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Medicare: What You Need to Know

Table of Contents


Topic Overview

What is Medicare?

Medicare is health insurance that the United States government provides for people ages 65 and older. It also covers some people younger than 65 who have disabilities and people who have long-term (chronic) kidney failure who need dialysis or a transplant.

Medicare helps pay for most hospital services and doctor visits. It also helps pay for physical therapy, occupational therapy, and some other home health services.

But Medicare doesn't cover everything. It doesn't pay for:

Medicare services are offered in parts. Parts A and B are often called original Medicare.

Do you have to pay for Medicare?

Part A

Part B

Part C

These plans have different costs depending on the plan you choose. You may have monthly premiums, as well as deductibles and co-pays.

Part D

You pay a premium for the drug plan, which can vary based on what is covered in the plan.

How do you sign up for Medicare?

Most people are automatically enrolled in Part A and Part B if they:

If you qualify for automatic enrollment, you will be sent your Medicare card 3 months before you turn 65 or your 25th month of disability.

You need to apply to get Part A and Part B benefits if you aren't getting Social Security or railroad benefits. (You're 65 or older but still working, for example.)

You also need to sign up if you have end-stage renal disease. Medicare covers dialysis treatment for people who have permanent kidney failure.

You can get more information and sign up for Medicare by calling the Social Security office at 1-800-772-1213 or by applying online at www.socialsecurity.gov/medicareonly.

Penalty for late enrollment

If you don't sign up for Parts A and B when you are first eligible—by the first day of the month you turn 65—you may pay a higher premium (for the rest of your life) than if you had signed up then. A penalty also may apply for late enrollment in Part D, depending on how long you went without drug coverage.

What is Medigap?

Medigap is an insurance policy that you can buy from a private company to cover costs that are not covered by original Medicare. These costs include co-payments and deductibles. The cost of a Medigap policy depends on what is covered. Some policies pay for health care costs when you travel outside the United States.

You pay a monthly premium to the insurer, as well as paying the Medicare premium for Part B.

A Medigap policy only covers one person, so you and your spouse would each need your own policy.

What is Medicaid?

Medicaid is health insurance for adults who have low income and limited resources. It also covers people who have disabilities.

Medicaid and Medicare are run by the Centers for Medicare and Medicaid Services (CMS) of the U.S. government.

How does the health insurance marketplace affect Medicare?

The health insurance marketplace is a way for people who don't have health insurance to get coverage. The marketplace is part of the Affordable Care Act. Here are some important things to know:

Where can you get more information?

You can find out more about Medicare, whether you are eligible, and what it would cost you in your situation at www.medicare.gov. Or you can call 1-800-633-4227.

You can look at Medicare plans at www.medicare.gov/find-a-plan/questions/home.aspx.

The website www.cms.gov has information on both Medicare and Medicaid.

You also can get help to decide what plans might be best for you through your state's Health Insurance Assistance Program. For more information, see www.shiptalk.org/Public/home.aspx.


Credits for Medicare: What You Need to Know

Current as of: February 11, 2021

Author: Healthwise Staff
Medical Review:
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine


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