Medicare is health insurance run by the federal government for people 65 and older

Medicare is a federal health insurance program. If you are 65 or older, you are likely covered by it, or you can sign up for it. Some younger people with disabilities or end-stage renal disease can also get Medicare. The program is run by the Centers for Medicare & Medicaid Services (CMS), which is part of the U.S. Department of Health and Human Services.

Medicare pays for hospital stays, doctor visits, prescription drugs, and other medical care. It does not cover everything — you will have out-of-pocket costs like deductibles, copayments, and coinsurance. Understanding what Medicare covers and what it does not will help you plan for your healthcare costs as you age.

Key Takeaways

  • Medicare has four parts: Part A covers hospital care, Part B covers doctor visits and outpatient services, Part D covers prescription drugs, and Part C is an alternative plan run by private insurance companies.
  • You become may be able to access for Medicare at age 65, and you can sign up during your initial enrollment period, which starts three months before your 65th birthday.
  • Most people do not pay a monthly premium for Part A if they or their spouse paid Medicare taxes while working, but Part B and Part D have monthly premiums that vary by income.
  • Medicare has annual deductibles, copayments, and coinsurance amounts that change each year, so your out-of-pocket costs depend on which parts you have and how much care you use.
  • You can change your Medicare coverage once a year during the Annual Enrollment Period, which runs from October 15 to December 7.

The four parts of Medicare and what each one covers

Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health services. If you stay in a hospital, Part A pays for your room, meals, and standard nursing care. You pay a deductible for each hospital stay, and if you stay longer than 60 days, you pay coinsurance for days 61 through 90.

Part B covers doctor visits, outpatient services, medical equipment, and preventive care like screenings and vaccines. This includes visits to your primary care doctor, specialists, lab tests, and X-rays. Part B has a monthly premium, an annual deductible, and then you typically pay 20 percent coinsurance for most services after you meet the deductible.

Part D covers prescription drugs. You choose a Part D plan from private insurance companies, and each plan has its own list of covered drugs, monthly premium, and out-of-pocket costs. Part D is optional, but if you do not sign up when you first become may be able to access and you go without coverage, you may pay a penalty later.

Part C, also called Medicare Advantage, is an alternative to Original Medicare (Parts A and B). Private insurance companies offer Part C plans, and they must cover everything Part A and Part B cover, but they often include prescription drug coverage and extra benefits like dental or vision. Part C plans have their own networks of doctors and hospitals, so you may not be able to see any doctor you choose.

How much Medicare costs

Most people do not pay a monthly premium for Part A because they or their spouse paid Medicare payroll taxes for at least 10 years while working. If you did not pay those taxes, you can still get Part A, but you will pay a monthly premium — the amount depends on how many years you or your spouse worked and paid taxes.

Part B has a monthly premium that most people pay directly to Medicare. In 2024, the standard Part B premium is $164.90 per month, but your actual premium may be higher if your income is above a certain level. Higher-income beneficiaries pay an additional amount called the Income-Related Monthly Adjustment Amount (IRMAA).

Part D premiums vary by plan and by insurance company. You choose which plan to join, so you can compare premiums and coverage before you sign up. Part D also has an annual deductible and copayments for each prescription, which vary by plan.

Part C premiums also vary by plan. Some Part C plans have no monthly premium, while others charge a premium on top of your Part B premium. Part C plans have their own deductibles and copayments, which may be different from Original Medicare.

When you can sign up for Medicare

You can sign up for Medicare starting three months before the month you turn 65. Your initial enrollment period lasts for seven months — it includes the three months before you turn 65, the month you turn 65, and the three months after. If you sign up during this window, your coverage can start as early as the first day of the month you turn 65.

If you miss your initial enrollment period, you can still sign up during the General Enrollment Period, which runs from January 1 to March 31 each year. However, if you sign up late, your coverage will not start until July 1 of that year, and you may have to pay a permanent penalty on your Part B and Part D premiums.

If you are still working and have health insurance through your employer, you may be able to delay signing up for Part B without penalty. You will need to sign up within eight months of leaving your job or losing your employer coverage.

What Medicare does not cover

Medicare does not cover dental care, vision care, or hearing aids. It does not cover long-term care in a nursing home or assisted living facility, though Part A covers short-term skilled nursing care after a hospital stay. Medicare also does not cover routine foot care, cosmetic surgery, or most acupuncture.

Some preventive services are covered at no cost to you, such as annual wellness visits, cancer screenings, and vaccines. However, if you need treatment for a condition, you will have out-of-pocket costs. Medicare also does not cover care you receive outside the United States, except in limited situations.

If you want coverage for services Medicare does not cover, you can buy a Medigap policy from a private insurance company. Medigap helps pay for some of the costs that Original Medicare does not cover, such as copayments and coinsurance. Part C plans often include extra benefits like dental or vision, so you may not need Medigap if you choose a Part C plan.

How to find more information about your Medicare coverage

You can visit Medicare.gov to learn about your coverage, compare plans, and find answers to common questions. The site has a tool called the Plan Finder that lets you compare Part D and Part C plans side by side. You can also call Medicare directly at 1-800-MEDICARE (1-800-633-4227) to speak with someone who can answer your questions.

Your state's Health Insurance information Program (SHIP) offers free, one-on-one counseling about Medicare. A counselor can help you understand your coverage, compare plans, and sort through your options. You can find your state's SHIP by visiting the Eldercare Locator at 1-800-677-1116 or searching online for your state name plus "SHIP".

If you receive Social Security, you can also log into your My Social Security account online to view your Medicare information and make changes to your coverage during the enrollment periods.

Frequently Asked Questions

Do I have to sign up for Medicare when I turn 65?

You do not have to sign up, but if you delay and do not have other may have access to coverage, you may pay a permanent penalty on your Part B and Part D premiums. If you are still working and have health insurance through your employer, you can delay Part B without penalty, but you should still sign up for Part A.

Can I have both Medicare and private insurance?

Yes. If you have Original Medicare (Parts A and B), you can buy a Medigap policy to help cover costs that Medicare does not pay. You cannot have both Original Medicare and Part C at the same time. If you have Part C, it replaces Original Medicare.

What happens if I do not sign up for Part D when I first become may be able to access?

If you go without Part D coverage and do not have other may have access to drug coverage, you will pay a penalty when you do sign up. The penalty is added to your Part D premium for as long as you have Medicare. The amount depends on how long you went without coverage.

Can I change my Medicare plan after I sign up?

Yes, you can change your coverage during the Annual Enrollment Period, which runs from October 15 to December 7 each year. Changes take effect on January 1. You can also make changes if you have a may have access to life event, such as moving to a new state or losing other health coverage.

Does Medicare cover preventive care?

Yes. Medicare covers many preventive services at no cost to you, including annual wellness visits, cancer screenings, cardiovascular screenings, diabetes screenings, and vaccines. You do not have to pay a copayment or coinsurance for these services, but you must see a doctor who accepts Medicare.