Learn the basics
What is Medicare?
Medicare is a federal health insurance program for people who are 65 and older, as well as people under 65 with certain disabilities or medical conditions like End-Stage Renal Disease.
It’s made up of several parts, known as Parts A, B, C, and D, each designed to meet different healthcare needs.
Original Medicare
Parts A and B
Medicare Parts A and B are referred to as “Original Medicare.” These parts are managed by the federal government.
Some people who receive Social Security benefits are automatically enrolled in Original Medicare, while others need to apply as they approach their 65th birthday.
Medicare Part A
Hospital insurance
Part A covers inpatient care in hospitals and skilled nursing facilities, as well as home health care and hospice care for people with terminal illnesses.
Deductible
You must first meet a Part A deductible before Part A helps with your covered medical expenses.
Premium
There’s no premium for Part A if you or your spouse paid Medicare taxes for at least 10 years. If not, you can choose to buy Part A.
Copays
Copayments or cost-sharing may apply to certain services, including longer hospital or skilled nursing facility stays.
Coinsurance
- Inpatient hospital care, days 61–90 per benefit period
- Inpatient mental health care, days 61–90 per benefit period
- Skilled nursing care, days 21–100 per benefit period
Coinsurance also applies to a limited number of additional days.
Where you can use it
You can use your coverage anywhere in the United States, since most hospitals in the country participate in Medicare.
Medicare Part B
Medical insurance
Part B covers doctor visits, durable medical equipment, physical, occupational, and speech therapy, and many other outpatient services.
Deductible
Like Part A, you must first meet a deductible before Part B helps with your medical costs.
20% coinsurance
You’re generally responsible for 20 percent of the cost of covered services, including doctor visits, outpatient therapy, and durable medical equipment.
Copays
Copayments or cost-sharing may apply to certain services, such as care in an outpatient hospital setting.
Preventive care
Medicare-covered preventive services, including annual wellness visits and mammograms, are covered with no deductible, copay, or coinsurance when your provider accepts assignment.
Premium
Part B has a monthly premium based on when you enroll and your household income. It’s usually deducted from Social Security benefits, and it’s separate from any Medigap, Medicare Advantage, or Part D premium.
Where you can use it
You can see any doctor in the United States who accepts Medicare. Premiums, deductibles, and cost-sharing amounts are adjusted every year, with changes taking effect January 1.