Based in the United States and trusted by millions of customers since the early 2000's, The Medicare Resource Center brings choice, clarity, and convenience to your entire Medicare plan shopping experience.

Choice - We offer one of the largest selections of affordable Medicare plans on the market.

• Browse thousands of Medicare plans available from multiple leading Medicare insurance companies.
• We offer free quotes for Medicare plans at the lowest available cost to you.
• Compare Medicare Advantage plans, Medicare Part D prescription drug plans, and Medicare Supplement Insurance plans all in one place.

Clarity - We take the mystery out of a complex process with accurate information and resources. Here's how:

• We answer your Medicare questions with numerous articles and clear explanations.
• Our drug tool helps you estimate potential savings on prescription drug coverage.
• We break down plan costs, coverage, and benefits to help you better understand your options.

Convenience - We provide you with a fast and simple online shopping experience.

• Enter your zip code to start comparing Medicare plan options in minutes.
• We make it easy to shop for available Medicare plans in your area and enroll.
• Choose our convenient, straightforward online enrollment, or speak with one of our friendly, licensed insurance agents.

Our mission is to help guide your Medicare journey. By answering your questions, empowering you with resources, and connecting you to a variety of affordable, quality plans, we aim to be your go-to source for all things Medicare.

Better understand your Medicare coverage choices

If you are a new or current Medicare beneficiary looking for information about your options, you may have many questions about how Medicare works or what plans are available.

When you choose The Medicare Resource Center, you get a wealth of plans, resources, and choices. We offer an unparalleled amount of articles to help you find the right Medicare plan. No matter your financial or medical needs, The Medicare Resource Center is here for you.

• Frequently Asked Questions - Use our online resources to find answers to your most pressing Medicare questions. We cover topics including plans, coverage, and enrollment.
• High-Quality Information - Our easy-to-read articles and in-depth guides include helpful, accurate summaries that quickly give you the information you need.
• Relevant Insights -  Empower yourself with more knowledge about your Medicare choices. Get the clarity you need to enroll in the right Medicare plan, coverage, and benefits.

Helping you find the right Medicare coverage for your needs is what we do best. Use The Medicare Resource Center to start shopping for your optimal Medicare plan today.

Find Medicare plans at no additional cost to you

At The Medicare Resource Center, we value transparency. Our services, including free calls with licensed insurance agents, free plan quotes, and free online tools, are provided with no additional cost to you. There is no obligation to enroll.

Here's a quick overview of how we help you potentially save during your Medicare shopping process:

• The federal government strongly regulates the costs of Medicare plans. 
• You should know that any individual Medicare plan listed on our website has the same costs and exact same benefits regardless of whether you purchase the plan from our website, a government website, or your local insurance broker.
• Since our commissions are paid by insurance companies, there is no additional cost to you.

In addition to answering your questions, our licensed insurance agents provide you with unbiased advice to make sure that the Medicare plan you choose works for you.

We are committed to helping you find affordable Medicare plans.

We are committed to helping you find affordable Medicare plans. To learn more about your Medicare plan options and to start finding the right coverage for your needs, explore our website today.

Some Medicare beneficiaries have seen the same doctor for decades and hope to continue for many years into the future. Here’s what to do in the unfortunate circumstance when your Medicare doctors stops accepting Medicare payment.

Not all doctors accept Medicare – here’s why that matters.

According to the Centers for Medicare and Medicaid Services (CMS) most doctors will accept Medicare. This means that they will:

• Accept Medicare’s guidelines as the full payment for bills
• Submit claims to Medicare, so you only have to pay your share of the bill

To become participating Medicare doctors, according to CMS, they must sign an agreement with Medicare. That means they need to follow the rules for any medical services they provide you with. This also applies to other medical providers, like nurse practitioners, nutritionists, and therapists.

In other words, Medicare doctors only ask you to pay coinsurance or copays and/or deductibles when you visit. They will send a claim to Medicare for their portion of the cost. They also can’t add an extra charge for agreeing to submit your claim for you.

Your costs are generally lowest if you get your services from a Medicare-participating doctor or provider. Participating providers agree to accept assignment for all Medicare-covered services, meaning that they will not charge you above the Medicare-approved amounts for a service. You’ll still be responsible for any cost sharing that may apply, such as copayments, coinsurance, or deductibles. 

When Medicare doctors stop accepting Medicare

A doctor or provider may decide to “opt out” of Medicare for various reasons; for example, a practice may feel the need to reduce overhead costs or wish to keep the number of patients down in order to maintain a suitable level of care.

If your doctor opts out of Medicare, this means that he or she is no longer enrolled in the Medicare program and does not submit any claims to the federal program or Medicare health plans. The doctor becomes exempt from Medicare-approved spending limits, and you become responsible for paying the complete cost of the charges from the non-Medicare doctor.

There may be other situations where your doctor remains in the Medicare program, but can choose on a case-by-case basis whether or not to accept Medicare assignment. This is known as a non-participating provider. If a doctor does not accept Medicare assignment for a given service, it means he or she does not accept the Medicare-approved cost amount and can charge you up to 15% more for their services. This is known as a “limiting charge.”

Original Medicare (Part A and Part B)

If you’re enrolled in Original Medicare and your doctor opts out of the Medicare program, you can find doctors who accept Medicare through Medicare.gov’s Physician Compare website. This site is a national database of physicians, specialists, and other health-care professionals who are enrolled in the Medicare program. The site includes both participating and non-participating providers, but you can choose to filter your search to only display doctors that accept assignment.

Using the site is hassle-free and easy. The Physician Compare tool lets you search for doctors and providers by:

• Location and zip code
• Area of practice (for example, cardiology)
• Gender
• Hospital affiliation
• Your doctor’s last name

After entering in your search criteria, the Physician Compare page will display a list of doctors in your area that meet your requirements. Before settling on a doctor, you should first call to confirm that he or she accepts Medicare assignment and is taking new patients.

Medicare Advantage plans (Part C)

If you are enrolled in a Medicare Advantage plan (such as an HMO or PPO), your plan can make changes to its provider network anytime throughout the year. Your doctor and providers may also join or leave your plan’s network at any time. If your doctor leaves your Medicare Advantage plan’s provider network and you’d like to continue seeing him or her, you have a few options.

• Switch plans during the Annual Election Period: If your doctor is part of another Medicare Advantage plan’s provider network, you can switch plans during the next Annual Election Period (October 15 to December 7).
• Disenroll from your Medicare Advantage plan: If your doctor is no longer in the provider network for any Medicare Advantage plan (but is still accepting Medicare), you may decide to go back to Original Medicare in order to continue seeing him or her. You can use the Annual Election Period to disenroll from your Medicare Advantage plan and return to Original Medicare. Or you can also disenroll from your plan during the Medicare Advantage Open Enrollment Period (January 1 to March 31); you can also use this period to enroll in a stand-alone Medicare Prescription Drug plan.
• Switch plans during a Special Election Period: In some situations, the Centers for Medicare & Medicaid Services (CMS) may decide that the change in provider network was significant enough to warrant a Special Election Period. Your Medicare Advantage plan will notify you if your situation qualifies, and you’ll then be able to use your Special Election Period to either enroll in another Medicare Advantage plan or return to Original Medicare.

There may be certain circumstances where your Medicare Advantage plan leaves the Medicare program entirely or makes changes in its contract with CMS that affect you. When this happens, you may be eligible for a Special Election Period (SEP) that lets you make changes to your coverage.

