This article provides a quick overview of Medicare and how it works.
Medicare is a federal health insurance program for people age 65 and older, as well as some individuals under 65 with certain disabilities or medical conditions.
Medicare coverage is divided into four parts:
Part A (Hospital Insurance)
Part B (Medical Insurance)
Part C (Medicare Advantage)
Part D (Prescription Drug Coverage)
Part A
Part A helps cover:
Inpatient hospital stays
Skilled nursing facility care
Hospice care
Some home health care
Most people qualify for premium-free Medicare Part A. To be eligible, you or your spouse must have paid Medicare taxes (FICA) for at least 10 years (40 quarters). If you're eligible for Part A when you turn 65, you're enrolled automatically.
If you don't qualify for premium-free Part A, you may be able to purchase this coverage through the Social Security Administration (SSA).
People under age 65 may also qualify for Part A if they have received disability benefits for at least 24 months or have certain medical conditions, such as End-Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS).
See Medicare Part A Overview for more information.
Part B
Part B helps cover:
Doctor visits and outpatient care
Services from other healthcare providers
Home health care
Durable medical equipment, such as wheelchairs and walkers
Preventive care, including screenings, vaccines, and annual wellness visits
If you're receiving Social Security benefits when you become eligible for Medicare, you're typically enrolled in Part B automatically. If not, you'll need to sign up at ssa.gov or call the SSA at 1-800-772-1213 (TTY: 1-800-325-0778).
Part B requires a monthly premium.
See Medicare Part B Overview for more information.
Part C
A Medicare Advantage plan, also known as Part C, replaces Original Medicare (Parts A and B) and is offered by private insurance companies approved by Medicare.
Most Medicare Advantage plans also include prescription drug coverage (Part D).
Keep in mind:
You must continue paying your Part B premium.
Medicare Advantage plans can’t be combined with a Medicare Supplement Insurance (Medigap) policy.
Part D
A Prescription Drug plan (PDP), also known as Part D, helps cover the cost of prescription medications, including many recommended vaccines.
You can get Part D coverage by:
Enrolling in a standalone Prescription Drug plan (PDP) with Original Medicare.
Choosing a Medicare Advantage plan that includes drug coverage.
Private insurance companies offer these plans and must follow Medicare guidelines.
Medicare Supplement Insurance (Medigap)
A Medigap is optional coverage that helps pay some out-of-pocket costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles.
The key aspects of Medigap plans are that they:
Work with Original Medicare only.
Can’t be used with a Medicare Advantage plan.
Don't include prescription drug coverage, so you may want to enroll in a PDP separately.
Provide standardized benefits across insurers, although plans are regulated only by the state in which they're sold, not Medicare.