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Frequently asked questions about Medicare


This section contains common questions and answers about Medicare.
Click the arrow to the right of each subject to open and close it.

What is Original Medicare?

 

Original Medicare consists of Medicare Part A (hospital coverage) and Medicare Part B (medical coverage). It’s a federal health insurance program for individuals 65 or older; under 65 who have a qualifying disability; and of any age with a diagnosis of end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS, also called Lou Gehrig’s disease).

 

 

What is Medicare Part A?


Medicare Part A is hospital coverage. It helps pay for hospital stays and inpatient care in hospitals, skilled nursing facilities and hospice care.

 

 

What is Medicare Part B?


Medicare Part B is medical coverage. It helps pay for doctor visits and outpatient care.

 

What does Original Medicare cover?
 

Medicare Part A covers the hospital charges and most of the associated services received while you are admitted as an inpatient.

Medicare Part A coverage includes:
 

  • A semi-private room
  • Hospital meals
  • Skilled nursing services
  • Care on special units such as intensive care
  • Drugs, medical supplies and medical equipment used during your inpatient stay
  • Lab tests, X-rays and medical equipment when you are an inpatient
  • Operating room and recovery room services
  • Some blood transfusions (in a hospital or skilled nursing facility)
  • Rehab services such as physical therapy received through home health care
  • Skilled health care in your home if you are homebound and only need part-time care
  • Hospice care

 

Medicare Part B covers doctor visits, even when you are in the hospital, and outpatient services.

 

 

Is Medicare the same as Medicaid?


No. Medicare and Medicaid are both government programs that help people pay for health care, but they are not the same thing.

 

Medicare is a federal program that provides health care coverage for people who are 65 or older or have certain qualifying disabilities.

 

Medicaid is a joint state and federal program that provides health care coverage for individuals and families with limited incomes.

 

“Dual eligibility” means you qualify for both Medicare and Medicaid.

 

 

Is Medicare mandatory?


No. Medicare is not mandatory. But if you do decide to enroll after your Initial Enrollment Period and don't qualify for a Special Enrollment Period, you could face late enrollment penalties for Medicare Part A, Part B, Part C or Part D.

 

 

Can I get my prescription drugs covered under Original Medicare? 

 

No. Original Medicare doesn’t generally cover prescription drugs. Part A may cover some drugs you get as an inpatient. Medicare Part D prescription drug coverage is available separately through private insurance companies approved by Medicare. You can get prescription drug coverage either through a standalone Part D plan (PDP) or a Medicare Advantage plan (MAPD) that includes prescription drug benefits.

 

 

Can I choose my doctor? Does Medicare require referrals?

 

Your choice of doctor depends on what Medicare coverage you have. You can see any doctor that accepts Medicare if you have Original Medicare (Part A and Part B). Most Medicare Advantage plans have provider networks, and some plans may require referrals to specialists. Both Original Medicare and Medicare Advantage plans cover most emergency care when and where it’s needed.

 

 

Does Original Medicare cover vision, dental, or hearing care?

 

Generally, no. Original Medicare doesn’t cover routine vision or dental care, eyeglasses or hearing aids. Part B may cover some dental or vision services if you meet certain conditions and they are considered medically necessary, but you will have to check with your health care provider and Medicare first. Many Medicare Advantage (Part C) plans do offer these benefits. Be sure to compare the benefits of all plan options to find the coverage that best fits your needs.

 

 

Does Original Medicare pay for a nursing home stay?

 

Original Medicare Part A pays for some skilled nursing services, but doesn’t cover long-term or custodial care for daily life activities like eating and bathing. You would also still be responsible for a portion of the costs, such as deductibles, copays and coinsurance.

Learn more about Original Medicare  

What is a Medicare Advantage plan?

Medicare Advantage plans (Part C) include all the benefits and coverage of Medicare Part A and Part B, and may also offer:

  • Part D prescription drug coverage
  • Routine vision, dental and hearing coverage

  • Fitness benefits, wellness programs and more
     

Not all plans are available in all locations. Find out which plans are available where you live.

 

 

Do Medicare Advantage plans have vision (eye care) benefits?
 

Most Medicare Advantage (Part C) plans offer routine vision care, such as eye exams, eyeglasses, and corrective lenses. Original Medicare (Part A and Part B) does not cover routine vision care.

 

 

Do Medicare Advantage plans have dental care benefits?

 

Most Medicare Advantage (Part C) plans offer routine dental care, such as dental exams. Original Medicare (Part A and Part B) does not cover routine dental care.

 

 

Do Medicare Advantage plans have hearing benefits?

 

Most Medicare Advantage (Part C) plans offer hearing care, such as hearing tests and hearing aids. Original Medicare (Part A and Part B) does not cover routine hearing care.