Times when you may be eligible for a Special Election Period may include, but are not limited to:

• Your Medicare Advantage plan does not renew its plan contract or reduces its service area for the upcoming plan year.
• Your Medicare Advantage plan substantially changes its contract with CMS.
• Your Medicare Advantage plan violates its contract with CMS.
• CMS terminates your Medicare Advantage plan’s contract as a result of misconduct or other problems.

During a Special Election Period, you can enroll in another Medicare Advantage plan or return to Original Medicare. The rules about what you can do may vary depending on the situation that prompted the Special Election Period in the first place.

To avoid paying higher costs, it’s a good idea to make sure your doctor is a participating Medicare doctor and, if applicable, in your Medicare plan’s network.

For Original Medicare, is there a Medicare network of providers?

If you have Original Medicare, Part A and Part B, you can usually choose any doctor that is enrolled in Medicare. To find out if your doctor accepts Medicare assignment, you can do either of these:

• Call the doctor and ask.
• Use Medicare.gov’s Physician Compare tool. The finder tool lets you search through a list of physicians in your area to see which ones accept Medicare.

Medicare Advantage plans

Instead of receiving your benefits through Original Medicare, perhaps you opted for Medicare Advantage, also known as Medicare Part C. There are several different types of Medicare Advantage plans, but all of them are available from private, Medicare-approved insurance companies, and cover your Medicare Part A and Part B benefits. Hospice care is the only exception; Medicare Part A still covers this care if you’re enrolled in a Medicare Advantage plan. Many plans include additional benefits, such as prescription drug coverage and wellness programs. You still pay a monthly premium for Medicare Part B along with any premium the Medicare Advantage plan charges.

If you belong to a Medicare Advantage plan — for example, if it’s a Health Maintenance Organization (HMO) — the plan might have required you to choose a primary care physician from a list of doctors in the plan’s network. If you did this, you know the doctor is a participating Medicare provider within the plan’s service area. Your plan will notify you if the doctor leaves your plan.

If you did not have to choose a primary care physician when you enrolled in your Medicare Advantage plan — for example, if you are in a Preferred Provider Organization (PPO) — you can check with your plan provider to see if your doctor of choice is in the network.

In situations where your doctor is not in the plan’s network, you might need to change to a doctor who is in the network, or change Medicare Advantage plans. There are certain times when you can sign up for, or switch, Medicare Advantage plans.

In any case, it’s always a good idea to check with your doctor before any appointment to make sure he or she is still in the Medicare Advantage plan. If he or she is not in the plan, you might have to pay for services.

When you’re ready to compare plans and get quotes, you can use the simple form on this page to view the Medicare Advantage plan options in your area. Simply enter your zip code and then choose the sort of Medicare plan you are shopping for (such as Medicare Advantage) to see a list of what’s available near you.

Can I change my primary care provider?

In most cases it is possible for you to change primary care providers with Medicare Advantage coverage. You may want to make sure this is an option before enrolling in a plan, and use your plan’s instructions for changing providers.

If your Medicare card is lost, stolen or damaged, you can request a replacement Medicare card through the Social Security Administration in the following ways:

• Online at www.ssa.gov.
• By phone at 1-800-772-1213 (TTY users, dial 1-800-325-0778), Monday through Friday, from 7AM to 7PM.
• In person at your local Social Security office.

How soon will I get my replacement Medicare card?

Your new red, white, and blue card will be mailed to the address that Social Security has on file for you within 30 days.

If you have moved and have not reported this information to Social Security, you will need to report your address change before they can process your request for a replacement card.

If you need proof that you have Medicare sooner than 30 days, you also can request a letter to use as temporary proof. This letter should be mailed to you in about 10 days. If you need proof immediately for your doctor or for a prescription, visit your nearest Social Security office.

If you signed up for Medicare through the Railroad Retirement Board (RRB), you’ll need to request a replacement Medicare card through the RRB:

• Visit www.rrb.gov.
• Call 1-877-772-5772 (TTY users, dial 1-312-751-4701, Monday through Friday, from 9AM to 3:30PM.
• Contact your local Railroad Retirement Board office.

In general, once you’re enrolled in Medicare, you don’t need to take action to renew your coverage every year. This is true whether you are in Original Medicare, a Medicare Advantage plan, or a Medicare prescription drug plan. As long as you continue to pay any necessary premiums, your Medicare coverage should automatically renew every year with a few exceptions as described below.

Medicare renewal – when might you have to renew your Medicare coverage?

There are some exceptions where you’ll need to take action to continue your coverage. Some situations where your Medicare Advantage or stand-alone Medicare Part D prescription drug plan coverage won’t be automatically renewed include, but aren’t limited to:

• Your plan reduces its service area, and you now live outside of its coverage area.
• Your plan doesn’t renew its Medicare contract for the upcoming year.
• Your plan leaves the Medicare program in the middle of the year.
• Medicare terminates its contract with your plan.

If your Medicare plan doesn’t renew its contract with Medicare for the coming year, your Special Election Period will run from December 8 to the last day of February of the following year. If you have Medicare Advantage and don’t enroll in a new plan by the date that your current plan ends its contract with Medicare, you’ll be automatically returned to Original Medicare.

Keep in mind that your new coverage starts on the first day of the month after you submit your enrollment application, meaning if you apply on February 8, your new Medicare plan wouldn’t begin until March 1.

You’ll also get a three-month Special Election Period if your Medicare Advantage or Medicare Part D Prescription Drug Plan terminates its contract with Medicare. This period starts two months before the contract ends and runs an additional month after the contract ends. If Medicare terminates your plan’s contract, you will have a Special Election Period that begins 1 month before the termination effective date and ends 2 months after the effective date of the termination.

While you may not need to renew your Medicare coverage, it’s still a good idea to review your coverage annually. Benefits, provider and pharmacy networks, drug formularies, and cost sharing can all change from year to year and affect how much you pay out of pocket. Comparing plans annually is one way to make sure your coverage continues to meet your health needs and budget.

If you suspect any sort of disability fraud, you can report it to the Social Security Administration (SSA) via internet, phone, or mail. According to the Centers for Medicare & Medicaid Services, fraud is any act of intentional deception in order to receive an unlawful benefit. Examples of disability fraud may include making false statements on claims or concealing employment in order to continue receiving disability benefits.

Reporting disability fraud - can you remain anonymous?

If you are reporting disability fraud, you have the option to remain anonymous during the reporting process. However, keep in mind that this may limit the Social Security Administration's ability to investigate your allegations, since the office will not be able to follow up with you for additional information.

To report fraud, waste, or abuse online, fill out this form on the Social Security website.

To report it via mail, send your report to:

Social Security Fraud Hotline
P.O. Box 17785
Baltimore, MD 21235

To report via telephone, call the Fraud Hotline at 1-800-269-0271 (TTY users 1-866-501-2101) from 10 AM to 4 PM Eastern Time. If you cannot reach a representative during this time, you may also report disability fraud through the Social Security toll-free number, and your information will be sent to the Fraud Hotline. Call Social Security at 1-800-771-1213 (TTY users 1-800-325-0778), Monday through Friday, from 7 AM to 7 PM.

Summary:

You or the funeral home can report a death of a Medicare beneficiary to Social Security if you have the deceased's social security number. Usually it only requires a phone call.

According to the Centers for Disease Control and Prevention, over 2,813,000 people died in the USA in 2017. When someone dies, many preparations must be made, including in some cases, reporting the death to Social Security.

When the death of a Medicare beneficiary occurs, the family member or person responsible for the beneficiary's affairs may notify Social Security. However, in most cases, the funeral home will report the person's death to Social Security. If you want the funeral home to do that, you will need to give the deceased's Social Security number to the funeral director so he or she can make the report.

