If you’re new to Medicare:
- Learn about your Medicare choices. There are 2 different ways to get your Medicare coverage—see the next few pages to learn more.
- Find out how and when you can sign up. If you don’t have Medicare Part A or Part B, see Section 1, which starts on page 15. If you don’t have Medicare prescription drug coverage (Part D), see Section 6, which starts on page 73. There may be penalties if you don’t sign up when you’re first eligible.
- If you have other health insurance, see pages 20–21 to find out how it works with Medicare.
If you already have Medicare:
- You don’t need to sign up for Medicare each year. However, you can review your Medicare health and prescription drug coverage and make changes each year.
- Mark your calendar with these important dates! This may be the only chance you have each year to make changes to your coverage.
October 1
Start comparing your coverage with other options. You may be able to save money. Visit Medicare.gov/find-a-plan.
October 15 to December 7
Change your Medicare health or prescription drug coverage, if you decide to. This includes returning to Original Medicare or joining a Medicare Advantage Plan.
January 1
New coverage begins if you made a change. If you kept your existing coverage and your plan’s costs or benefits changed, those changes will also start on this date.
January 1 to March 31
If you’re in a Medicare Advantage Plan, you can make one change to a different plan or switch back to Original Medicare (and join a stand-alone Medicare Prescription Drug Plan) once during this time. Any changes you make will be effective the first of the month after the plan gets your request.
What are the parts of Medicare?
Part A (Hospital Insurance)
Helps cover:
- Inpatient care in hospitals
- Skilled nursing facility care
- Hospice care
- Home health care
See pages 25–28.
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 and supplies)
- Many preventive services (like screenings, shots, and yearly “Wellness” visits)
See pages 29–49.
Part D (Prescription drug coverage)
Helps cover:
- Cost of prescription drugs
Part D plans are run by private insurance companies that follow rules set by Medicare.
See pages 73–82.
Your Medicare options
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
- Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
- If you want drug coverage, you can join a separate Part D plan.
- To help pay your out-of-pocket costs in Original Medicare (like your deductible and 20% coinsurance), you can also shop for and buy supplemental coverage.
Includes:
You can add:
You can also add:
- Supplemental Coverage - (Some examples include coverage from a Medicare Supplement Insurance (Medigap) policy, or coverage from a former employer or union.)
Medicare Advantage (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.
- Some plans may have lower outof-pocket costs than Original Medicare.
- Some plans offer extra benefits that Original Medicare doesn’t cover— like vision, hearing, or dental.
Includes:
Most plans include:
Some plans also include:
- Lower out-of-pocket costs
- Extra benefits
Original Medicare vs. Medicare Advantage
Doctor and hospital choice
Original Medicare
- You can go to any doctor that accepts Medicare.
- In most cases you don’t need a referral to see a specialist.
Medicare Advantage
- In most cases, you’ll need to use doctors who are in the plan’s network (for non-emergency or non-urgent care). Ask your doctor if they participate in any Medicare Advantage Plans.
- You may need to get a referral to see
Original Medicare
- For Part B-covered services, you usually pay 20% of the Medicareapproved amount after you meet your deductible.
- You pay a premium (monthly payment) for Part B. If you choose to buy prescription drug coverage, you’ll pay that premium separately.
- There’s no yearly limit on what you pay out-of-pocket.
- You can buy supplemental coverage to help pay your out-of-pocket costs (like your deductible and 20% coinsurance).
Medicare Advantage
- Out-of-pocket costs vary—some plans have low or no out-of-pocket costs.
- You may pay a premium for the plan (most include prescription drug coverage) and a premium for Part B. Some plans have a $0 premium or will help pay all or part of your Part B premium.
- Plans have a yearly limit on what you pay out-of-pocket for Medicare Part A and B covered services. Once you reach your plan’s limit, you’ll pay nothing for Part A- and Part Bcovered services for the rest of the year.
- You can’t buy or use separate supplemental coverage—but some plans have lower out-of-pocket costs than Original Medicare.
Original Medicare
- Original Medicare covers medical services and supplies in hospitals, doctors’ offices, and other health care settings.
- You can join a separate Medicare Prescription Drug Plan to get drug coverage.
- In most cases, you don’t have to get a service or supply approved ahead of time for it to be covered.
Medicare Advantage
- Plans must cover all of the services that Original Medicare covers. Some plans offer extra benefits that Original Medicare doesn’t cover— like vision, hearing, or dental.
- Prescription drug coverage is included in most plans.
- In some cases, you have to get a service or supply approved ahead of
time for it to be covered by the plan.
Original Medicare
Original Medicare generally doesn’t cover care outside the U.S. You may be able to buy supplemental coverage that covers care outside the U.S.
Medicare Advantage
Plans usually don’t cover care outside the U.S. Also, plans usually don’t cover non-emergency care you get outside of your plan’s network.
Get the most out of Medicare
Get help choosing the coverage option that’s right for you:
- Get free, personalized counseling from your State Health Insurance Assistance Program (SHIP)—see pages 109–112 for the phone number.
- Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
- Visit the Medicare Plan Finder at Medicare.gov/find-a-plan.
Get free help with your Medicare questions
For general Medicare questions, visit Medicare.gov, or call 1-800-MEDICARE.
Get preventive services
Ask your doctor or other health care provider which preventive services (like screenings, shots, and tests) you need to get. Medicare covers many common preventive services at no cost to you.
Get help paying for health care
Find out if you can get help paying your health and prescription drug costs. Go to Section 7, which starts on page 83, to see if you qualify.
Go paperless
Help save tax dollars by choosing to access future “Medicare & You” handbooks electronically.
