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What Is Medicare Insurance?

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Medicare is a US Federal health insurance program enacted in 1966 to cover hospital and medical expenses for individuals.

 

Medicare 101: Video Presentation

What you will learn:

This video explains the different parts of Medicare, different enrollment times, and various coverage scenarios.

Download the Presentation

 

 

Who Qualifies?

  • Turning 65
  • Under the age of 65 with certain disabilities
  • Of any age with an end-stage renal disease (permanent kidney failure that requires dialysis or a kidney transplant)
Learn more about who qualifies

Lifetime Coverage

Medicare coverage remains in place year after year, as long as you pay your monthly premium.

Learn more about coverage costs

What Are the Different Parts for Medicare?

Original Medicare

Offered by the Federal Government.

Part

A

 

Hospital Insurance

Covers hospital and nursing home stays. and hospice care.

Part

B

 

Medical Insurance

Covers doctor services, outpatient hospital care, durable medical equipment, and other medical services.

Additional Coverage

Offered by Private Insurance Companies.

Part

C

 

Medicare Advantage

Insurance offered by Medicare-approved private companies to provide all the benefits of Part A and Part B, optional Part D coverage, plus additional things that Medicare doesn't cover. 

Drug Coverage

Offered by Private Insurance Companies.

Part

D

 

Prescription Drug Plan

Insurance offered by Medicare-approved private companies to cover the cost of prescription drugs for anyone who has Original Medicare (Part A and B) or a Medicare Supplement plan.

Learn more about the parts of Medicare


How Do the Parts of Medicare Work Together?

There are a number of different options you can choose from when considering your Medicare insurance coverage.  These options are best described by looking at a number of coverage scenarios.  

Explore different coverage scenarios »


How Do You Apply?

  •  
    1

    Who Qualifies

    People turning age 65, people under age 65 with certain disabilities, and people with end-stage renal disease (permanent kidney failure that requires dialysis or a kidney transplant).

    Learn more about who qualifies for Medicare »
  •  
    2

    When to Apply

    For people turning 65, apply during the sign up period that begins 3 months before you turn 65 and ends 3 months after.

  •  
    3

    What You'll Need

    You'll need information about yourself, spouse, health insurance and work history.

  •  
    4

    How to Apply

    Apply online, call toll free or go to a Social Security office in person.

    Learn more about how to apply for Medicare »

How Do You Pay for Medicare?

Medicare Parts A & B - Hospital & Medical Insurance 

If you or your spouse paid Medicare taxes while employed, there is typically no additional monthly premium for hospital insurance - Part A. There is an annual Part A deductible, however. Your Part B premium for medical expenses is deducted from your Social Security payments automatically. You do, however, have to pay both an annual deductible and 20% coinsurance after Medicare pays 80% of the approved amount.

Medicare Part C - Medicare Advantage

The premiums you pay for your Medicare Advantage (Part C) plan cover your Medicare Part A & B payments and, if included, your Part D drug coverage. You are responsible for paying any premium, co-payment and deductible that is part of your Medicare Advantage plan.

Learn more about Medicare costs

Medicare Terms Glossary

Maximum Out-of-Pocket Limit - A limit that Medicare Advantage plans set on the amount of money you will have to spend out of your own pocket in a plan year. In Medicare Part D, this is the maximum amount of money you will have to spend out of your own pocket before catastrophic coverage begins for the remainder of the year.

Medicare Advantage (Medicare Part C) - A type of plan offered by a private company. In Medicare Advantage plans, a single plan provides you with both hospital and doctors’ care. Many Medicare Advantage plans also include prescription drug coverage. You must have Part A and Part B to enroll in a Medicare Advantage plan and continue to pay Part B premiums, in addition to any plan premium.

Network - A group of doctors, hospitals, pharmacies and other health care providers contracted with a health plan to take care of its members. In an HMO, you must use network providers. With PPO plans, you pay less when you use the plan’s network providers – or you can use providers outside the network for a higher copay or coinsurance.

Out-of-Pocket Maximum - The total amount a member pays for coinsurance and copays in a calendar year before the plan picks up the full cost of covered expenses.

Full Tufts Medicare Terms Glossary »