Medicare coverage: Common questions and answers
Looking for help with Medicare questions? We break it down for you and explain what it is and what Medicare covers.
If you’re having trouble navigating all the Medicare information out there, these answers to common questions might help put you on a path of understanding.
What is Medicare?
Medicare is a federal health insurance program that is divided into “Parts” you can use individually or together. Each part has a letter assigned (A, B, C and D), and each letter aligns to a specific type of service (i.e., hospital insurance, medical insurance and prescription drug coverage). Parts A and B are commonly referred to as "Original Medicare" since they were created before Parts C and D.
What is Medicare Part A?
Medicare Part A is hospital insurance. It covers hospital stays, skilled nursing care, hospice and some home health care.
What is Medicare Part B?
Medicare Part B is medical insurance. It covers some doctors' visits, medical supplies, preventative services and outpatient care, such as rehabilitation.
What is Medicare Part C?
Medicare Part C (also called Medicare Advantage) is an alternative Medicare plan sold by private insurance companies and typically includes Medicare Part A, B and D. Some Medicare Advantage plans may also offer additional benefits like hearing, vision and dental.
What is Medicare Part D?
Medicare Part D provides prescription drug coverage. You can purchase Part D when you enroll in Parts A and B.
Who is eligible for Medicare?
Medicare is for people 65 or older, certain people under 65 with disabilities and people of any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
When do I sign up for Medicare?
The first time you become eligible for Medicare, you’ll be able to sign up for Part A and Part B during your initial enrollment period, which spans for seven months including the three months prior to the month you turn 65, the month you turn 65, and the three months following the month you turned 65.
Use this online eligibility estimator tool from Medicare to determine the dates for your initial enrollment period.
Many people sign up for Part A as soon as they turn 65 since it can be easy and typically free of charge. Many people also sign up for Part B during their initial enrollment period, but it may be more beneficial to wait depending on your situation.
If you do not anticipate having group coverage through your own or your spouse's employer when you turn 65, think about signing up for Part B during your initial enrollment period so you don’t have to pay a late enrollment penalty. However, if you anticipate having group coverage through your own or your spouse’s employer when you turn 65, you may want to consider holding off on signing up for Part B until you’re no longer eligible for that group coverage. Just make sure to enroll in Part B within 8 months of that group coverage ending, otherwise you will get penalized for waiting too long and you’ll have to pay an additional fee.
How do I sign up for Medicare?
You can sign up for Medicare online or in person at your local Social Security office.
How much does Medicare cost?
Medicare Part A is offered free of charge if you or your spouse have paid Medicare taxes for at least 10 years by the time you turn 65. If you or your spouse have not paid Medicare taxes for at least 10 years by the time you turn 65, the premium you pay will be based on the number of years you’ve fallen short.
The monthly premium cost for Medicare Part B is $164.90 (for 2023, but prices may vary from year to year). It could be more if your income is over a certain amount or if you’ve waited too long before signing up.
How does Medicare work with my existing insurance?
If you have group coverage through your own or your spouse's employer, your group coverage will pay first if the employer has more than 20 employees. Part A may cover a portion of the remaining cost for eligible hospital in-patient expenses.
If you have what's known as retiree insurance, which works like a Medicare Supplement insurance policy, then Medicare will pay first.
What does Medicare cover?
Medicare helps cover many of the costs associated with health care; however, it does not cover everything. So, keep in mind that you will still be responsible for many out-of-pocket expenses such as coinsurance, co-payments, and deductibles. For example, you will be responsible for 20% of the cost of most Part B eligible expenses, but this amount could be more if you see a doctor who does not accept the amount Medicare agrees to pay for the service.
What is Medicare Supplement Insurance?
Medicare Supplement Insurance is a private health insurance that helps cover some of the costs not covered under Original Medicare. You might see it referred to as Medicare Supplement, Medigap, or even Med Supp as a shortened version. Find out how Medicare Supplement Insurance can be beneficial in helping pay for some of the out-of-pocket health care costs that aren’t covered by Medicare.
What if I decide to retire before I’m 65?
The earliest you can sign up for Medicare is three months before your 65th birthday. If you decide to retire before turning 65, you may want to either look into staying on your company’s group plan for 18 or 36 months through COBRA (the Consolidated Omnibus Budget Reconciliation Act), or visit HealthCare.gov to compare the options available through the Affordable Care Act.
What if I decide to keep working after I turn 65?
Even if you decide to keep working after you turn 65, you may want to consider signing up for Medicare during your initial enrollment period to avoid having to pay additional penalty fees in the future.