How to notify Social Security of a death

You can call Social Security toll-free at 1-800-772-1213 (TTY 1-800-325-0778) between 7 AM and 7 PM, Monday through Friday.

If monthly benefits were being paid via direct deposit, the bank or other financial institution also needs to be notified of the beneficiary's death. Any funds received for the month of death and any later months may need to be returned to Social Security.

If benefits were being paid by check, do not cash any checks received for the month in which the beneficiary died or thereafter. Return the checks to Social Security as soon as possible. A one-time payment of $255 is payable to the surviving spouse if he or she was living with the beneficiary at the time of death or if the surviving spouse was living apart from the beneficiary, but was receiving Social Security benefits from the beneficiary's earnings record. If there is no surviving spouse, the payment is made to a child who was eligible for benefits from the beneficiary's earnings record in the month of death. Certain family members may be eligible to receive monthly benefits. Contact Social Security to learn more. 

To find a Medicare plan that meets your needs, enter your zip code above.

Summary:

There are three ways to change your Social Security address: online, over the phone, or in person.

Social Security needs your address to send you communications for Medicare, such as the Medicare & You handbook each year and a new Medicare card.

You can make updates to your Medicare change of address with Social Security

• Online
• Over the phone 
• In person at your local Social Security office

If you get Social Security benefits, you can change your Medicare address online at the Social Security website. If you change your address online, you will be asked a series of questions to verify your identity. Your answers must match the information Social Security has in its records. You can only change your address online if you have established a permanent password, which can be created by visiting My Social Security.

If you do not want to answer the questions online or you do not have a permanent password, you cannot submit a change of address online. Instead, you can call the Social Security Administration at 1-800-772-1213 (TTY 1-800-325-0778), Monday through Friday, from 7 AM to 7 PM in all time zones and speak to one of their representatives or visit your local Social Security office.

To find a Medicare plan near you, enter your zip code above.

"The Welcome to Medicare" physical exam is a one-time, preventive physical exam Medicare covers within the first 12 months that you have Medicare Part B. This visit will include a thorough review of your health, along with education and counseling about the preventive services you need, like certain screenings, shots, and referrals for other care.

This visit is a great way to get up-to-date on important screenings and shots and to talk with your doctor about your family history and how to stay healthy. During the "Welcome to Medicare" visit, your doctor will record your medical history and check your vision, blood pressure, and weight and height to measure your body mass index (BMI). Body mass index is a measure of body fat that applies to both adult men and women.

Your doctor will check that you are up-to-date with preventive screenings and services, such as cancer screenings and immunizations. Further tests may be ordered, if necessary, depending on your general health and medical history. Your doctor will also give you advice to help you prevent disease, improve your health, and stay well. You will get a written plan (such as a checklist) when you leave, letting you know which screenings and other preventive services you should get in the future.

Your doctor will also talk with you about creating advance directives. Advance directives are legal documents that explain in writing what kind of health care you would want if you were too ill to speak and/or make decisions for yourself. Talking to your family, friends, and health care providers about your wishes is important, but these legal documents help ensure your wishes are followed.

When do I get my "Welcome to Medicare" physical exam?

Once you enroll into Medicare Part B, schedule your "Welcome to Medicare' preventive visit right away. Medicare will only cover this physical exam if it occurs within the first 12 months from when you enroll into Medicare Part B.

If you've had Medicare Part B for over 12 months, you can get a yearly "Wellness" visit instead. This visit is also covered and can help you and your doctor develop a personalized health plan.

How much does the "Welcome to Medicare" exam cost?

You pay nothing for your "Welcome to Medicare" preventive visit or the yearly "Wellness" visits if the doctor or health care provider accepts assignment. If you have additional tests or receive other services during this visit that aren't covered under these preventative benefits, you may have to pay coinsurance and the Medicare Part B deductible may apply.

What should I bring with me to the exam?

You should bring the following things with you when you go to your "Welcome to Medicare' visit:

• Medical records, including immunization records.
• A list of prescription drugs, as well as over-the-counter drugs and supplements that you currently take, how often you take them, and why.
• Family health history . Try to learn as much as you can about your family's health history before your appoitment.
• Any information you can give your doctor to help determine if you are at risk for certain diseases.

Summary:

The Medicare.gov physician compare tool will help you find a Medicare doctor in your area. Seeing Medicare doctors generally makes your out of pocket costs less.

Maybe you've had a favorite primary care physician for years and hope to keep her when you have Medicare. Not every doctor accepts Medicare assignment ( a payment agreement), although most do.

If your Medicare doctor accepts assignment:

• Your out-of-pocket costs may be less,
• The doctor will submit a claim directly to Medicare and can't charge you before submitting it, and 
• You generally only pay your deductible and coinsurance amounts.

If my doctor accepts Medicare, what does that mean?

Doctors who accept Medicare assignment can fall into any of the following categories:

• Participating doctors accept Medicare assignment, meaning that they accept the Medicare-approved amount as payment for their services. These doctors charge the Medicare program 80% and the beneficiary 20% of the cost of the benefit.
• Non-participating doctors can choose to either accept or not accept Medicare assignment. If the doctor does not accept Medicare assignment, you might have to pay a 15% additional charge above the cost of the service, known as a Medicare excess charge. You would then be responsible for up to 35% of the reduced Medicare-approved amount instead of 20%.
• Doctors who have opted out of Medicare may charge you whatever they see fit for services and supplies. You would then be responsible for the full cost of the benefits.

To find a participating doctor in your area, you may use the Medicare.gov Physician Compare tool. This tool will help you find an approved Medicare doctor based on medical specialty, geographical area, or doctor's name. In addition to finding Medicare-approved physicians, this tool provides information about each doctor, along with maps and directions to help you find the doctor's office.

To begin looking for Medicare coverage accepted by Medicare doctors today, enter your zip code above.

Summary:

The Centers for Medicare & Medicaid Services (CMS) created Star Rating system to help beneficiaries and their families compare plan performance and quality for Medicare Advantage plans, Medicare Prescription Drug Plans, and Medicare Cost Plans.

Medicare plans are rated on a scale of 1 to 5, with a 5-star rating being the highest score a plan can receive. More stars indicate better performance and quality:

• 5-star rating: Excellent
• 4-star rating: Above Average
• 3-star rating: Average
• 2-star rating: Below Average
• 1-star rating: Poor

Medicare plan star ratings: what do they measure?

For Medicare plans providing health coverage, such as Medicare Advantage or Medicare Cost plans, each plan is given an overall summary rating based on how it performs across five main categories:

• Staying healthy: Plans are rated on whether members had access to preventive services to keep them healthy. This includes physical examinations, vaccinations like flu shots, and preventive screenings.
• Chronic conditions management: Plans are rated for care coordination and how frequently members received services for long-term health conditions.
• Member experience: Plans are rated for overall satisfaction with the health plan.
• Member complaints:  Plans are rated on how frequently members submitted complaints or left the plan, whether members had issues getting needed services, and whether plan performance improved from one year to the next.
• Customer service: Plans are rated for quality of call center services (including TTY and interpreter services) and processing appeals and new enrollments in a timely manner.

For Medicare Part D stand-alone Prescription Drug Plans and Medicare Advantage plans that include drug coverage, Medicare star ratings are also based on the following criteria:

• Member experience
• Member complaints
• Customer service
• Drug safety and drug pricing accuracy

The drug safety score is based on factors such as how accurate the plan's pricing information is and how often members with certain medical conditions are prescribed drugs in a way that is safer and clinically recommended for their condition. Plans are also rated for whether drug pricing information on Medicare Part D Prescription Drug Plan and Medicare Advantage Prescription Drug plan websites is up-to-date and accurate. In addition, the percentage of plan members who got prescriptions for certain drugs with a high risk of serious side effects when there may have been a safer drug choice is also reviewed and scored.