 

 

How can some Medicare Advantage plans have $0 premiums?

 

Although you may not have to pay a premium to the insurance company, you must still pay your Medicare Part B premium (and your Part A premium if you don’t qualify for premium-free Part A). You must keep both Medicare Part A and Part B to qualify for a Medicare Advantage plan.

 

Medicare Advantage plans with a $0 premium will cover all services that Original Medicare (Part A and Part B) covers. These plans may also include prescription drug coverage and ancillary benefits such as vision, dental or fitness options.

 

 

What’s the difference between a Medicare Advantage HMO and PPO?

 

A Medicare Advantage HMO plan usually helps pay only for care you receive from providers in the plan network. A PPO plan will generally help pay for care received outside the plan network, but it may pay less than for the same care received within the network.

 

 

What’s the difference between a Medicare Advantage plan and a Medicare Supplement plan?

 

A Medicare Advantage (Part C) plan combines Part A, Part B, and often Part D prescription drug coverage in one plan. These plans may include additional benefits, such as hearing, vision, dental and fitness. Medicare Advantage plans have an annual limit on out-of-pocket costs on covered services.

 

A Medicare Supplement (Medigap) insurance plan helps with some of the out-of-pocket costs that Original Medicare doesn’t pay, like coinsurance and copayments.

 

You can have either a Medicare Advantage plan or a Medicare Supplement plan, but not both at the same time.

Learn more about Medicare Advantage plans 

What is a Medicare Part D plan?


Medicare Part D is prescription drug coverage. Medicare Part D plans (PDP) help pay for medications prescribed by a doctor. Part D plans are offered by private insurance companies approved by Medicare. The U.S. government decides which types of drugs are covered. Beyond that list, every Medicare Part D plan covers a different set of drugs. When choosing a Part D plan, make sure it covers the drugs you need.


Most Medicare Advantage (Part C) plans already include Part D prescription drug coverage, combined into a single plan with hospital and medical coverage. Another option is to have a separate Part D plan in addition to Original Medicare, a Medicare Supplement insurance plan, or a Private Fee-For-Service plan.


 

How do I know if my drugs are covered by a Medicare Part D plan?


All Part D plans have a drug list (formulary) that shows which drugs are covered. The formulary can change, but your plan will let you know ahead of time if it does. The formulary will also tell you if your drug has any special rules or limits. Your plan will send you your formulary and/or give you a way to get all of your drug list information online.

Learn more about Medicare Part D plans  

What is Medicare Supplement insurance?

 

Medicare Supplement insurance plans, also called Medigap, are offered by private insurance companies. These plans help pay some of the out-of-pocket costs that Original Medicare (Part A and Part B) doesn’t pay.

 

 

When can I apply for Medicare Supplement insurance?

 

The best time to enroll in a Medicare Supplement plan is during your Medicare Supplement Open Enrollment period because your acceptance is guaranteed. It starts on the first day of the month in which you are both age 65 or older and enrolled in Medicare Part B. Some states have additional Open Enrollment periods and Guaranteed Issue requirements.

 

If you apply outside these Open Enrollment or Guaranteed Issue periods, you may be denied coverage or charged more based on your health history. (This does not apply to residents of Connecticut and New York where Open Enrollment and Guaranteed Issue is ongoing and Medicare Supplement plans are guaranteed available.)

 

 

How much Medicare Supplement insurance coverage do I need? 

 

Medicare Supplement insurance plans help pay some of the out-of-pocket costs Original Medicare (Part A and Part B) doesn’t pay. Benefits and costs vary depending on the plan you choose. Some plans pay more of your out-of-pocket costs but have a higher monthly premium. Other plans have a lower monthly premium but pay fewer of your out-of-pocket costs.

 

Plans that cover the Part B deductible are only available to individuals who were eligible for Part A or who turned 65 before January 1, 2020.

 

 

Does a Medicare Supplement insurance plan replace Original Medicare (Part A and Part B)?

 

No. A Medicare Supplement insurance plan works with Original Medicare (Part A and Part B). It helps cover some of the out-of-pocket health care costs that Original Medicare doesn’t pay. For instance, Medicare Part B generally covers about 80% of Part B expenses. You are responsible for paying the rest. A Medicare Supplement insurance plan could help pay your share.

 

Learn more about Medicare Supplement Insurance (Medigap) 

 

 

Do I have to be an AARP member to apply for Medicare Supplement insurance from UnitedHealthcare?

 

Yes. You must be an AARP member to enroll in an AARP Medicare Supplement Insurance plan. If you are not a member, you can join AARP for just $20.00 a year.

