It’s open enrollment season for Affordable Care Act health insurance! Here are 11 things you need to know.
En español | Medicare is often confusing because its rules affect different people in different circumstances. AARP’s Medicare Question and Answer Tool offers practical and comprehensive information to help you navigate the program according to your own situation. The tool clarifies eligibility and enrollment requirements and provides answers to questions on Medicare’s plan options, coverage and costs in an easy-to-understand manner.
Choose a topic below and click “See all questions” to find the answers you are looking for.
Q: What is Medicare?
A: Medicare is a federal health insurance program for people who are age 65 and over and for some younger people who receive Social Security disability benefits. — Read full answer
Q: What are the different parts of Medicare?
A: Medicare has four parts, each offering a different type of coverage: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage) and Part D (prescription drug coverage). — Read Full Answer
Q: What is the difference between Medicare and Medicaid?
A: Medicare is a federal health insurance program for people age 65 and over and younger people who qualify due to disability. Medicaid, a state-run program, provides health coverage for people with low incomes. — Read Full Answer
Q: What is Original Medicare?
A: Original Medicare is a fee-for-service health program. This means you can choose any doctor or hospital that accepts Medicare patients, anywhere in the United States, and Medicare will pay its share of the bill. — Read Full Answer
Q: What is Medicare Advantage?
A: Plans in the Medicare Advantage program (Part C) are offered as an alternative to Original Medicare and run by private companies. — Read Full Answer
Q: What is Medigap supplemental insurance (if I’m age 65 or older)?
A: Medigap is private insurance that covers out-of-pocket expenses in the Original Medicare program. (If you are under age 65 and have Medicare due to disability, see the next Q&A in this section, because the rules are different for your situation.) — Read Full Answer
Q: Can I get Medigap supplemental insurance if I’m under 65?
A: If you qualify for Medicare under age 65 due to disability, you may find it more difficult to buy Medigap insurance than people 65 and older, but it depends on where you live. — Read Full Answer
Q: How do I qualify for Medicare?
A: You can qualify for Medicare on the basis of either age or disability. — Read Full Answer
Q: Do I automatically receive Medicare when I turn 65 or become eligible for disability benefits?
A: Some Medicare enrollments are automatic, but many aren’t. It depends on your circumstances. — Read Full Answer
Q: I turn 65 in a few months. When should I sign up for Medicare?
A: If you have coverage from a current employer (your own or your spouse’s), you can delay enrollment until the job ends. Otherwise, you should sign up shortly before turning 65. — Read Full Answer
Q: How do I enroll in Medicare?
A: You can apply for Medicare online, by phone or in person, depending on your circumstances. — Read Full Answer
Q: How do I order a replacement Medicare card?
A: You can apply to the Social Security Administration to replace a Medicare card. — Read Full Answer
Q: Does Medicare cover all of my health care costs?
A: Medicare does not cover all your health care costs. It requires you to pay premiums, deductibles and copays, which vary according to the type of Medicare coverage you choose and, in some cases, your income. — Read Full Answer
Q: I want to be sure I understand the Part D “doughnut hole” or coverage gap. Could you tell me how it works?
A: Originally the doughnut hole, if you fell into it, was a period in which you paid 100 percent of the cost of your prescription drugs. But since 2011 the gap has been narrowing. — Read Full Answer
Q: Where can I find answers to my Medicare questions?
A: Two government agencies, Social Security and Medicare, are responsible for different aspects of Medicare. The state health insurance assistance programs (SHIPs) provide personal help on Medicare issues. — Read Full Answer
Q: Can I get help to pay for my prescription drugs if my income is low?
A: Yes. You can apply to the Extra Help program, which provides Medicare Part D prescription drug coverage at low or reduced cost for people with incomes under a certain level. — Read Full Answer
Q: What are the basic rights and responsibilities of people with Medicare?
A: No matter what type of Medicare coverage you have, you have certain rights and responsibilities. — Read Full Answer
Q: What does it mean when doctors “opt out” of Medicare?
A: If you go to a doctor who has opted out of Medicare, you are responsible for the full bill. — Read Full Answer
Q. My doctor told me he doesn’t accept assignment. Can you explain what this means?
A: A doctor who doesn’t accept assignment can charge you up to 15 percent more for a medical service than a doctor who accepts assignment. — Read Full Answer
Q. Is my doctor required to file my Medicare claims or do I file them with Medicare directly?
A: In most situations, doctors and other providers that accept Medicare are required by law to submit claims to Medicare. — Read Full Answer
Q. Will my Medicare Part D prescription drug plan notify me if its list of covered drugs (formulary) changes?
A: Your drug plan is required to notify you of changes in its coverage and costs in specific circumstances. — Read Full Answer
Q. Can I be denied Medicare coverage, or asked to pay more, because of my current health problems or preexisting medical conditions?
A: No. Medicare does not discriminate between people in poor or good health. — Read Full Answer
Q. How do I find an insurance company that is approved to sell Medicare supplemental plans (Medigap) in my area?
A: You can find a complete list online on Medicare’s website. Or you can call Medicare’s help line or your state department of insurance. — Read Full Answer
Q: Is there anyone I can go to for personal help in choosing a Medicare plan or to resolve other issues with Medicare — even if I have to pay for assistance?
A: You don’t have to pay to get personal help with Medicare issues. Your state health insurance assistance program (SHIP) provides this service free of charge. — Read Full Answer
Q: Whom do I contact to report Medicare fraud?
A: The office of Medicare’s inspector general investigates Medicare fraud and welcomes tip-offs from Medicare beneficiaries. — Read Full Answer
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