Make sure you know key facts about Medicare before enrolling. Review the statements below and click the arrows on the left for more information. Once you understand each statement, click the box on the right.
1. Medicare Essentials
Medicare consists of four parts:
• Part A helps pay for inpatient stays in hospitals and skilled nursing facilities, some home health services and end-of-life hospice care.
• Part B helps pay for doctor and outpatient care. It also helps cover diagnostic tests and some medical equipment and supplies.
• Part C, better known as Medicare Advantage, is a private insurer alternative to original Medicare, and most plans include Part D prescription drug coverage.
• Part D helps cover the cost of outpatient prescription drugs through plans from private insurers.
As you approach age 65, you generally want to sign up for parts A and B of Medicare during your initial enrollment period — unless you’re receiving Social Security retirement benefits and are automatically enrolled. This seven-month period spans the three months before the month in which you turn 65 until three months after.
If you miss that deadline, you may have to wait to enroll during Medicare’s annual general enrollment period and you could have gaps in your insurance coverage. You also may have to pay a late-enrollment penalty for the rest of your life unless you qualify for a special enrollment period.
Original Medicare, also known as traditional Medicare, consists of Part A hospitalization and Part B doctors' services and outpatient care. It generally doesn’t cover routine dental care, eye exams, hearing aids, medical expenses when traveling outside the U.S., prescription drugs and nursing home care. It also has out-of-pocket costs.
Medicare Advantage, a private insurance alternative to original Medicare, usually covers prescription drugs and may cover dental work, emergency care outside the U.S., hearing aids and vision care.
Part D plans cover some prescription drug costs for both traditional Medicare recipients and Medicare Advantage participants who don’t have drug coverage included.
Medicare supplement plans, known as Medigap policies, help with original Medicare’s deductibles and cost sharing. Some plans offer foreign travel coverage. These plans can’t be used when you choose Medicare Advantage.
Long-term care insurance can help cover home care and nursing home expenses for anyone.
The federal government requires Medicare Advantage plans, which are available from private insurers, to cover everything that original Medicare covers. Some plans pay for services that original Medicare doesn’t cover, such as routine dental, hearing and vision care. Most cover prescription medications. Medicare Advantage plans generally have a provider network.
The price you’ll pay for your medications with a Part D plan depends on whether they’re included in the plan’s formulary, which is its list of covered drugs, and the cost sharing required based on a drug’s pricing tier. Generic drugs tend to have the lowest cost sharing while brand name and specialty medications tend to be more expensive. You also may pay less if you use a pharmacy in the plan’s network.
After you enroll in Part B of Medicare, you have six months to buy any Medigap policy in your area, no matter what your health problems may be. If you want to sign up or switch policies after that, insurers in many states can refuse to sell you a plan or charge you more because of preexisting conditions. Find out about any special Medigap rules in your state.
• Domestic travel. Original Medicare covers visits to any doctor nationwide who accepts Medicare, even if it’s not your usual physician.
Medicare Advantage plans typically use local provider networks, and it may be difficult to find in-network providers in some locations. If you see an out-of-network provider, you may not be covered or you may have to pay more. All plans cover emergency and urgent care with cost sharing.
• Foreign travel. Original Medicare generally doesn’t provide coverage, but some supplemental Medigap policies can cover some of the costs of foreign travel emergencies. Most Medicare Advantage plans don’t cover health care abroad although some have limited coverage for emergency care.
• Original Medicare allows you to see any doctor nationwide who accepts Medicare.
• Medicare Advantage plans have local provider networks and may charge more for out-of-network doctors or may not cover them all, except in emergencies. Some plans also require a referral from a primary care physician to see a specialist.