The overall rating gives a quick summary of a plan's performance, but you can also look up how the plan scored for individual areas within the above main categories. For more information on the criteria Medicare considers when rating its plans, visit Medicare.gov.

Keep in mind that plan ratings can change from year to year and are updated every fall. If you are enrolled in a Medicare plan, be sure to check the Medicare star ratings every fall so you can make an informed decision about whether to stay on the plan or switch to a different plan.

How to enroll in a Medicare 5-star rated plan

You can sign up for 5-star rated Medicare Advantage, Medicare Prescription Drug Plan, or Medicare Cost Plan during the Annual Election Period.

If your Medicare plan doesn't have a 5-star rating, you can switch to a Medicare 5-star rated plan within your service area one time during the 5-Star Special Election Period (SEP) from December 8th to November 30th. If you have just switched Medicare Advantage plans during your AEP, this SEP is only available the following year.

If you decide to switch from your current Medicare Advantage plan to one with a 5-star rating, make sure you choose a plan that has prescription drug coverage, if you want this kind of coverage. Otherwise, you could pay a late-enrollment penalty if you add drug coverage at a later date.

To learn about Medicare plan options in your service are, which may include Medicare 5-star rated plans, you can contact an Medicare Resource Center licensed insurance agent today by calling 1-888-601-6334.

Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.

There can be good reasons to consider changing Medicare Supplement (Medigap) insurance plans if you can find another insurer that's willing to sell you a policy. Unlike other types of Medicare coverage, you can join or switch Medigap plans any time the plan is taking new members and will accept your enrollment.

However, you'll usually have fewer options available if you switch plans after your Medigap Open Enrollment Period, the six-month period when you're first eligible for Medicare Supplement insurance. During your Open Enrollment Period, you can join any plan with guaranteed issue, meaning Medigap insurers must sell you a policy and can't charge you a higher premium for health reasons. After this period, you may have trouble finding an insurer that will sell you a plan, especially if you have pre-existing conditions*.

If you decide to switch plans, know that your Medigap coverage may cost more, and the plan may require medical underwriting. Also, keep in mind that if you switch Medigap plans and change your mind, you may not be able to get your old plan back.

Reasons to switch Medigap plans

That being said, there are certain situations where you might consider changing Medigap plans; you could even have guaranteed-issue rights in some circumstances. Some reasons include:

You're unhappy with your Medigap insurance company. There are 10 Medigap plans available in most states, and coverage is standardized, meaning that plans of the same letter provide the same benefits, regardless of insurer. If you're dissatisfied with your Medigap insurer and can find another insurance company that sells your current plan, you may want to switch plans and get the same benefits you currently have.

Your health needs have changed. If you're in good health, you may want to switch to a Medicare Supplement insurance plan with more basic coverage, so that you're paying for benefits you're not using. Or, conversely, your health may have declined recently, and you may want to switch to a Medigap plan with more comprehensive coverage.

Your financial situation has changed. If your finances have changed, you may want to switch to a plan with a less expensive premium, especially since benefits are standardized for the same plans. Keep in mind that Medigap plans use different methods for pricing plan premiums. Some base premiums on your current age, meaning the premium cost increases with your age. Other insurers base the premium on your age when you enroll, while others charge all plan members the same premium, no matter how old they are. Always ask the Medicare Supplement insurer which pricing method it uses so you know how much you'll pay both now and in the future.

You have a Medicare SELECT plan and moved out of the plan's service area. Medicare SELECT plans are a type of Medigap that may require you to use certain provider networks to be covered. If you move out of your Medicare SELECT plan's coverage area, you can switch to a Medigap Plan A, B, C, F, K, or L sold by any company in your new location that is licensed to sell the Medigap policy, no later than 63 calendar days after your coverage ends.

Your Medigap insurance company goes out of business.  If you lose your Medigap plan because the insurer goes bankrupt, you have a guaranteed-issue right to join another Medicare Supplement Insurance plan. You can join a Medigap Plan A, B, C, F, K, or L sold by any company in your state that is licensed to sell the Medigap policy no later than 63 calendar days after your coverage ends.

Your Medigap insurance company committed fraud. If your Medicare Supplement insurer misled you, you have a guaranteed-issue right to change Medigap plans. You can switch to a Medigap plan A, B, C, F, K, or L sold by any company in your state that is licensed to sell the Medigap policy no later than 63 calendar days after your coverage ends.

There are other situations when you may have guaranteed issue rights; check with Medicare (contact information below) or your health insurance plan.

If you're thinking of changing Medicare Supplement insurance plans, you can wait to drop your first policy while deciding which plan to keep. You have a right to try out your new Medigap policy for 30 days before dropping your original plan - or going back to your first policy if you're not satisfied. This is known as your free-look period. You must pay both plan premiums for that month and state in your Medigap application that you'll cancel the first Medigap plan after 30 days. After the first month, you can drop the Medigap plan you don't want.

Need help finding a Medicare Supplement insurance plan? You can get in touch with one of The Medicare Resource Center's licensed insurance agents at 1-888-601-6334.

*Pre-existing conditions are generally health conditions that existed before the start of a policy. They may limit coverage, be excluded from coverage, or even prevent you from being approved for a policy; however, the exact definition and relevant limitations or exclusions of coverage will vary with each plan, so check a specific plan's official plan documents to understand how that plan handles pre-existing conditions.

Medical underwriting involves a review of your medical history. Some health insurers use underwriting to determine whether they will provide coverage to a prospective beneficiary, what premium to charge, and whether to impose a waiting period before coverage starts.

If you're enrolled in Medicare, and you decide to add a Medicare Supplement (also known as Medigap or MedSup) insurance plan to your Original Medicare coverage, the private insurance company might require underwriting before selling you a Medigap policy. 

You can avoid underwriting and enroll in any Medigap plan that's available where you live if you sign up for the Medigap plan during your six-month Medigap Open Enrollment Period. This period begins on the first day of the month that you're both 65 years old and enrolled in Medicare Part B. For example, if you turn 65 on July 14th and are enrolled in Medicare Part B, you have until December 31st to enroll in a Medigap plan. If you apply for a Medigap plan during your Medigap Open Enrollment Period, your acceptance into the plan is guaranteed, and the plan can't charge more if you have a health condition. As a prerequisite, you must be enrolled in Original Medicare, Part, and Part B.

If you apply for Medigap coverage after your open enrollment period has passed, you may have to go through medical underwriting. The insurer may review your medical history and refuse to sell you a policy, or sell you one at a higher cost if you do not meet its underwriting requirements.

Sometimes you can join a Medigap plan after the Medigap Open Enrollment Period without undergoing a medical underwriting review. For example, if you're enrolled in a Medicare Advantage plan, and the plan leaves the Medicare program, you might have a "guaranteed-issue right" to a Medigap plan.

Medicare Supplement (or Medigap) insurance plans are standardized across the nation, except in Massachusetts, Minnesota, and Wisconsin. Each of the 10 plans is denoted by a letter. The currently available plans are A, B, C, D, F, G, K, L, M, and N. These plans are provided through private insurance companies. Still, plan type with the same letter must offer the same set of basic benefits regardless of location.