How to apply for Medicare Supplement Insurance (Medigap)  

When am I eligible for Original Medicare?

 

You are eligible for Original Medicare once you turn 65 and are a U.S. citizen or legal resident. If you're a legal resident, you must have lived in the United States for at least five years in a row before you're eligible for Original Medicare.

 

 

I’m not 65 yet. Could I still be eligible for Original Medicare?

 

You may be eligible for Original Medicare even if you are not 65 yet. You need to be a U.S. citizen or legal resident for at least 5 years in a row, and:

 

  • Have a diagnosis of amyotrophic lateral sclerosis (ALS, also called Lou Gehrig’s disease) or end-stage renal disease (ESRD), or
  • Have a condition that qualifies you for Social Security Disability Insurance (SSDI) support

 

 

I’m disabled. When can I get Medicare coverage?

 

In general, you are eligible for Medicare coverage after you receive Social Security Disability Insurance (SSDI) benefits for 24 months. If you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS, also called Lou Gehrig’s Disease), you will become eligible much sooner.

 

Learn more about Medicare and disability  

 

 

How do I become eligible for a prescription drug plan?


You can get prescription drug coverage from a standalone Part D plan (PDP), or from a Medicare Advantage plan that includes prescription drug benefits (MAPD).


For a Medicare Advantage (Part C) plan, you must have both Original Medicare Part A and Part B to apply.

 

For Medicare Part D prescription drug plans, you need to first enroll in either Medicare Part A or Part B. You cannot be denied enrollment in a Part D plan. You must enroll in a Part D plan during your Initial Enrollment Period to avoid the late enrollment penalty for Part D. The exception to this rule is if you qualify for a Special Enrollment Period.

Learn more about eligibility  

I’m over 65, retiring in the next 3 to 6 months and have Medicare Part A. How do I get Part B?

 

If you are over 65 and retiring soon, getting Part B is simple. If you qualify for a Special Enrollment Period, you will have up to eight months to enroll in Part B without penalty. If you don’t quality for an SEP, you will have a Part B late penalty. To get Part B, you will enroll directly with Social Security, which you can do online, in person or over the phone.

 

If you will have additional coverage under an employer retirement plan, talk with your employer benefits administrator before making any Medicare decisions.


 

I’ll be 65 soon but plan to keep working full-time. Should I keep my employer’s health insurance or get Medicare?


If you are still working when you turn 65, you need to make some decisions — even if you are covered by your employer’s health plan. When you turn 65, you may want to enroll in Medicare Part A, which is premium free. If you have qualified insurance from your employer, you may be able to delay enrolling in Part B and Part D without penalty. Or you may need to enroll when you turn 65. Talk to your employer’s benefit administrator to help you learn more about your choices.

 

 

What if I get health insurance under my working spouse?

 

If you are 65 or older and covered by your spouse’s employer health insurance plan, you may be able to delay enrolling in Medicare or you may need to enroll at age 65. Employers have certain rules for covered dependents of Medicare age, so talk with the employer’s benefits administrator to understand your options.

Learn more about Medicare and working past 65  

When do I need to enroll in Original Medicare?

 

If you are turning 65 AND are already receiving Social Security or Railroad Retirement Board benefits, you will be automatically enrolled in Original Medicare (Part A and Part B). If you are not already receiving any of these benefits when you turn 65, you will need to sign up during your Initial Enrollment Period (IEP).

 

 

How do I enroll in Original Medicare?

 

If you are not enrolled in Original Medicare automatically, visit ssa.gov/benefits/medicare   or call or stop in to your local Social Security office. If you are eligible for Medicare due to disability or end-stage renal disease (ESRD), check www.medicare.gov   for details on how to enroll.

 

 

What is the Medicare Initial Enrollment Period?

 

The Medicare Initial Enrollment Period (IEP) is a seven-month period that includes your 65th birthday month, the three months before and the three months after. You can enroll in Medicare Part A, Part B, Part C, Part D and Medigap during this time.

 

 

What is a Medicare Special Enrollment Period?

 

Medicare grants a Special Enrollment Period (SEP) when you are working past 65 with “creditable coverage” from your employer and for certain qualifying situations and life events.

 

With the SEP for working past 65, you are granted eight months to enroll in Medicare Part A and Part B. However, you only get the first two months of this time to get a Medicare Advantage (Part C) and Part D plan without penalty.

 

Medicare offers a special 2-month SEP for people who already have Medicare coverage and experience a qualified life event. For example, if you move to a different state and your Medicare Advantage plan is not offered there, you would qualify for this SEP. During this two-month period, you can change Medicare Advantage or Part D plans, or if you choose, you can also return to Original Medicare.

 

 

What is the Medicare Advantage Open Enrollment Period?

