Medicare questions, answered.

Medicare is the federal health insurance program for people 65 and older, and for some people under 65 with certain disabilities or conditions. It's run by the Centers for Medicare & Medicaid Services (CMS), and many people enroll through Social Security. The parts, simply put:

• Part A: hospital and inpatient care, skilled nursing facility care, hospice, and some home health care.
• Part B: doctor visits, outpatient care, durable medical equipment, and preventive care.
• Part C (Medicare Advantage): a private-plan alternative to Original Medicare that includes Part A and Part B and usually Part D.
• Part D: prescription drug coverage.

Most people become eligible at 65; some qualify earlier. If you're already receiving Social Security benefits before 65, you may be enrolled automatically. Otherwise, you generally sign up through Social Security. Each fall, Medicare Open Enrollment runs from October 15 through December 7 and allows people to review or change Medicare Advantage and drug coverage for the following year.

Official information: Medicare.gov — Parts of Medicare · Social Security — When to sign up · Medicare.gov — Open Enrollment

Part A is Medicare's hospital insurance. It helps cover inpatient hospital care, skilled nursing facility care after a qualifying hospital stay, hospice, and some home health care. It's one half of Original Medicare; the other half is Part B.

Part A generally does not cover long-term custodial care, most dental, vision, or hearing care, or most non-medical help at home. Doctor services are usually billed under Part B, even when you receive them in a hospital.

Official information: Medicare.gov — What Part A covers · Medicare.gov — What Original Medicare doesn't cover

Part B is Medicare's medical insurance. It helps cover doctor visits, outpatient care, durable medical equipment, home health care, and many preventive services. In short, it covers:

• Medically necessary services to diagnose or treat a condition
• Outpatient care, labs, imaging, and mental health services
• Durable medical equipment, such as wheelchairs and walkers
• Many preventive services, often at no cost when the provider accepts assignment

Official information: Medicare.gov — What Part B covers

Part C is Medicare Advantage: Medicare-approved private plans that provide your Part A and Part B coverage, and usually Part D drug coverage, in one bundle. Plans must follow Medicare's rules, but their costs, provider access, and coverage details vary.

• All-in-one coverage: includes Part A and Part B; most plans also include Part D.
• Networks and rules: many plans use provider networks and may require referrals or prior authorization for some care.
• Costs: you generally keep paying the Part B premium, plus any plan premium and copays or coinsurance. Every plan has a yearly out-of-pocket limit for covered Part A and Part B services.
• Extra benefits: many plans include benefits Original Medicare doesn't cover, such as some dental, vision, or hearing care, but details vary by plan and county.

You can't use a Medigap policy to pay Medicare Advantage plan costs.

Official information: Medicare.gov — Compare Original Medicare and Medicare Advantage

Part D is Medicare's prescription drug coverage. Private insurers approved by Medicare offer it either as a stand-alone drug plan with Original Medicare or as part of many Medicare Advantage plans. Your costs and access can depend on:

• The formulary: each plan has a list of covered drugs and places them in cost-sharing tiers.
• The pharmacy network: you will generally pay less at preferred in-network pharmacies.
• Coverage rules: some drugs require prior authorization, step therapy, or have quantity limits.

If you go 63 days or more without Part D or other creditable drug coverage after you're first eligible, you may owe a late-enrollment penalty that is added to your premium, usually for as long as you have Part D.

Official information: Medicare.gov — Part D overview · Medicare.gov — Creditable drug coverage

Medicare is federal health insurance, mainly for people 65 and older and for some younger people with certain disabilities or conditions. Part A helps cover hospital stays, skilled nursing facility care, hospice, and some home health care. Part B helps cover doctor visits, tests, medical equipment, and outpatient care. Part D helps cover prescription drugs.

You can receive Part A and Part B directly through the federal government as Original Medicare, or through a private Medicare Advantage plan.

Official information: Medicare.gov — What Original Medicare covers · Medicare.gov — Your coverage options

Yes, sometimes. If you have health coverage based on your or your spouse's current employment, you may be able to enroll in premium-free Part A and delay Part B without a late penalty. First ask the employer's benefits administrator how the group plan works with Medicare.

If you or your employer contributes to a Health Savings Account, check the timing before enrolling. Medicare enrollment ends your eligibility to contribute to an HSA, and Part A can begin retroactively when you enroll after 65.

Official information: Medicare.gov — Working past 65 · Social Security — When to sign up

Sign up for Part B when you're first eligible unless you have qualifying group health coverage based on your or your spouse's current employment. If you have that coverage, you may be able to wait.

Your eight-month Special Enrollment Period starts when the employment ends or the group health coverage ends, whichever happens first. COBRA and retiree coverage do not extend that eight-month period, so check your timing before your job-based coverage ends.

