What Is Medicare?
How the federal insurance program helps older Americans afford the health care vital to their well-being
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En español | What is Medicare? For more than 57 years, it's been the program that older Americans and people with disabilities turn to for their health care coverage. In 2022, it will help more than 63 million people pay for everything from hospital stays to doctor visits to prescription drugs.
At 65, you become eligible for the program. You’ll need to set aside time around that milestone birthday to sift through many options so you can sign up for the coverage that meets your health needs and budget.
It's up to you to get ready. Unless you are already receiving Social Security benefits and then will be automatically enrolled in the program, you won't get a letter in the mail reminding you that it's time to start making these decisions. What's more, the timetable is specific — and important. You can start signing up three months before you turn 65, and you'll have until three months after your birthday month to enroll. If you miss that deadline, you may end up paying higher premiums. If you are still working and have employer-sponsored health coverage, you can probably wait to sign up — but more about that later.
Taking control of your health care
You'll need to do some homework before you start assessing options and picking plans. Make a list of your doctors and decide how important it is to you that you can continue seeing them once you are on Medicare. Also, make a list of medications you take so that you can make sure the prescription drug plan you select will meet your needs.
Think about your lifestyle. Are you a homebody and never travel outside the U.S.? Are you an adventurer who goes abroad frequently? Do you split your time between residences and need medical care in different states? All these factors are likely to figure into the decisions you make.
Your financial situation also is important. You'll learn through this guide that Medicare helps pay for medical care for older Americans and people with disabilities. But it's not free. You'll want to choose an option you can afford and build the out-of-pocket costs into your budget. And take time to review the ways the federal government can help you pay Medicare's costs if you can't afford them.
You need to pay attention to all of Medicare's parts. Part A covers hospital and hospice care, and some skilled nursing services after you've been in the hospital. Part B includes doctor visits and other outpatient services. Part C is Medicare Advantage, which is a combination of parts A and B — and usually Part D, which helps pay for prescription drugs.
Medicare getting some enhancements
Medicare is an evolving program. Some long-fought-for changes to Medicare's prescription drug benefits will begin to take hold in 2023. Vaccines recommended for adults by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices will be free. Copays for insulin covered by Medicare will be capped at $35 a month. Drugmakers that raise their prices more than inflation will begin to pay a penalty to Medicare for those increases. In the future, out-of-pocket costs for prescription drugs will be capped at $2,000 a year, and the Medicare program will begin negotiating with pharmaceutical companies for the prices of some high-cost medications that many beneficiaries take.
Adapting to the coronavirus
Medicare officials have made changes in the program’s rules and procedures in an effort to help enrollees cope with the needs and uncertainties brought on by COVID-19.
For example, the federal government said early on in the pandemic that Medicare would cover the cost of coronavirus testing for beneficiaries. It also decided that doctors could order that tests be brought to enrollees’ homes and administered there. Like all Americans, Medicare beneficiaries will not have to pay to get a COVID-19 vaccine. Medicare enrollees also can receive treatments for the coronavirus, such as Paxlovid, free of charge.
Medicare had already expanded its coverage of telehealth in recent years, but the arrival of the coronavirus accelerated the use of remote care. Beneficiaries can now use a phone, a tablet or a computer to communicate with medical providers. And Medicare will cover telehealth visits with nurse practitioners, physical therapists and occupational therapists, in addition to doctors.
Now that you have a taste of what Medicare has to offer, take some time to gain a better understanding of this vital but complex health care program.Now that you have a taste of what Medicare has to offer, take some time to gain a better understanding of this vital but complex health care program.
Editor's note: This story has been updated to reflect new information.
Dena Bunis covers Medicare, health care, health policy and Congress. She also writes the Medicare Made Easy column for the AARP Bulletin. An award-winning journalist, Bunis spent decades working for metropolitan daily newspapers, including as Washington bureau chief for the Orange County Register and as a health policy and workplace writer for Newsday.