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About Medicare

Find information about the Medicare program. 

Get to know Medicare

Get to know Medicare

Medicare is the federal government’s health care program. It's for people age 65 and older, and younger people with certain disabilities. Medicare also covers people of any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant). There are different parts of Medicare that cover different things. We’re here to help you understand them.  

 

You can apply for Medicare online at ssa.gov or enroll at your Social Security office. 

What are the parts of Medicare?

 

Knowing the ABCs of Medicare can help you choose the right plan for you.  

 

Parts A + B = Original Medicare.  

Part A covers: 

  • Inpatient care in a hospital 

  • Inpatient care in a skilled nursing facility (not custodial or long-term care)  

  • Hospice care 

  • Home health care  

Part B covers: 

  • Medically necessary doctors' services 

  • Outpatient care 

  • Home health services 

  • Durable medical equipment and other medical services  

  • Many preventive services

Part C – Medicare Advantage

Medicare Advantage plans typically offer more benefits than Original Medicare. They include Medicare Part A, Part B and may include Part D prescription drug coverage. In general, Medicare Advantage:  

 

  • Includes all Part A and Part B (Original Medicare) benefits and services 

  • Usually includes Medicare Prescription Drug Coverage (Part D) as part of the plan 

  • Is run by Medicare-approved private insurance companies, including Aetna  

  • May include extra benefits and services not covered by Original Medicare

Part D – Prescription drug plan

Part D prescription drug coverage is available on its own or as part of many Medicare Advantage plans. Part D plans: 

 

  • Are often included in Medicare Advantage (Part C) plans 

  • Cover your medicines, but not medical expenses 

  • Can be purchased to add drug coverage to Original Medicare (Parts A and B) or a Medicare Supplement Plan (Medigap)

Part D plans have four coverage phases

Part D plans have four coverage phases

  1. Deductible – This is the first phase of a Part D plan. Your deductible is the amount you must pay before Medicare or the plan begins to pay. This amount can change each year. If your plan doesn't have a deductible, then the initial coverage phase starts at once. 
  2. Initial Coverage – You pay a copay (set dollar amount) or coinsurance (percentage of the cost). Your plan covers the rest. This amount can change each year. 
  3. Coverage Gap – After you and the plan have spent enough to reach the initial coverage limit, you enter the coverage gap or “donut hole.” You may be responsible for paying a larger portion of your drug costs, depending upon the plan.  
      
    Medicare plans that include prescription drug coverage often offer different levels of coverage during the gap. Once you spend enough to get out of the coverage gap, you automatically get catastrophic coverage. 
  4. Catastrophic Coverage – You pay a smaller copay or coinsurance than you did during the initial coverage phase or the coverage gap. This lasts until the end of the plan year. 

Medicare Supplement (Medigap)

Medicare Supplement insurance plans help you pay for some of the health care costs not covered by Original Medicare (Parts A and B). This includes deductibles and coinsurance. There are no network restrictions, but many Medicare Supplement plans do not include Part D prescription drug coverage. If you want your drugs covered, you’ll have to buy a separate Part D plan.