Official information: Medicare.gov — Working past 65 · Social Security — When to sign up

Medigap is supplemental insurance that works alongside Original Medicare and helps pay some of its out-of-pocket costs. Medicare Advantage is a private-plan alternative for receiving your Medicare benefits. You can't use Medigap to pay Medicare Advantage plan costs.

Medigap (Medicare Supplement) works with Original Medicare, so you can use any provider that accepts Medicare. Plans are standardized by letter in most states; Massachusetts, Minnesota, and Wisconsin standardize them differently. Drug coverage is separate. Your six-month Medigap Open Enrollment Period begins when you're 65 or older and enrolled in Part B. After that period, medical underwriting may apply, depending on your situation and state rules.

Medicare Advantage (Part C) is offered by private insurers. Many plans use provider networks and plan rules, most include Part D, and some include extra benefits. Every plan has an annual out-of-pocket limit for covered Part A and Part B services.

Medigap may appeal to someone who values broad provider access and more predictable cost-sharing. Medicare Advantage may appeal to someone comfortable with a plan's network and rules who prefers bundled coverage. The right fit depends on your doctors, prescriptions, travel, budget, and local plan choices.

Official information: Medicare.gov — Compare Original Medicare and Medicare Advantage · Medicare.gov — How Medigap works

Medigap is supplemental insurance from a private insurer that helps pay some of your share of Original Medicare costs, such as deductibles, copays, and coinsurance. You must have Part A and Part B to buy a policy.

• It works with Original Medicare; it isn't a replacement for it, and it can't be used with Medicare Advantage.
• Plans are standardized by letter in most states. Massachusetts, Minnesota, and Wisconsin standardize plans differently.
• Medigap generally doesn't include drug coverage, so you may need a separate Part D plan.
• Each policy covers one person and is generally guaranteed renewable when premiums are paid on time.
• Some plans include limited foreign-travel emergency coverage.

Your six-month Medigap Open Enrollment Period begins the month you're 65 or older and enrolled in Part B. After that period, insurers can often use medical underwriting, although state rules and other guaranteed-issue rights may apply.

Official information: Medicare.gov — Medigap basics · Medicare.gov — Medigap Open Enrollment

It depends on your county and the plan. Most people keep paying the Part B premium, which Medicare sets each year, plus any premium charged by the plan. Some plans have a $0 plan premium.

You may also pay copays or coinsurance as you receive care, up to the plan's yearly out-of-pocket limit for covered Part A and Part B services. Compare the full cost picture, not just the monthly premium.

Official information: Medicare.gov — Understanding health plan costs

There isn't one Medicare option that covers everything, and the best fit depends on your doctors, prescriptions, travel, budget, and comfort with networks and plan rules. Medicare offers two main paths:

• Original Medicare with Medigap and Part D: broad provider access and potentially more predictable cost-sharing, with separate premiums and separate drug coverage. Routine dental, vision, and hearing benefits generally aren't built in.
• Medicare Advantage: Part A and Part B coverage through a private plan, usually with Part D, an annual out-of-pocket limit, and sometimes extra benefits. Provider networks, plan rules, and benefits vary by plan and county.

Compare the details that matter in your situation rather than looking for one plan that promises everything.

Official information: Medicare.gov — Compare Original Medicare and Medicare Advantage

Medicare Advantage plans vary by county and can change each year. Use Medicare's official Plan Compare tool, choose the year you need coverage, and enter your ZIP code to compare the plans available where you live.

Review each plan's premiums, estimated costs, drug coverage, benefits, and star ratings, and confirm your doctors and hospitals with the plan before enrolling. We're also glad to walk through the options with you.

Official information: Medicare.gov — Plan Compare

Original Medicare lets you use any doctor or hospital that accepts Medicare anywhere in the U.S. Medicare Advantage travel coverage depends on the plan: emergency and urgent care are covered, but routine non-emergency care may be limited to the plan's network and service area or cost more out of network.

Original Medicare generally doesn't cover care outside the U.S. Some Medigap and Medicare Advantage plans offer limited foreign-travel emergency benefits. Check the plan before you travel.

Official information: Medicare.gov — Compare Original Medicare and Medicare Advantage · Medicare.gov — Travel outside the U.S.

Hang up and verify the request through an official number. Medicare will not contact you uninvited and ask for personal or private information. Don't give an unexpected caller your Medicare Number, Social Security number, or payment details.

• Verify directly. If you need a replacement card or need to update your address, use your secure Medicare.gov account or call 1-800-MEDICARE (TTY 1-877-486-2048).
• Report suspected fraud. Call 1-800-MEDICARE or use Medicare's fraud-reporting guidance.
• If you already shared information, call 1-800-MEDICARE promptly and review your Medicare Summary Notices for services you didn't receive.

Official information: Medicare.gov — Your Medicare card · Medicare.gov — Report Medicare fraud and abuse