Original Medicare
Parts A & B
- Choose any doctor that accepts Medicare
- No referrals needed for specialists
- No prescription drug coverage (unless you add Part D)
- No coverage for vision, dental, or hearing
Medicare Advantage
Part C
- All-in-one bundled coverage
- Usually includes prescription drugs
- May include extra benefits like vision, dental, hearing
- Limited to network providers in most plans
Medicare Supplements
Medigap
- Helps pay Original Medicare costs
- Standardized plans make comparison easy
- Use with any doctor that accepts Medicare
- Additional monthly premium
Who is eligible?
- People 65 or older
- People under 65 with certain disabilities who receive Social Security Disability Insurance (SSDI) for 24 months
- People with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS)
When to enroll
Initial Enrollment Period
7-month period: 3 months before your 65th birthday month, your birthday month, and 3 months after
General Enrollment Period
January 1 - March 31 each year (if you missed Initial Enrollment)
Special Enrollment Period
Available in certain situations (e.g., if you're covered under a group health plan)
How to apply
Part A (Hospital Insurance)
What it covers:
- • Hospital stays
- • Skilled nursing facility care
- • Home health care
- • Hospice care
What you pay:
- • $0 premium for most people
- • $1,600 deductible per benefit period (2023)
- • $0 for first 60 days in hospital
- • $400/day for days 61-90
Part B (Medical Insurance)
What it covers:
- • Doctor visits
- • Outpatient care
- • Preventive services
- • Medical equipment
- • Lab tests
What you pay:
- • $164.90/month premium (2023 standard)
- • $226 annual deductible (2023)
- • 20% of Medicare-approved amount
- • No out-of-pocket maximum
Part D (Prescription Drug Coverage)
What it covers:
- • Prescription medications
- • Some vaccines
What you pay:
- • Monthly premium varies by plan
- • Annual deductible up to $505 (2023)
- • Copays or coinsurance for medications
- • Coverage gap ("donut hole")
When should I sign up for Medicare?
Most people should sign up during their Initial Enrollment Period around their 65th birthday to avoid late enrollment penalties.
Do I need Medicare if I have other insurance?
It depends on your situation. If you have employer coverage, you may be able to delay enrollment without penalty.
What's the difference between Medicare and Medicaid?
Medicare is primarily for people 65+ regardless of income. Medicaid is for people with limited income and resources.
Get free, personalized Medicare counseling from your State Health Insurance Assistance Program (SHIP).
Find Your Local SHIPOr call Medicare directly:
1-800-MEDICARE (1-800-633-4227)