Medicare Supplement Plan F

Medigap Plan F* is considered one of the most popular plans because it offers the most comprehensive coverage of certain health care costs, including:

• Medicare Part A coinsurance and hospice care coinsurance
• Medicare Part A deductible
• Medicare Part B coinsurance or copayment
• Medicare Part B deductible
• Part B excess charges
• First three pints of blood used in a procedure
• Skilled nursing facility (SNF) care coinsurance.
• Coverage outside of the United States (up to plan limits)

Medicare Supplement Plan N

Medigap Plan N covers the same benefits as Plan F except for the Part B deductible and Part B excess charges. Also, it covers the Medicare Part A deductible at 50% versus 100%. Medigap Plan N pays for 100% of the Part B coinsurance, except for copayments of up to $20 for certain office visits and up to $50 for emergency room visits that do not result in an inpatient admission.

By entering your zip code above, you can start comparing Medicare Supplement insurance plans in your area instantly. But you’re also more than welcome to reach out to us at 1-888-601-6334.

*As of January 1, 2020, people new to Medicare can’t buy plans that cover the Medicare Part B deductible. This means that Medicare Supplement Plans C and F will no longer be available to new Medicare enrollees. However, if you already have a Plan C, Plan F, or high-deductible Plan F, you can keep it. If you were eligible for Medicare before January 1, 2020, you also might be able to buy Medicare Supplement Plan C, F, or high-deductible Plan F.

If you enrolled in Original Medicare (Part A and Part B) and you think you want coverage with Medicare Supplement Plans, it’s important to apply when you have Medicare Supplement guaranteed issue rights. These rights, also called Medigap protections, give you the best opportunity to buy the plan you want at the most affordable price. Read on for a breakdown of Medicare Supplement guaranteed issue rights and how they affect you.

What are Medicare Supplement guaranteed issue rights?

Medicare Supplement Plans are actually private insurance plans sold by private companies approved by Medicare. Although plan benefits are determined and standardized by the federal government, private insurers generally have the final say about who they will cover and at what price—unless you have Medicare Supplement guaranteed issue rights.

When you have Medicare Supplement guaranteed issue rights, the insurance company must sell you any Medicare Supplement plan sold in your state, regardless of your health history. The insurer must also cover your pre-existing conditions. Finally, the company cannot increase your premiums if you have a serious health condition; they generally must sell you the plan at the same premium they charge anyone else.

If you plan to buy one of the Medicare Supplement Plans available in your state, you should generally do so when you have guaranteed issue rights.

Can I buy Medicare Supplement Plans without guaranteed issue rights?

It’s impossible to say whether or not a company will sell you a plan without Medicare Supplement guaranteed issue rights. Most companies will make you pass medical underwriting before offering you a plan. During medical underwriting, the insurer can look at your past medical history and medical records. If you have serious or chronic health conditions such as diabetes, heart disease, or COPD, they may decide not to issue you a policy.

Depending on your health history, they could also sell you a different plan with less comprehensive coverage, or they could impose a waiting period on pre-existing conditions. They could also offer to sell you a plan, but charge you more than they charge others.

When do I have Medicare Supplement guaranteed issue rights?

The Open Enrollment period for Medicare Supplement Plans starts when you are both age 65 or older and enrolled in Part B, and lasts for six months. Everyone has guaranteed issue rights during that six-month period.

Outside of Open Enrollment, you may have guaranteed issue rights for a short period of time related to certain special situations. For example:

• If you have Medicare Advantage, and your plan is no longer operating in your area, or you move out of your plan’s service area, you have a window of time with guaranteed issue rights to buy Medicare Supplement Plans.
• If you joined Medicare Advantage when you first became eligible for Medicare, but decided to switch to Original Medicare within the first 12 months, you have Medicare Supplement guaranteed issue rights for 60 days before your plan ends and 63 days after you switch.
• If you dropped a Medigap plan to enroll in Medicare Advantage, but decide within 12 months to switch back (known as “trial right”), you have Medicare Supplement guaranteed issue rights for the same four-month period described above.
• If you joined a Medicare Advantage plan or bought a Medicare Supplement Plan, but the plan doesn’t follow Medicare rules or behaved unethically, you may also have short-term guaranteed issue rights.

Your window for Medicare Supplement guaranteed issue rights may vary depending on the situation; be sure to check the time-frame for your specific circumstance. Also, in some cases, you may be limited to just a few Medicare Supplement Plans. In other words, in certain situations where you have Medicare Supplement guaranteed issue rights, it may not apply to all available plans.

There are different ways that you can receive your Medicare coverage or add to that coverage. Medicare Advantage and Medicare Supplement insurance are options that may sound similar, but they’re quite different. They do have one main thing in common: they’re both offered by private insurance companies.

There are two options commonly used to replace or supplement Original Medicare. One option, called Medicare Advantage plans, is an alternative way to get Original Medicare. The other option, Medicare Supplement (or  Medigap) insurance plans, work alongside your Original Medicare coverage. These plans have significant differences when it comes to costs, benefits, and how they work. It’s important to understand these differences as you review your Medicare coverage options.

Original Medicare, Part A, and Part B is a government health insurance program for those who qualify by age or disability. Part A is hospital insurance, and Part B is medical insurance. There are some out-of-pocket costs associated with Original Medicare, such as copayments, coinsurance, and deductibles. To help with those costs, if you’re enrolled in Original Medicare, you can purchase a Medicare Supplement (Medigap) insurance plan.

Medicare Advantage plans offer an alternative way to receive your Medicare benefits through a private, Medicare-approved insurance company. They must include all your Medicare Part A and Part B coverage (except hospice care, which is covered under Medicare Part A). Still, They may offer additional benefits not included in Original Medicare.

You generally cannot enroll in both a Medicare Advantage plan and a Medigap plan at the same time.

Medicare Advantage plans

If you have a Medicare Advantage plan, you’re still enrolled in the Medicare program; in fact, you must sign up for Medicare Part A and Part B to be eligible for a Medicare Advantage plan. The Medicare Advantage plan administers your benefits to you. Depending on the plan, Medicare Advantage can offer additional benefits beyond your Part A and Part B benefits, such as routine dental, vision, hearing services, and even prescription drug coverage.

There are many different types of Medicare Advantage plans, described below:

• Health Maintenance Organizations (HMOs) require you to use health-care providers in a designated plan network. They may require referrals from a primary care physician in order to see a specialist.
• Preferred Provider Organizations (PPOs) recommend the use of “preferred” health-care providers in an established network, and these plans are likely to cover more of your medical costs if you stay inside that network. You don’t need a referral to see a specialist.
• Private Fee-for-Service (PFFS) plans determine how much they will pay health-care providers and how much the beneficiary is responsible for covering out-of-pocket.
• Medical Savings Account (MSA) plans deposit money into a “health-care checking account” that you use to pay for health-care costs before the deductible is met.
• Special Needs Plans (SNP) are tailored health insurance plans designed for beneficiaries with certain health conditions.

If you decide to sign up for a Medicare Advantage plan, you may want to shop around because costs and coverage details are likely to vary. Our obligation-free Medicare Resource Center plan finder tool above lets you see all available Medicare Advantage options in your area, including a list of coverage details once you click on the plan of interest.

Some of the costs associated with Medicare Advantage might include a monthly premium (not counting your Part B premium, which you must continue to pay as well), annual deductible, coinsurance, and copayments.

To be eligible to enroll in a Medicare Advantage plan, you must be enrolled in Original Medicare, reside in the plan’s service area, and (in most cases) not have end-stage renal disease (ESRD).

