What is Medicare?

Before you can decide what kind of Medicare coverage is right for you, it’s important to understand what Medicare is and how it works. Don’t worry, though – we’re here to guide you.

Medicare is federal health insurance available for eligible individuals age 65 and over (or) individuals under 65 with certain disabilities or medical conditions, such as End-Stage Renal Disease. Medicare has different parts (referred to as Parts A, B, C and D) designed to address your healthcare needs.

Part A&B

Original Medicare

Original Medicare

Medicare Parts A and B (Original Medicare) are managed by the federal government. Some individuals who receive Social Security benefits are automatically enrolled in Original Medicare while others need to apply for it as they approach their 65th birthday.

Part A

Medicare Part A covers inpatient care provided in hospitals or skilled nursing facilities, home health care and hospice care for the terminally ill.

Limits

The following coverage restrictions apply to Medicare Part A:

  • Inpatient hospital care is limited to 90 days total per benefit period.

  • Inpatient mental care is limited to 90 days total per benefit period.

  • Skilled nursing care is limited to 100 days total per benefit period.

    For each type of care, you can receive coverage for 60 additional days throughout your lifetime. These are known as "lifetime reserve days."

Things to Consider

Coverage can be used anywhere in the United States.

  • Most hospitals in the U.S. participate in Medicare.

Part B

Medicare Part B covers doctor visits, durable medical equipment, speech therapy, occupational therapy, physical therapy, and other outpatient services.

Limits

Under Medicare Part B, there are annual limits on services for physical therapy, occupational therapy and speech language pathology.

Things to Consider

  • Part B coverage can be used anywhere in the United States if you have Original Medicare and the physician accepts Medicare.

  • You can select any doctor in the United States who accepts Medicare patients.

  • Part B premiums and standard deductibles and cost sharing amounts generally change annually on January 1st.

Part C, part d, and medigap

Other Medicare Coverage Options

Private insurance companies provide coverage options beyond Part A and Part B, including Medicare Advantage (Part C), Prescription Drug Coverage (Medicare Part D), and Medigap. These plans may include benefits Original Medicare doesn't cover and/or lower your healthcare expenses. Your health needs, finances and lifestyle are all important considerations when evaluating other Medicare coverage options.

Medicare Advantage (Part C)

Medicare Advantage plans provide an alternative to Original Medicare. They offer Parts A and B services and often include additional benefits, such as wellness programs, hearing aids and eye exams. You must have Medicare Parts A and B to enroll in a Medicare Advantage plan.

Prescription Drug Coverage (Part D)

Medicare Part D is Medicare prescription drug coverage. You can get Part D coverage from your Medicare Advantage plan or, if you are enrolled in Original Medicare, you can get it through a stand-alone Medicare Prescription Drug plan available in your area.

Medigap (Medicare-Supplement)

Medigap plans are state-regulated insurance policies for individuals who receive Medicare coverage through Original Medicare. Medigap plans vary in what they cover, but help pay some of the health care costs that Original Medicare doesn't cover and may cover other extra benefits. You must have Part A and Part B to enroll in a Medigap plan.