What's Medicare? (2024)

New to Medicare? Learn how to get started.

Medicare
The federal health insurance program for:

  • People who are 65 or older
  • Certain younger people with disabilities
  • People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

What are the parts of Medicare?

The different parts of Medicare help cover specific services:

  • Medicare Part A (Hospital Insurance)
    Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
  • Medicare Part B (Medical Insurance)
    Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.
  • Medicare Part D (prescription drug coverage)
    Helps cover the cost of prescription drugs (including many recommended shots or vaccines).

Part A & Part B Premiums

Most people don’t pay a monthly premium for Part A.

You usually don't pay a monthlypremiumforPart Aif you or your spouse paid Medicare taxes while working for a certain amount of time.This is sometimes called "premium-free Part A."

Learn more about premium-free Part A.

If you don't qualify for premium-free Part A, you can buy Part A.

If you aren't eligible for premium-free Part A, you may be able to buy Part A. You'll pay up to $505each month in 2024. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $505. If you paid Medicare taxes for 30–39 quarters, thestandard Part A premium is $278.

Learn more about Part A premiums.

Everyone pays a monthly premium for Part B.

Most people will pay the standard Part B premium amount. The standard Part B premium amount in 2024 is $174.70. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you'll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.

Learn more about Part B premiums.

How does Medicare work?

With Medicare, you have options in how you get your coverage. Once you enroll, you’ll need to decide how you’ll get your Medicare coverage. There are 2 main ways:

Original Medicare

Original Medicare includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). You pay for services as you get them. When you get services, you’ll pay a deductible at the start of each year, and you usually pay 20% of the cost of the Medicare-approved service, called coinsurance. If you want drug coverage, you can add a separate drug plan (Part D).

Original Medicare pays for much, but not all, of the cost for covered health care services and supplies.AMedicare Supplement Insurance (Medigap) policycanhelp pay some of the remaining health care costs, like copayments, coinsurance, and deductibles. Some Medigap policies also cover services that Original Medicare doesn't cover, like emergency medical carewhen you travel outside the U.S.

Learn the general rules for how Original Medicare works.

Medicare Advantage

Medicare Advantage is Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D. Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services. Medicare Advantage Plans have yearly contracts with Medicare and must follow Medicare’s coverage rules. The plan must notify you about any changes before the start of the next enrollment year.

Learn about the types of Medicare Advantage Plans.

Each Medicare Advantage Plan can charge different out-of-pocket costs. They can also have different rules for how you get services.

Medicare prescription drug coverage (Part D)

Medicare drug coverage helps pay for prescription drugs you need. To get Medicare drug coverage, you must join a Medicare-approved plan that offers drug coverage (this includes Medicare drug plans and Medicare Advantage Plans with drug coverage).

Learn more about how to get Medicare drug coverage.

Each plan can vary in cost and specific drugs covered, but must give at least a standard level of coverage set by Medicare. Medicare drug coverage includes generic and brand-name drugs. Plans can vary the list ofprescription drugs they cover (called a formulary) and how they place drugs into different "tiers" on their formularies.

Learn more about Medicare drug coverage.

Plans have different monthly premiums. You’ll also have other costs throughout the year in a Medicare drug plan. How much you pay for each drug depends on which plan you choose.

Learn about your costs for Medicare drug coverage.

How does Medicare work with my other insurance?

When you have other insurance, there'smore than one "payer"for your coverage.

Learn how Medicare works with other insurance.

What's Medicare? (2024)

FAQs

What are the 6 things Medicare doesn't cover? ›

Some of the items and services Medicare doesn't cover include:
  • Long-term care (also called. custodial care. Custodial care. ...
  • Most dental care.
  • Eye exams (for prescription glasses)
  • Dentures.
  • Cosmetic surgery.
  • Massage therapy.
  • Routine physical exams.
  • Hearing aids and exams for fitting them.

What does Medicare not cover for seniors? ›

Original Medicare doesn't cover some benefits like eye exams, most dental care, and routine exams. Plans must cover all medically necessary services that Original Medicare covers.

Does everyone pay $170 for Medicare? ›

Is Medicare free for seniors age 65 and older? No, most seniors pay between $175 and $371 per month depending on what kinds of Medicare coverage they buy. However, seniors who have a low income can qualify for free or reduced-cost Medicare.