 

The Medicare Advantage Open Enrollment Period (MA OEP) runs from January 1 to March 31 every year. During this period, you can make a one-time election to leave a Medicare Advantage plan, switch to a different Medicare Advantage plan, or leave a Medicare Advantage plan and go back to Original Medicare (Part A and Part B). If you do that, you can also then enroll in a standalone Part D plan.

 

 

What if I want to change plans?

 

The Medicare Annual Enrollment Period (AEP) happens at the same time every year, from October 15 to December 7. During this time you can join, switch or drop Medicare plans — including Medicare Advantage (Part C) and Medicare Part D prescription drug plans.

 

 

How does Medicare automatic renewal work?

 

Your Medicare coverage choices will stay in place year after year unless you change your plan. This ensures that your coverage continues. Plan benefits and costs may change even if a plan renews. Review your Medicare choices every year during the Medicare Annual Enrollment Period from October 15 to December 7.

 

 

Do I have to change plans every year or can I keep the same one?

 

You don’t have to change plans, but you should always check your options. 

 

Your needs may have changed, or the benefits your current plan offers may have changed. Review the Annual Notice of Change (ANOC) your insurer sends you each fall. It lists any changes in plan coverage, costs, or service areas.

Learn more about Medicare enrollment  

How much does Original Medicare Part A and Part B cost?


Most people pay no premium for Medicare Part A. The premium for Medicare Part B depends on your income and may change each year. For both Part A and Part B, there are also deductibles and coinsurance. You may also qualify for help paying for Medicare costs.

 

 

What will my out-of-pocket costs be with a Medicare plan?

 

Depending on the plan you choose, you may be responsible for two types of out-of-pocket costs: copays and coinsurance. A copay is a set amount, such as $10 for a visit to the doctor, for example. Coinsurance is a percentage, such as 20% of the billed service for an inpatient hospital stay.

 

If you have Original Medicare (Part A and Part B), you will pay 20% coinsurance based on the Medicare-approved amount. This includes things such as inpatient care and durable medical equipment (like a wheelchair or a CPAP machine). Many Medicare Advantage plans also have a 20% coinsurance payment. The difference is that the 20% a Medicare Advantage plan charges is based on a discounted amount negotiated with providers, not the Medicare-approved amount, so your cost may be less.

 

 

How much does a Medicare Part D plan cost?

 

Standalone Part D prescription drug plans are offered through private insurance companies and usually charge a monthly premium. You may also consider a Medicare Advantage (Part C) plan that includes Part D coverage. Some plans also require you to pay an annual deductible and coinsurance or copayment amounts.
 

If you are concerned about your prescription drug costs, look at these options:

 

  • A Dual Special Needs plan (D-SNP) is a Medicare Advantage plan for people who have both Medicare and Medicaid coverage. A D-SNP includes prescription drug coverage.
  • People with low incomes and limited assets may get Extra Help, also called Low Income Subsidy or LIS. Check to see if you qualify.


 

I can see what my plan premiums will be. What else should I know about costs?


Always compare plans based on potential out-of-pocket costs. Deductibles, copays, coinsurance and the out-of-pocket maximum are key factors in choosing a plan.

 

Many people are surprised that Original Medicare does not typically cover services like dental and vision care, but many Medicare Advantage plans do. If you are interested in added wellness offerings, such as a free gym membership, or things like over-the-counter credits or healthy food benefits, check to see what plans offer these extras.

 

 

Can I get financial help to pay for Medicare?

 

Financial assistance programs for people with limited income and assets include Extra Help for prescription drugs, Medicare Savings Programs and Medicaid. Program requirements and levels of support will vary.

Learn more about Medicare costs  

What type of Medicare plan should I get?

 

Choosing a plan can be complicated. You may ask friends and family members what plans they have, and want to pick one that makes someone else happy. But everyone has different health care needs, and your plan should be one that fits you.

 

 

Where else can I compare Medicare plans?

 

The plan comparison page at Medicare.gov   shows options from all providers. You can compare 2027 plans available where you live, with search results for things like premiums, projected drug spend, out-of-pocket costs and added plan benefits.

 

You can also create an account at My Medicare  , which should show Medicare plans that are available to you.

 

 

What should I do if I get overwhelmed?

 

We hope you can find all the information you need in Medicare Made Clear. You can also get answers from Medicare.gov   or from your State Health Insurance Assistance Program (SHIP)  , which provides free Medicare help from trained counselors.

Read next: Medicare glossary

Learn more about Medicare terms  

Read next: Medicare glossary

Learn more about Medicare terms  

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    UnitedHealthcare pays royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers. AARP does not employ or endorse agents, brokers or producers.

     

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