Medicare Supplement insurance plans

Medicare Supplement insurance, also known as Medigap or MedSup, is also sold through private insurance companies, but it is not comprehensive medical coverage. Instead, Medigap functions as supplemental coverage to Original Medicare. Current Medigap plans don’t include prescription drug coverage.

Medigap plans may cover costs like Medicare coinsurance and copayments, deductibles, and emergency medical care while traveling outside of the United States. There are 10 standardized plan types in 47 states, each given a lettered designation (Plan G, for example). Plans of the same letter offer the same benefits regardless of where you purchase your plan. Massachusetts, Minnesota, and Wisconsin offer their own standardized Medigap plans.

The standardized Medigap plans each cover certain Medicare out-of-pocket costs to at least some degree. Every Medigap plan covers up to one year of Medicare Part A coinsurance and hospital costs after Medicare benefits are used up. For example, Medigap Plan G plans don’t cover your Medicare Part B deductible, while Medigap Plan C plans do. So, if you’d like to enroll in a Medicare Supplement insurance plan, you might want to compare the Medigap policies carefully.

While benefits are standardized, the costs are not, meaning they could fluctuate depending on the insurance company offering the plan and location. That is, while Medigap Plan G includes the same coverage no matter where you buy it, the premium for this plan can vary. Also, not every standardized lettered plan is offered in every state.

If you decide to sign up for a Medigap policy, a good time to do so is during the Medigap Open Enrollment Period, a six-month period that typically starts the month you turn 65 and have Medicare Part B. If you enroll in a Medigap plan during this period, you can’t be turned down or charged more because of any health conditions. But if you apply for a Medigap plan, later on, you may be subject to medical underwriting; your acceptance into a plan isn’t guaranteed.

Whether you enroll in a Medigap policy or a Medicare Advantage plan, you must continue paying your Part B premium.

"Free" according to the Merriam Webster dictionary means "not costing or charging anything." Some people may refer to $0 premium Medicare Advantage plans as "free." However, these plans are not actually free in the way that they could still cost you.

Are $0 premium Medicare Advantage plans really free?

You might have been searching for Medicare Advantage plans available in your zip code and found a plan with a $0 monthly premium. This plan may appear to be "free" in the way that you don't have to pay an additional monthly amount to be covered by the plan. You generally still have to pay your Medicare Part B premium, however.

Keep in mind that Medicare Advantage plans are offered by private insurance companies which generally do business to make a profit. In order to offer $0 premium plans, they may charge in other ways, such as copayments/coinsurance.  A copayment or coinsurance is an amount you pay whenever you receive a service (such as a doctor visit or an emergency room trip) or pick up a prescription drug. In fact, plans with lower premiums or $0 premiums may have higher copayments/coinsurance.

Another way a $0 premium Medicare Advantage plan may cost you is with a deductible. A deductible is an amount, for example, $1,000 that you must pay out-of-pocket before your Medicare Advantage plan begins to pay your medical bills. Most Medicare Advantage plans have separate medical and prescription drug deductibles. You may have a $0 medical deductible, for example, but a $250 prescription drug deductible. Some Medicare Advantage plans have both $0 premiums and $0 deductibles.

Is there a way to get free Medicare coverage?

If you're a low-income person eligible for Medicare, you also may be eligible for Medicaid. Being eligible for both Medicare and Medicaid is called being "dual eligible." Unlike other types of Medicare coverage, you may not have premiums, deductibles, or copayments/coinsurance if you are covered by Medicaid. Medicaid may also offer additional benefits that Medicare doesn't, such as routine dental and routine vision services and hearing aids.

Are you looking for a Medicare Advantage plan with a $0 premium? To see if one is available in your area, just enter your zip code above.

A Medicare Advantage plan is a way to get your Medicare coverage from a private insurance company that has a contract with Medicare.

A premium is an amount you pay monthly to have coverage from your Medicare Advantage plan. You must pay this premium whether or not you use covered services. What you pay in premiums doesn’t count towards your out-of-pocket maximum.

Learn more about premiums and out-of-pocket maximum for your Medicare Advantage plans below.

The average premium for a Medicare Advantage plan went down in 2019

Premiums vary among Medicare Advantage plans. It’s not just that they come from private, Medicare-approved insurance companies who set their own premiums. It’s also true that some Medicare Advantage plans may offer more benefits beyond Medicare Part A and Part B coverage.

Some Medicare Advantage plans have premiums as low as $0 per month. 

Counting $0-premium plans, the average Medicare Advantage premium decreased by a third ($12 to $8) between 2018 and 2019.

What will I pay in premiums?

Premiums vary widely among plans. For example:

If you pay a $30 premium per month, you’ll pay $360 a year in Medicare Advantage premiums.

If you pay a $50 premium per month, you’ll pay $600 a year in Medicare Advantage premiums.

Some plans have premiums as low as $0, but plans may have other costs – deductibles, co-payments, and/or coinsurance, for example.

If you have Medicare Advantage you also must pay your Medicare Part B premium. The standard Part B premium is $150.00 in 2020, or $1,800.00 a year. If you pay $150.00 monthly for your Medicare Part B premium and $50 a month for your Medicare Advantage premium, you’ll pay a total of $2,400.00 a year in health coverage premiums. This is just an example – again, Medicare Advantage plans premiums vary among plans.

What is an out-of-pocket maximum?

An out-of-pocket maximum is a limit on the amount you pay for medical bills. This amount may vary year to year, and among plans. Knowing you have a maximum can be very reassuring. If you have a $30,000 surgery, for example, your out-of-pocket costs could be less than that if you have a Medicare Advantage plan.

What costs count towards an out-of-pocket maximum?

Usually amounts you spend on coinsurance or co-payments for covered services count towards your out-of-pocket maximum. For example, if you visit a primary care doctor and pay $5 and visit the emergency room and pay $50, these amounts will generally count towards your out-of-pocket maximum.

Costs that typically do NOT count towards your out-of-pocket maximum include:

• Premiums
• Bills from out-of-network health-care providers
• Services not covered by the plan

Summary:

Medicare Part A and Part B have deductibles you may have to pay. Medicare Part C and Part D may or may not have deductibles, depending on the plan.

Original Medicare has two parts: Part A for hospital insurance and Part B for medical insurance. Each covers different services and has different costs for the beneficiary. Both Part A and Part B have deductibles that you may need to pay before certain benefits are covered.

Medicare Part A deductible

Medicare Part A benefits include inpatient hospital care, skilled nursing facility care, home health services, and hospice.

For a hospital stay, you usually have to pay the Part A hospital inpatient deductible, which is $1,408 in 2020 for each benefit period. You may have other costs for the specific health-care services you receive while in the hospital. On the 61st day of a hospital stay, you would also start to have coinsurance costs. Your coinsurance costs depend on the length of your stay:

• Days 61 to 90: Daily coinsurance of $352 in 2020 for each benefit period
• Days 91 and over: Daily coinsurance of $704 in 2020 for each "lifetime reserve day" in each benefit period (up to a maximum of 60 days over your lifetime)
• After lifetime reserve days are used up: you pay all costs.

For home health-care services, all costs are covered under Medicare Part A for a limited time under certain conditions. However, if your doctor orders durable medical equipment and supplies it as part of your care, you'll pay 20% of the Medicare-approved amount for the equipment.

For hospice care, all costs are covered. Some exceptions include:

• If you take prescription medications or similar items for pain relief or symptom control while on hospice. You may be responsible for a copayment of no greater than $5 per prescription drug.
• If you need inpatient respite services. You may need to pay 5% of the Medicare-approved amount for that care.
• If you get hospice care in a nursing home. You typically pay for room and board costs.

