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Medicare is a government-funded health insurance program that provides medical coverage for people ages 65 or older. You can also qualify if you have certain health conditions or disabilities.
Medicare is divided into a few “parts.” Each part of Medicare covers different healthcare needs. Currently, the parts of Medicare include:
- Medicare Part A. Medicare Part A is hospital insurance. It covers you during short-term, inpatient stays in hospitals and skilled nursing facilities or for some in-home services like limited home healthcare or hospice.
- Medicare Part B. Medicare Part B is medical insurance that covers everyday care needs like doctor's appointments, therapist visits, medical equipment, and urgent care visits.
- Medicare Part C. Medicare Part C is also called Medicare Advantage. These plans combine the coverage of parts A and B into a single plan. Medicare Advantage plans are offered by private insurance companies and are overseen by Medicare.
- Medicare Part D. Medicare Part D is prescription drug coverage. Part D plans are standalone plans that only cover prescriptions. These plans are also provided through private insurance companies.
- Medigap. Medigap is also known as Medicare supplement insurance. Medigap plans help cover the out-of-pocket costs of Medicare, like deductibles, copayments, and coinsurance amounts.
Medicare Part A and Medicare Part B together are known as “original Medicare.” Original Medicare has a set standard for costs and coverage nationwide. That means your coverage will be the same no matter what state you live in, and you can use it in any state you visit.
Medicare Advantage plans, however, can be very different depending on where you live. Since these plans are offered by private companies, they have different price points and covered services depending on the plan and company you choose.
Many companies only serve their local area. Even large companies that offer plans throughout the country offer different plans in different states or even counties.
Unlike original Medicare, most Medicare Advantage plans also have a network you’ll need to stay in for coverage, especially if your plan is an HMO. Your plan builds a network of contracted healthcare providers, suppliers, and pharmacies in your area to provide a cost benefit.
What to look for in a plan
Tips for selecting plans that meet your needs
- Assess your current and potential healthcare needs. Are there doctors, facilities, or medications that you can't compromise on for your care? This may impact your policy choice, particularly when deciding between original Medicare and Medicare Advantage.
- Consider your income. If you have a fixed or limited income, paying monthly premiums may be difficult. However, if you may need care that only Medicare Advantage would cover, this might be a good option to save costs in the long run.
- Look for cost savings programs. You may qualify for certain programs to help with your costs, including Medicaid and Extra Help.
- Find the right plan. Use Medicare’s plan finder tool to compare available Medicare Advantage plans in your area. You can search by prescription drugs you need, as well as covered providers and services.
What differs by state
Medicare Advantage plans are offered by both local insurance companies and large national companies. No matter which company you go with, your plan will be specific to where you live.
Many plans are only available in a certain state, region, city, or even a single ZIP code. Even if the plan has the same name and covers the same services, your ZIP code could affect the price you pay.
Both Medicare Part D and Medigap plans work similarly. Like Medicare Advantage plans, they’re offered by private companies. You purchase them in addition to your original Medicare coverage, and the plans that are available to you will depend on where you live.
In general, plans in all states need to follow the same rules. For example, all Medicare Advantage plans must cover all the same services as original Medicare.
An exception to this is Medigap plans. In most states, Medigap plans will have the same letter names across all insurance companies and offer the same coverage. However, that’s not the case in Minnesota, Wisconsin, and Massachusetts. All three of these states have their own Medigap regulations and plan types.
Medicare enrollment: When can I apply?
If you’re planning to enroll in Medicare, you'll need to know several enrollment deadlines and dates:
- Initial enrollment period. This is a 7-month window around your 65th birthday when you can sign up for Medicare. It begins 3 months before your birthday, includes the month of your birthday, and extends 3 months after your birthday. During this time, you can enroll for all parts of Medicare without a penalty.
- Open enrollment period (October 15–December 7). During this time, you can switch from original Medicare (parts A and B) to Part C (Medicare Advantage), or from Part C back to original Medicare. You can also switch Part C plans or add, remove, or change a Part D plan.
- General enrollment period (January 1–March 31). You can enroll in Medicare during this timeframe if you didn’t enroll during your initial enrollment period.
- Special enrollment period. If you delayed Medicare enrollment for an approved reason, you can later enroll during a special enrollment period. You have 8 months from the end of your coverage or the end of your employment during which to sign up without penalty.
- Medicare Advantage open enrollment (January 1–March 31). During this period, you can switch from one Medicare Advantage plan to another or go back to original Medicare. You cannot enroll in a Medicare Advantage plan if you currently have original Medicare.
- Part D enrollment/Medicare add-ons (April 1–June 30). If you don’t have Medicare Part A, but you enrolled in Part B during the general enrollment period, you can sign up for a Part D prescription drug plan..
- Medigap enrollment. This 6-month period starts after the first day of the month that you apply for original Medicare or from your 65th birthday. If you miss this enrollment period, you may not be able to get a Medigap plan. If you do get one later, you may pay higher premiums for it.