Medicare is federally funded insurance for people 65 or older and people with chronic conditions or disabilities. It offers different insurance options to help meet your needs.

Medicare offers a variety of plans that cover outpatient medical care, hospital care, and prescription drugs. These plans become available to you once you qualify for Medicare.

You can choose a plan or combination of plans that allows you to access the healthcare you need. Making lists of the conditions you have, medications you take, and doctors you see can help you choose.

Whether you’re new to Medicare or just interested in staying informed, here’s what to know about the basics of this federal health insurance program.

Medicare is a government-funded health insurance program that provides medical coverage for people over 65. You may be eligible for Medicare if you:

You can use Medicare as your primary insurance or supplemental backup coverage. You can use Medicare to help pay for medical care, but it might not cover all your medical expenses.

It’s funded by taxes and, in some cases, premiums that you pay or that are deducted from your social security checks.

Medicare covers essential medical needs, such as hospital stays and doctor visits. The program consists of four parts: Part A, Part B, Part C, and Part D.

Part A and Part B, sometimes called Original Medicare, provide the majority of services.

Part A (hospitalization)

Medicare Part A covers your hospital care, including various hospital-related services. Most of your care related to treatment is covered by Part A if you have to go to the hospital as an inpatient. Part A also covers hżospice care for those who qualify for it.

Most people with a modest income pay no premiums. People with higher incomes may have to pay a small amount monthly for this plan.

Part B (medical)

Medicare Part B covers general medical care and outpatient care you may need to stay healthy, including:

The premium for Medicare Part B coverage is based on your income. You typically also have coinsurance payments for the services you use, such as doctor appointments, after you meet your deductible. Coinsurance costs 20% of the Medicare-approved cost of a particular service.

Part C (Medicare Advantage)

Medicare Part C, or Medicare Advantage, is not a separate medical benefit. It’s a provision allowing approved private insurance companies to provide insurance plans to people enrolled in Parts A and B.

These plans cover all the benefits and services that parts A and B cover. They may also offer extra benefits, such as:

Medicare Advantage plans usually have additional fees such as copays and deductibles. Some plans have no premiums, but if the plan you choose has a premium, it may be deducted from your social security check.

Medicare Advantage plans typically require you to get medical care from in-network facilities for the plan to cover the service. If you visit an out-of-network facility, you may have to pay out of pocket for some or all of the associated costs.

Part D (prescriptions)

Medicare Part D covers prescription drugs. The cost or premium for this plan depends on your income, and your copayments and deductible depend on the type of medications you need.

Medicare provides a list, called a formulary, of drugs each Part D plan covers so that you will know if the medications you need are covered by the plan you are considering.

Medicare supplement (Medigap)

Even though Medicare supplement isn’t called a “part” of Medicare, it is one of the five major types of Medicare insurance for you to consider. Medigap works with original Medicare and helps cover the out-of-pocket costs that original Medicare does not.

Private companies sell Medigap, but Medicare requires that most states offer similar coverage. There are 10 Medigap plans available: A, B, C, D, F, G, K, L, M, and N. Each plan is slightly different in terms of the specifics of what it covers.

It’s important to note that if you do not sign up for a Medigap plan during your initial enrollment, you may have to pay a higher premium for specific plans or be unable to enroll in certain plans. If you plan on getting a Medigap plan, it’s typically best to enroll during the initial enrollment period to avoid this. Some plans may charge more if you enroll later and have a pre-existing medical condition. Others may not let you enroll if you miss the initial enrollment period.

If you were first eligible for Medicare after January 1, 2020, you are not eligible to purchase plans C or F; but, if you were eligible prior to that date, you can purchase them. Medigap Plan D and Plan G currently provide similar coverage as plans C and F.

You may be automatically be enrolled in Medicare if you’re already receiving Social Security benefits. If you aren’t already receiving benefits, you can contact the Social Security office to enroll during your initial enrollment period. This period begins 3 months before your 65th birthday month and lasts until 3 months after your birthday month. If you miss this enrollment period, you may be able to enroll during a special enrollment period.

The Social Security Administration handles Medicare enrollment. There are three ways to apply:

  • using the Medicare online application at the Social Security Administration’s website
  • calling the Social Security Administration at 1-800-772-1213 (TTY: 1-800-325-0778)
  • visiting your local Social Security Administration office

If you’re a retired railroad employee, contact the Railroad Retirement Board at 1-877-772-5772 (TTY: 1-312-751-4701) to enroll.

When choosing the Medicare options, it’s important to consider your healthcare needs. Here are a few tips for choosing a plan or combination of plans to work for you:

  • Estimate how much you spent on healthcare last year to better predict which plans will save you money.
  • List your medical conditions so you can be sure they are covered by the plans you consider.
  • List the doctors you currently see and ask if they accept Medicare or which Health Maintenance Organizations (HMO) or Preferred Provider Organization (PPO) networks they may be in.
  • List any medical treatment or hospitalizations you may need in the upcoming year.
  • Note any other insurance you have, if you can use it with Medicare, and how to end that coverage if necessary.
  • Do you need dental work, wear glasses or hearing aids, or would you like other additional coverage?
  • Are you planning to travel outside your coverage area or out of the country?

These factors can help you decide which parts of Medicare best meet your needs and which individual plans to consider.

While Original Medicare covers many services, not every medical situation is covered. For example, long-term care is not considered part of Medicare. If you need long-term care, consider a Medicare Advantage or Medigap plan, which may offer limited long-term care benefits.

Since Original Medicare doesn’t usually cover prescription drugs, if you need prescription drug coverage, you must enroll in Medicare Part D or Medicare Advantage, which offers plans that cover some prescription drugs.

What are the 6 things Medicare doesn’t cover?

Medicare covers medically necessary care. It does not cover long-term care in a nursing home, massage therapy, most dental services (including routine dental care and dentures), hearing exams and hearing aids, eye exams, glasses and contact lenses, or cosmetic surgery.

Who is Medicare eligible?

You are eligible for Medicare around your 65th birthday. You may also qualify for Medicare if you have a disability and receive Social Security benefits.

Is Medicare free after 65?

Medicare is not free. The amount you pay for Medicare depends on your income. Some people may qualify for assistance programs.

What are the three requirements for Medicare?

To qualify for Medicare, you must be 65 or have a disability, ALS, or ESRD. You must also be a U.S. citizen or resident or have been lawfully admitted and residing in the U.S. for 5 continuous years before applying for Medicare.

Knowing which plans are suitable for you depends on various factors, including:

  • your income
  • overall health
  • age
  • the kind of care you will need

It’s best to read through the services and plans carefully and choose the plans that work best for you.

Some plans have limited enrollment periods, so sign up early to avoid a coverage gap.

If you’re concerned about whether Medicare covers your desired service, you can ask your doctor, search the Medicare Coverage Database online, or contact Medicare at 1-800-MEDICARE (1-800-633-4227).