Medicare Part B deductible

Medicare Part B benefits include (but aren't limited to) doctor's office visits, preventive screenings, and durable medical equipment. For some of these services, a deductible will apply ($198 in 2020). Often, you will pay 20% of the Medicare-approved amount for health-care services after this deductible is met. Make sure to check with your doctor and Medicare because each benefit's coverage is different.

Medicare Supplement (Medigap) insurance plans and Medicare deductibles

To get help paying for your Medicare deductibles, you might consider a Medicare Supplement (Medigap) insurance plan. If you have Original Medicare, you can get this additional insurance to help cover some of your Medicare expenses. There are 10 standardized Medigap plans that are available in most U.S. states; Massachusetts, Minnesota, and Wisconsin have their own types of Medicare Supplement insurance plans. Not every Medigap plan covers Part A and/or Part B deductible, but most of the standardized plans cover at least one of these deductibles in full or partially.

If you're concerned about Medicare deductibles and planning for future costs, you may want to consider all your options, including Medicare Supplement insurance plans. To get help finding a Medicare insurance plan, you can type your zip code into the form on this page to see a list of Medicare plans in your vicinity.

The product and service descriptions, if any, provided on The Medicare Resource Center pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

Medicare beneficiaries may have other insurance coverage in addition to their Medicare plan. When an insurance company has "primary insurance status," it means that that insurer will pay on the beneficiary's health-care claims first, while Medicare pays second. Please note that regardless of whether Medicare or the other insurance pays first, you will still be responsible for cost-sharing associated with each.  This refers to out-of-pocket costs paid by the beneficiary and may include any deductibles, copayments, and/or coinsurance costs required for covered services, both for Medicare and your other insurance.

Other types of insurance you may have include:

• Auto insurance
• Black lung benefits
• Group health plans under certain conditions*
• Homeowner's insurance
• Workers' compensation
• COBRA
• Veterans' benefits
• TRICARE

If you do not have any of the above types of insurance and do not have another type of insurance listed as the primary payer, then Medicare is your primary insurance. In this scenario, your doctor or health provider will generally submit a claim to Medicare first before billing you for your share. You will still be responsible for paying the Medicare deductible, coinsurance, and copayment amounts for covered services. 

If a beneficiary's other insurance has primary insurance status but does not pay first in time, Medicare may make a conditional payment and then recover the payments from the primary insurer later. 

*A group health plan may be the primary payer under some situations if specific conditions are met. For example, one situation where the group plan would pay first if  (a) the beneficiary has end-stage renal disease (ESRD) and is covered under a group plan, and (b) the beneficiary is in the first 30 months of Medicare eligibility or entitlement. This isn't the only situation where your group health plan may pay first. For a list of common situations where Medicare might be a primary or secondary payer, see this publication, "Your Guide to Who Pays First." If you have questions about how Medicare works with other insurance you may have, contact the Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627; TTY users should call 1-855-797-2627.

Summary:

Some secondary insurance payers may pay your Medicare deductibles and coinsurance. However, having secondary insurance is not a guarantee that you won't have any out-of-pocket expenses.

In the best-case scenario, your insurance would cover all your health care expenses and leave you with no out-of-pocket costs. This is not possible with Original Medicare alone, but it may be possible if you have secondary insurance.

Beneficiaries who are enrolled in more than one insurance plan have more than one "payer," which means that "coordination of benefits" rules determine which payer pays first. The primary payer pays what it owes on your claim first, while the secondary payer pays its part of the remainder of the claim. In some cases, there may be a third payer as well as secondary insurance. Some secondary payers may pay your Medicare deductibles and coinsurance.

What does primary and secondary insurance mean?

Primary insurance pays first up to coverage limits. Then secondary insurance pays if there is a balance that the primary insurance didn't cover. However, even with primary and secondary insurance, you may not have 100% of your costs, such as deductibles, covered.

Who is considered your primary and secondary insurance depends on what type of insurance you have in addition to Medicare. For example, if you have:

Medicaid: Medicaid is your secondary insurance; it pays after Medicare. Medicaid may pay your Medicare deductibles and coinsurance.

Employer coverage over 20 employees: If your employer has 20 or more employees, the employer group health plan usually is the primary insurance, and Medicare is the secondary insurance. Your group health plan may pay your Medicare deductibles. 

Employer coverage under 20 employees: If your company has fewer than 20 employees, generally, it's the secondary insurance, and Medicare pays first.

How can I get additional Medicare coverage?

Beneficiaries enrolled in Original Medicare may choose to enroll in a Medicare Supplement insurance plan to fill in the gaps in coverage and cover some of the costs of care not covered through Original Medicare. Some Medicare Supplement insurance plans cover the out-of-pocket costs associated with Original Medicare, such as deductibles and coinsurance payments. Therefore, some Medicare Supplement insurance plans may pay for your deductible and/or your coinsurance and/or other out-of-pocket costs not covered by Original Medicare. Medicare Supplement insurance plans usually require a monthly premium.

Starting January 1, 2020, Medicare Supplement insurance plans can't cover the Medicare Part B deductible. This eliminates Plan C and Plan F for new beneficiaries. However, if you already have one of these plans, you can keep it. If you're eligible to enroll in Medicare before January 1, 2020, you may be eligible to enroll in one of these plans. 

Most Medicare Supplement insurance plans cover the Part A deductible at least 50%. All Medicare Supplement plans also cover your Part A coinsurance and hospital costs 100% for an additional 365 days after your Medicare benefits are used up.

To begin looking for a Medicare Supplement plan in your area, enter your zip code above. You will be able to compare plans side by side.

Summary:

The out-of-pocket maximum for Medicare Advantage plans is not a deductible. It is the highest yearly amount you will have to pay out of pocket for covered health-care services.

The out-of-pocket maximum for Medicare Advantage plans is different from a deductible. The out-of-pocket maximum is the highest yearly amount you will have to pay out of pocket for covered health-care services. 

This spending maximum is one important difference between Medicare Advantage plans and the traditional fee-for-service Medicare program. Original Medicare doesn't have a yearly cap on your health-care costs.

Medicare Advantage out-of-pocket limit - lower is better for you.

An annual maximum out-of-pocket limit protects you from having to pay an unlimited amount for your health-care costs. Of course, the lower that limit is set, the better it protects you. Each Medicare Advantage plan can set its own out-of-pocket (OOP) limit, but it must be at least as low as a certain amount the government sets each year. 

All Medicare Advantage plans offer, at minimum, the same coverage as Original Medicare, Part A and Part B. These plans are sold by private insurance companies with the ability to set their own prices. They must be approved by the Centers for Medicare & Medicaid Services (CMS).

Costs of $0 monthly premium Medicare Advantage plans

However, although a Medicare Advantage plan may offer a monthly premium as low as $0, you should keep in mind that there may be other costs you could be responsible for. If you are enrolled in a Medicare Advantage plan, you will need to continue paying your Medicare Part B premium. Additional costs you may be responsible for include prescription drug costs, copayments, coinsurance, and annual deductibles. It is recommended that beneficiaries compare all of the different costs associated with Medicare Advantage plan coverage before enrolling in a plan in their service area.

Most people get Medicare Part A for free if they've worked at least 10 years (40 quarters) and paid Medicare taxes; otherwise, you can purchase Part A and pay a monthly premium for it, which will vary depending on your work history and the number of employment quarters you have. If you do not qualify for premium-free Medicare Part A and you choose to buy Part A, then you will be charged for your premium, also known as a "Notice of Medicare Premium Payment Due." You may get a bill, or it may be deducted from your monthly benefits as described below.