How do you qualify for $144 back from Medicare? ›

To qualify for the giveback, you must:
  1. Be enrolled in Medicare Parts A and B.
  2. Pay your own premiums (if a state or local program is covering your premiums, you're not eligible).
  3. Live in a service area of a plan that offers a Part B giveback.

Does Medicare cover 100% of hospital bills for seniors? ›

Medicare has two parts, Part A (Hospital Insurance) and Part B (Medical Insurance). Medicare does not cover 100% of all costs. CDI recommends purchasing a Medicare Supplement Insurance policy if you have traditional Medicare to help offset your health care costs.

What is the biggest problem with Medicare? ›

However, Jacobson says, “if you have a significant delay in care, depending on your condition, that can really result in poorer health outcomes.” The biggest challenges reported by those in Traditional Medicare and Medicare Advantage: Out-of-pocket medical costs and health services they needed but weren't covered.

Why are people leaving Medicare Advantage plans? ›

Most individuals that dislike a Medicare Advantage plan usually have had a bad experience with in-network providers, plan authorizations for medical care, or having to wait a long time to have an appointment scheduled. Some of these concerns can be attributed to the healthcare provider.

What part of Medicare is free when you turn 65? ›

If you qualify for Premium-free Part A: Your Part A coverage starts the month you turn 65. (If your birthday is on the first of the month, coverage starts the month before you turn 65.)

Can I drop my Medicare Advantage plan and go back to original Medicare? ›

You can drop your Medicare Advantage Plan and return to Original Medicare. You'll also be able to join a separate Medicare drug plan. During the Medicare Advantage Open Enrollment Period, if you have Original Medicare you can't: Switch to a Medicare Advantage Plan.

How much money does Medicare allow you to have in the bank? ›

On January 1, 2024 the asset test to qualify for a Medicare Savings Program was eliminated. This means individuals can have any amount of assets and still qualify for a Medicare Savings Program. Assets are things that you own, such as bank accounts, cash, second homes and vehicles.

Why is Social Security no longer paying Medicare Part B? ›

You Qualified for a Medicare Savings Program

Medicare Savings Programs help pay Medicare costs if you have limited income and assets. If you start getting assistance from one of these programs with your Part B premium, Social Security will no longer deduct the premium.

How much is taken out of my Social Security check for Medicare? ›

Most people pay the standard Part B monthly premium amount ($174.70 in 2024). Social Security will tell you the exact amount you'll pay for Part B in 2024. You pay the standard premium amount if you: • Enroll in Part B for the first time in 2024.

How can I reduce my Medicare Part B premium? ›

Use Form Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event to report a major life-changing event. If your income has gone down, you may also use Form SSA-44 to request a reduction in your income-related monthly adjustment amount.

How to get $800 back from Medicare? ›

All you have to do is provide proof that you pay Medicare Part B premiums. Each eligible active or retired member on a contract with Medicare Part A and Part B, including covered spouses, can get their own $800 reimbursem*nt.

Does my zip code add money back to my Social Security? ›

Social security benefits are not impacted by geographic location but other federal benefits are.

Which of the following is not covered by Medicare? ›

Long-term care, such as services that assist you with dressing, eating, and bathing, are not covered by Medicare or Medicare Supplemental Insurance (Medigap). These types of care are considered services for daily living activities that fall under personal care instead of medical care.

What is excluded from Medicare coverage? ›

Long-term care includes non-medical care for people who have a chronic illness or disability. This includes non-skilled personal care assistance, like help with everyday activities, including dressing, bathing, and using the bathroom. Medicare and most health insurance plans, don't cover long-term care.

Is there a Medicare supplement that covers everything? ›

Medicare Supplement Plan F

Plan F pays for Medicare deductibles, copays and other costs associated with Medicare-covered services, so beneficiaries don't have to worry about out-of-pocket expenses.

Are there procedures that Medicare does not cover? ›

These include preventive examinations represented by CPT codes 99381-99397. Medicare only covers three immunizations (influenza, pneumonia, and hepatitis B) as prophylactic physician services. Cosmetic procedures are never covered unless there is a medically-necessary reason for a procedure.

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