What Is Medicare, and What Does It Cover?
Medicare is a federal health insurance program for seniors and people under 65 who have certain illnesses or disabilities.
Its coverage helps control aging-related medical costs. Medicare doesn’t cover everything.
What is Medicare?
Medicare Parts A, B, C, and D Each part’s cost and coverage vary.
- Part A includes hospital care.
- Part B includes outpatient and doctor visits.
- Private insurers offer Part C, which offers the same benefits as A and B.
- Part D covers medicines.
Here are some Medicare costs and coverage details.
Medicare Eligibility
Medicare is available if you’re 65 or older and a U.S. citizen or five-year legal resident. Medicare provides assistance to disabled people under the age of 65.
After two years, Social Security disability recipients can get Medicare.
End-stage renal disease (permanent kidney failure) patients are automatically enrolled upon signing up, and ALS patients are eligible the month incapacity begins.
Medicare At Glance
Inpatient hospital or skilled nursing facility care. | Premium: $0 for most people; but up to $499 per month in 2022 ($506 in 2023) for those who don’t qualify for premium-free Part A. Deductible: $1,556 in 2022 ($1,600 in 2023). | |
Doctor visits and preventive services. | Premium: Starts at $170.10 per month in 2022 ($164.90 in 2023). Deductible: $233 in 2022 ($226 in 2023). | |
| Parts A and B coverage plus vision, hearing, and dental benefits | Premium: Continue to pay the Part B premium, plus premium billed by private insurer. (Some plans have $0 premiums.) Out-of-pocket limit: As much as $7,550 in 2022 ($8,300 in 2023). | |
Generic and brand-name prescription drugs. | Premium: Varies by private insurer; average is $33 per month in 2022 (projected at $31.50 in 2023). |
Original Medicare
Original Medicare is managed by the federal government and includes Parts A and B.
Medicare pays a big part of the cost for any doctor who takes an assignment.
Medicare Part A (Hospital Insurance)
Medicare Part A covers hospital or SNF inpatient treatment, but not custodial or long-term care. Part A covers hospice and home health care.
Medicare Part A patients pay a $1,556 deductible in 2022 ($1,600 in 2023) plus coinsurance.
Patients will pay $389 per day in 2022 ($400 in 2023) for the 61st through 90th days of hospitalization and more after that.
Most people who have paid Medicare taxes for at least 10 years don’t pay Part A premiums.
Medicare Part B (Medical Insurance)
Medicare Part A covers hospital or SNF inpatient treatment, but not custodial or long-term care. Part A covers hospice and home health care.
Medicare Part A patients pay a $1,556 deductible in 2022 ($1,600 in 2023) plus coinsurance.
Patients will pay $389 per day in 2022 ($400 in 2023) for the 61st through 90th days of hospitalization and more after that.
Most people who have paid Medicare taxes for at least 10 years don’t pay Part A premiums.
The Medicare Part B Penalty
If you don’t have employer-sponsored health insurance and don’t sign up for Medicare Part B at age 65, you may have to pay a 10% penalty for each year you wait.
If you had health insurance through your employer or your spouse’s when you became eligible, you can avoid the penalty.
You must sign up within eight months of your coverage ending and show proof of group insurance if you are over 65.
Medicare Advantage (Medicare Part C)
Medicare Advantage, often known as Medicare Part C, is a private health plan that combines Parts A, B, and D.
You must pay your Part B payment and an insurance premium.
Many Medicare Advantage plans have zero premiums.
These packaged plans may include vision, hearing, and dental services.
Unlike original Medicare, Medicare Advantage plans limit out-of-pocket expenses.
Medicare Part D (Prescription Drugs)
Medicare Part D covers generic and brand-name prescriptions.
Private insurers offer plans with monthly premiums of $33 in 2022 and $31.50 in 2023.
As with Part B, there is a late enrollment penalty.
After 63 days without creditable drug coverage, the Part D penalty is 1% of the national base beneficiary premium in 2022 ($32.37 in 2023), multiplied by the number of months you sign up late.
Medigap (Medicare Supplement Insurance)
Medigap, or Medicare Supplement Insurance, is private coverage that helps pay Medicare Part A and Part B payments.
This includes deductibles, coinsurance, and foreign health care.
Medigap insurance doesn’t cover long-term care, prescription medicines, dentistry, vision, or hearing aids.
Most states provide 10 Medigap plans. Medigap requires Medicare Parts A and B.
You must choose between Medigap and Medicare Advantage.
Enrolling in Medicare
When you turn 65 and get Social Security, you’re immediately enrolled in Medicare Part A, which covers hospital expenditures, and Part B, which covers doctor visits.
If you don’t get Social Security, you can sign up for Medicare online.
You should do this in the seven months before you turn 65 to avoid permanent penalties and long waits before your insurance starts.
Medigap enrollment begins the month you turn 65 and enrol in Medicare Part B. If you sign up during that period, private insurers must accept you.
Otherwise, they may not sell you a Medigap plan or charge you more.
Medicare Enrollment Periods
If you get Social Security or are disabled and turn 65, Medicare Parts A and B are signed up for you automatically. Otherwise, enroll yourself. Here’s when:
If you don’t sign up for Medicare automatically, you’ll have a chance to do so around the time you turn 65. This includes the three months before and after your birthday month.
If your birthday is the first of the month, this includes the four months before and after.
General enrollment period: If you don’t apply for Medicare during your initial enrollment time, you must wait from January to March.
Coverage begins July 1; late fees may apply.
Special enrollment period: You can join Medicare or modify your coverage if you leave a job or move out of your plan’s coverage area.
How To Enroll In Medicare
Online applications take under 10 minutes. Reopened Social Security Administration offices require masks and a 6-foot distance.
You must come alone unless you need help, and you may have to wait outside.
If you can’t enrol online, phone regarding in-person appointments. Appointments recommended.
What Medicare Doesn’t Cover
Common Medicare exclusions include:
Long-term care is the highest uninsured expense.
Medicaid supports custodial costs for low-income, low-savings people.
Medicare Vs. Medicaid
Medicare covers all people over the age of 65, SSDI recipients, and people with certain conditions, regardless of income.
Medicare is a federal program that’s the same nationwide.
Medicaid is a health-care program for low-income people of all ages, with little or no financial responsibility on the part of the patient.
Medicaid is a state-federal program that varies.
Frequently Asked Questions
Who Qualifies For Medicare?
If you’re 65 or older, have a disability and are approved for Social Security disability insurance, or have end-stage renal illness (kidney failure needing dialysis or a transplant), you qualify for Medicare.
Can I Keep My doctor On Medicare?
If you have Medicare Part B (medical insurance), you can see any Medicare-accepting doctor. Ask your doctor if they accept new Medicare patients.
Do I Need Medicare if I Already Have Health Insurance?
It depends on the size of your employer or your spouse’s employer if you have health insurance. If your employer has fewer than 20 employees, sign up for Medicare Part A and Part B when you’re first eligible. Medicare will pay your qualified health care costs before your other coverage does.
Does Medicare Cover Dental And Eye Care?
Original Medicare doesn’t cover cleanings, fillings, tooth extractions, dentures, dental plates, or other dental equipment. Medicare Part A, which covers hospital stays, will pay for dental care that is needed for another procedure or surgery. Medicare doesn’t fund eyeglasses or contact lens exams.
Where Can I Find Out More?
Medicare.gov is the official site for Medicare. You can browse the site, live chat with someone from Medicare, or call 800-MEDICARE (800-633-4227, TTY 877-486-2048). You can also input your state to find local organizations that can help.
