There are two ways to get Medicare. Original Medicare (Part A and Part B) and Medicare Advantage (Part C). You can also add a drug plan (Part D).
Standalone drug plans can be added to Original Medicare or Advantage plans without a drug plan, while some Advantage plans come bundled with a drug plan.
What is Medicare?
Medicare is the federal health insurance program for people who are 65 or older, certain people with disabilities, and people with End-Stage Renal Disease (ESRD).
Parts of Medicare
There are 4 parts of Medicare:
What is Original Medicare (Part A and Part B)? Original Medicare is health insurance most seniors are entitled to. Part A covers hospital insurance and Part B covers medical insurance. Part A has cost-sharing and Part B has a premium.
What is Medicare Advantage (Part C)? Medicare Advantage “bundles” Part A and Part B, and usually Part D, to offer an alternative to Original Medicare.
What is a Medicare Prescription Drug Plan (Part D)? Drug plans cover cost-sharing on drugs.
What is Medigap? Unlike Part C and Part D, Medigap is not part of Medicare. Medigap is insurance sold by private companies to help fill the gaps in Original Medicare. You can’t have Part C and Medigap, so you’ll have to choose between the two.
When to Get Medicare
Your first opportunity to enroll in Medicare is during your initial enrollment period, for most people that is the 7 month period surrounding their 65th Birthday when they first become eligible for Medicare.
During initial enrollment, you can either choose Original Medicare only, enroll in Medicare Advantage instead, and decide if you want an Advantage plan with a drug plan or a standalone drug plan. Those who go with Original Medicare and/or a drug plan may also want to get Medigap to fill in the gaps (Medigap can’t be paired with Advantage).
Outside of initial enrollment, there are annual enrollment periods each year where you can switch plans or enroll in a plan if you missed initial enrollment.
Although each Part of Medicare has specific rules, in most cases if you miss initial enrollment and didn’t have other qualifying coverage you will end up with a late penalty. So shopping for coverage during initial enrollment and maintaining it is important.
What Does Medicare Cover?
Original Medicare Part A (Hospital Insurance):
- Inpatient care in hospitals
- Skilled nursing facility care
- Hospice care
- Home health care.
Original Medicare Part B (Medical Insurance):
- Services from doctors and other health care providers
- Outpatient care
- Home health care
- Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
- Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)
Part C (Medicare Advantage) may cover the following depending on the plan:
- Additional cost-sharing on hospital insurance costs covered by Part A
- Additional cost-sharing for medical costs covered by Part B
- Drug costs covered by Part D
Part D (Prescription drug coverage):
- Prescription drugs (including many recommended shots or vaccines)
- Medicare & You. Medicare.gov.