can get Medigap to help pay your remaining out-of-pocket costs (like your 20% coinsurance). Or, you can use coverage from a former employer or union, or Medicaid. |
| Medicare Advantage |
| You can’t buy and don’t need Medigap. |
Cost
Original Medicare |
Medicare Advantage |
|---|---|
| For Part B-covered services, you usually pay 20% of the Medicare-approved amount after you meet your deductible. This amount is called your coinsurance. | Out-of-pocket costs vary – plans may have lower or higher out-of-pocket costs for certain services. |
| You pay a premium (monthly payment) for Part B. If you choose to join a Medicare drug plan, you’ll pay a separate premium for your Medicare drug coverage (Part D). | You pay the monthly Part B premium and may also have to pay the plan’s premium. Some plans may have a $0 premium and may help pay all or part of your Part B premium. Most plans include Medicare drug coverage (Part D). |
| There’s no yearly limit on what you pay out-of-pocket, unless you have supplemental coverage – like Medicare Supplement Insurance (Medigap) | Plans have a yearly limit on what you pay out of pocket for services Medicare Part A and Part B cover. Once you reach your plan’s limit, you’ll pay nothing for services Part A and Part B covers for the rest of the year. |
| You can get Medigap to help pay your remaining out-of-pocket costs (like your 20% coinsurance). Or, you can use coverage from a former employer or union, or Medicaid. | You can’t buy and don’t need Medigap. |
Cost
| Original Medicare |
| For Part B-covered services, you usually pay 20% of the Medicare-approved amount after you meet your deductible. This amount is called your coinsurance. |
| Medicare Advantage |
| Out-of-pocket costs vary – plans may have lower or higher out-of-pocket costs for certain services. |
| Original Medicare |
| You pay a premium (monthly payment) for Part B. If you choose to join a Medicare drug plan, you’ll pay a separate premium for your Medicare drug coverage (Part D). |
| Medicare Advantage |
| You pay the monthly Part B premium and may also have to pay the plan’s premium. Some plans may have a $0 premium and may help pay all or part of your Part B premium. Most plans include Medicare drug coverage (Part D). |
| Original Medicare |
| There’s no yearly limit on what you pay out-of-pocket, unless you have supplemental coverage – like Medicare Supplement Insurance (Medigap) |
| Medicare Advantage |
| Plans have a yearly limit on what you pay out of pocket for services Medicare Part A and Part B cover. Once you reach your plan’s limit, you’ll pay nothing for services Part A and Part B covers for the rest of the year. |
| Original Medicare |
| You can get Medigap to help pay your remaining out-of-pocket costs (like your 20% coinsurance). Or, you can use coverage from a former employer or union, or Medicaid. |
| Medicare Advantage |
| You can’t buy and don’t need Medigap. |
Coverage
Original Medicare |
Medicare Advantage |
|---|---|
| Original Medicare covers most medically necessary services and supplies in hospitals, doctors’ offices, and other health care facilities. Original Medicare doesn’t cover some benefits like eye exams, most dental care, and routine exams. | Plans must cover all medically necessary services that Original Medicare covers. Plans may also offer some extra benefits that Original Medicare doesn’t cover – like vision, hearing, and dental services. |
| You can join a separate Medicare drug plan to get Medicare drug coverage (Part D). | Medicare drug coverage (Part D) is included in most plans. In most types of Medicare Advantage Plans, you can’t join a separate Medicare drug plan. |
| In most cases, you don’t have to get a service or supply approved ahead of time for Original Medicare to cover it. | In many cases, you have to get a service or supply approved ahead of time for the plan to cover it. |
Coverage
| Original Medicare |
| Original Medicare covers most medically necessary services and supplies in hospitals, doctors’ offices, and other health care facilities. Original Medicare doesn’t cover some benefits like eye exams, most dental care, and routine exams. |
| Medicare Advantage |
| Plans must cover all medically necessary services that Original Medicare covers. Plans may also offer some extra benefits that Original Medicare doesn’t cover – like vision, hearing, and dental services. |
| Original Medicare |
| You can join a separate Medicare drug plan to get Medicare drug coverage (Part D). |
| Medicare Advantage |
| Medicare drug coverage (Part D) is included in most plans. In most types of Medicare Advantage Plans, you can’t join a separate Medicare drug plan. |
| Original Medicare |
| In most cases, you don’t have to get a service or supply approved ahead of time for Original Medicare to cover it. |
| Medicare Advantage |
| In many cases, you have to get a service or supply approved ahead of time for the plan to cover it. |
Foreign travel
Original Medicare |
Medicare Advantage |
|---|---|
| Original Medicare generally doesn’t cover medical care outside the U.S. You may be able to buy a Medicare Supplement Insurance (Medigap) policy that covers emergency care outside the U.S. | Plans generally don’t cover medical care outside the U.S. Some plans may offer a supplemental benefit that covers emergency and urgently needed services when traveling outside the U.S. |
Foreign travel
| Original Medicare |
|---|
| Original Medicare generally doesn’t cover medical care outside the U.S. You may be able to buy a Medicare Supplement Insurance (Medigap) policy that covers emergency care outside the U.S. |
| Medicare Advantage |
| Plans generally don’t cover medical care outside the U.S. Some plans may offer a supplemental benefit that covers emergency and urgently needed services when traveling outside the U.S. |