Medical Medicare is a federal health insurance program for people 65 and older, some younger people with disabilities, and people with end-stage renal disease

Medical Medicare — often called Original Medicare or Traditional Medicare — is run by the Centers for Medicare & Medicaid Services (CMS), a federal agency. It has two main parts: Part A covers hospital stays, skilled nursing care, hospice, and some home health services; Part B covers doctor visits, outpatient care, lab tests, and medical equipment. You pay premiums for Part B (most people do not pay a Part A premium if they or their spouse paid Medicare taxes for at least 10 years), and you also pay deductibles and coinsurance when you use services.

Medical Medicare is different from Medicaid, which is a separate program run by states for people with lower incomes. The two programs have different rules, different income limits, and cover different groups of people. Many people confuse them because both are government health programs, but they are not the same thing.

Key Takeaways

  • Medical Medicare Part A covers hospital and skilled nursing stays; Part B covers doctor visits and outpatient services.
  • You become may be able to access for Medical Medicare at age 65, or earlier if you have a disability or end-stage renal disease.
  • Medical Medicare is federal and the same rules explore everywhere, unlike Medicaid, which varies by state.
  • You pay premiums for Part B, and you also pay deductibles and coinsurance when you receive care.
  • Many people add Part D (prescription drug coverage) or a Medigap policy to cover costs that Medical Medicare does not.

Who is may be able to access for Medical Medicare

You are may be able to access for Medical Medicare if you are 65 or older and a U.S. citizen or permanent resident who has lived in the United States for at least five years. You do not have to be retired or have a low income — age alone qualifies you.

You can also get Medical Medicare before age 65 if you have received Social Security Disability Insurance (SSDI) for at least 24 months, or if you have end-stage renal disease (permanent kidney failure requiring dialysis or transplant) or amyotrophic lateral sclerosis (ALS). If you fall into one of these groups, you should contact Social Security to find out when your coverage begins.

What Medical Medicare Part A covers

Part A covers inpatient hospital care, including room, meals, and standard nursing services. It also covers skilled nursing facility care — care in a nursing home after a hospital stay, if a doctor says you need it and you meet specific conditions. Part A also covers hospice care if you have a terminal illness, and some home health services when ordered by a doctor.

Part A does not cover custodial care (help with daily activities like bathing or dressing if that is all you need), long-term care in a nursing home, or care in your home unless it is skilled care ordered by a doctor. You pay a deductible for each hospital stay and coinsurance for longer stays.

What Medical Medicare Part B covers

Part B covers doctor visits, whether in an office, hospital outpatient department, or urgent care center. It also covers preventive services like annual wellness visits, cancer screenings, and vaccinations. Part B pays for lab tests, X-rays, and imaging ordered by your doctor, as well as durable medical equipment like wheelchairs, walkers, and oxygen supplies.

Part B does not cover routine dental care, vision exams for glasses or contacts, hearing aids, or most long-term care. You pay a monthly premium for Part B (the amount varies by income), a yearly deductible, and coinsurance (usually 20 percent of the cost after you meet your deductible).

How Medical Medicare costs work

Medical Medicare has several costs: premiums (monthly payments), deductibles (amounts you pay before coverage starts), and coinsurance (a percentage of the cost you pay after the deductible). Part A has a deductible per hospital stay; Part B has a yearly deductible. After you meet the Part B deductible, you typically pay 20 percent of the cost for most services.

Part B premiums are based on your income. If you earned more in the past two years, you may pay a higher premium. The standard Part B premium changes each year. You also pay premiums if you add Part D (prescription drug coverage) or a Medigap supplemental policy. Many people find that Medical Medicare alone leaves them paying significant out-of-pocket costs, which is why they add coverage.

Medical Medicare versus Medicaid

Medical Medicare is federal and the same everywhere. Medicaid is run by states and the rules, income limits, and covered services vary by state. Medical Medicare is based on age or disability status, not income — a wealthy person can have Medical Medicare. Medicaid is based on income and other factors, and it is for people with lower incomes.

Some people have both programs, called "dual may be able to access." If you are 65 or older and have a low income, you may be able to have Medical Medicare and Medicaid at the same time. Medicaid can help pay your Medical Medicare premiums and cover some costs that Medical Medicare does not, like long-term care and dental care.

Adding coverage to Medical Medicare

Many people add Part D (prescription drug coverage) to pay for medications. Part D is run by private insurance companies approved by Medicare, and you choose which plan to join. You pay a monthly premium and a deductible, and then you pay a share of the cost of your drugs.

You can also buy a Medigap policy (also called supplemental insurance) from a private insurance company. A Medigap policy pays some or all of the deductibles, coinsurance, and copayments that Medical Medicare does not cover. Different Medigap plans cover different amounts, and you pay a monthly premium. Some people choose a Medicare Advantage plan (Part C) instead, which is an alternative way to get your Medical Medicare benefits through a private insurance company.

Frequently Asked Questions

Do I have to sign up for Medical Medicare at 65?

You should sign up during your initial enrollment period, which starts three months before the month you turn 65 and ends three months after. If you delay, you may pay a penalty on your premiums for as long as you have Medical Medicare. If you are still working and have health insurance through your job, you may be able to delay without penalty — contact Social Security to ask.

Can I use Medical Medicare outside the United States?

Medical Medicare generally does not cover care outside the U.S., with rare exceptions like emergency care in Canada or Mexico near the border. If you travel or live abroad, you should research your coverage before you go and consider a supplemental travel insurance policy.

What happens to my Medical Medicare if I move to a different state?

Your Medical Medicare coverage stays the same no matter where you live in the U.S. The benefits and rules do not change. However, if you have a Medigap or Medicare Advantage plan, you may need to switch plans because not all plans are available in every state.

Does Medical Medicare cover dental or vision care?

Original Medical Medicare does not cover routine dental care, vision exams for glasses, or hearing aids. Some Medicare Advantage plans include dental or vision benefits, but coverage varies by plan. You can also buy standalone dental or vision insurance, though these are separate policies.

How do I know if I should choose Original Medical Medicare or a Medicare Advantage plan?

Original Medical Medicare lets you see any doctor who accepts Medicare. Medicare Advantage plans usually have networks and lower out-of-pocket costs, but you may have to use doctors in the plan. Compare the doctors you see, the costs, and the coverage for medications and services you use. You can change your choice during the annual enrollment period each fall.