Medicare Part B premium bill

Medicare Part B comes with a monthly premium unless you qualify for financial assistance. If you get help with Medicare costs through a state Medicaid program, such as a Medicare Savings Program, then your Medicare premiums may be paid for by the state. However, if you don't qualify for Medicaid and enroll in Medicare Part B, you may receive a bill for your Medicare premiums, or it may be automatically deducted from your monthly benefits as described below.

If you receive benefits from the Social Security Administration, the Railroad Retirement Board, or the Civil Service, then your Medicare premiums will be deducted from your monthly benefit payment. Otherwise, you have several options when it comes to paying your Medicare premiums, including automated payments from a bank account or mailing a check or credit card payment to the Medicare Premium Collection Center. 

You may have to pay an additional premium if you're enrolled in a Medicare Prescription Drug plan, Medicare Supplement (Medigap) plan, or Medicare Advantage plan. In this case, your Medicare plan will send you a bill for your premium, and you'll send the payment to your plan, not the Medicare program. Some Medicare Advantage plans may offer premiums as low as $0. However, remember that regardless of whether you owe a premium for your Medicare plan, you'll need to keep paying your Medicare Part B premium.

Summary:

You should not need to submit a Medicare claim or bill, but there may be rare circumstances that you may need to. Original Medicare, Part A, and Part B, providers (including hospitals, skilled nursing facilities, home health agencies, physicians, pharmacies, and suppliers) that are enrolled in the Medicare program are required by law to file Medicare claims for covered services or supplies you receive. Medicare claims must be filed within one full calendar year following the year in which the services were provided.

When might you have to bill Medicare?

If you receive a service or supply from a health-care provider who does not accept Medicare assignment, you might have to pay the entire charge at the time of service. 

If a claim isn't filed within the time limit, Medicare may not pay its share. It's important to check your Medicare Summary Notice (MSN) to ensure your claims are being filed on time. If you discover claims are not being filed in a timely manner, you should first contact your physician and/or supplier and ask them to file the claim. If your claim is still not filed once you ask them to call 1-800-MEDICARE (1-800-633-4227), TTY users 1-877-486-2048; 24 hours a day, 7 days a week. You can also file the claim yourself by submitting the Patient request for Medicare Payment form (CMS-1490S).

Note: If you get your Medicare health-care benefits through a Medicare Advantage (MA) plan such as an HMO (Health Maintenance Organization) or a Private-Fee-For-Service plan, then the claims are filed with the Medicare Advantage plan. Medicare pays these private insurance companies a set amount every month to administer and manage your benefits. Therefore, a separate claim does not need to be filed with Medicare.

Most Medicare beneficiaries pay a monthly premium for Medicare Part B (medical insurance).

• If you receive Social Security, Railroad Retirement Board (RRB), or civil service benefits, the premium is typically deducted from your benefit payment. 
• If you don't receive the retirement payment listed above, you may be billed for the cost of your premium.

Some beneficiaries also pay a monthly premium for Medicare Part A (hospital insurance).

• If you did not qualify for premium-free Medicare Part A, you have to pay a monthly premium. You qualify for premium-free Part A if you worked at least 10 years (40 quarters) while paying Medicare taxes.

You may pay for Medicare premiums in the following ways:

Medicare premium payments through Medicare Easy Pay

Sign up for Medicare Easy Pay, which is a free, electronic payment option that automatically deducts premium payments from your savings or checking account each month it is due. To sign up, go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227; TTY users, call 1-877-486-2048). Representatives are available 24 hours a day, seven days a week.

Medicare premium payments through your bank account

Contact your bank, or go to your bank's website, to set up automatic payment. Here's the payee information you'll need:

• Your Medicare account number - it's on your red, white, and blue Medicare card. Don't enter the dashes when you enter this number.
• The payee name: CMS Medicare Insurance
• The remittance address: Medicare Premium Collection Center, P.O. Box 790355, St. Louis, MO 63179-0355
• The premium amount

Note: If your Medicare premium bill comes from the Railroad Retirement Board (RRB), or if you receive Civil Service benefits, see the information at the end of this article.

Medicare premium payments by credit or debit card

• Refer to the bottom portion of your Medicare bill and complete the instructions for paying by credit or debit card.
• You'll need your credit or debit card handy so that you can fill in the account number and other information.
• Mail your payment to the address above, unless you receive your retirement benefits from the RRB or Civil Service; in these cases, see the information at the end of this article.

Medicare premium payments by mail

Mail your check or money order to Medicare at Medicare Premium Collection Center, P.O. Box 790355, St. Louis, MO 63179-0355. Follow the instructions in your Medicare premium bill and mail your payment to the address listed in the form.

Note: If your Medicare premium bill comes from the Railroad Retirement Board, or if you receive Civil Service benefits, see the information at the end of this article.

IF your Medicare bill comes from the RRB

The payee's mailing address is: Railroad Retirement Board, Medicare Premium Payments, P.O. Box 979024, St. Louis, MO 6379-9000.

If you receive Civil Service retiree benefits

If you're a Civil Service retiree and not eligible for Social Security benefits, do either of the following: 

• Contact the Center for Medicare & Medicaid Services (CMS) at the following email address:
  
  [email protected]
• Call Medicare at 1-800-MEDICARE (1-800-633-4227; TTY users, call 1-877-486-2048). Representatives are available 24 hours a day, seven days a week.

If you're currently receiving retirement benefits from the Social Security Administration, Railroad Retirement Board, or Civil Service, then your Medicare Part A (if you pay a premium for it) and/or Part B premiums will be automatically deducted from your benefit payments. If you aren't currently receiving retirement benefits, you'll get a "Notice of Medicare Premium Payment Due" bill in the mail to pay your premiums manually.

You have a couple of options when it comes to paying your Medicare premiums.

Medicare premium payments - paying by mail

You can mail your Medicare premium payment in the pre-addressed envelope included with your billing notice. Be sure to fill out and include the bottom section of your premium bill when mailing back your payment.

You can send your Medicare premium payments by mail to the following address:

Medicare Premium Collection Center
P.O. Box 790355
St. Louis, MO 63179-0355

To ensure your account is credited properly, please write your Medicare number clearly on the check or money order. Or, if you are paying with a credit card or debit card, make sure to provide the account number and expiration date exactly as it appears on your card.

If you lose the pre-addressed envelope or have questions about where to send your payment, contact Medicare. You can reach Medicare by visiting Medicare.gov or calling 1-800-MEDICARE (1-800-633-4227) (TTY users 1-877-486-2048), available 24/7.

If you received a bill for your Medicare premiums from the Railroad Retirement Board (RRB), you should mail your payment to the RRB at:

RRB, Medicare Premium Payments
P.O. Box 979024
St. Louis, MO 63197-9000

Medicare premium payments - Medicare Easy Pay

Alternatively, you can also sign up for Medicare Easy Pay, an electronic payment method that automatically deducts your premium from your bank account each month. To sign up for Medicare Easy Pay, visit Medicare.gov and fill out an authorization form to sign up. If you need help or have questions about Medicare Easy Pay, call 1-800-MEDICARE (1-800-633-4227) (TTY users 1-877-486-2048), available 24/7.

Medicare premium payments - online bill payments through your bank

Your bank may offer an online bill payment service that lets you pay for your Medicare premiums over the Internet. Contact your bank to find out if they provide this service. Keep in mind that some banks may charge a fee to process online payments, so check with your bank for more details.

Premiums for Medicare plans

If you are enrolled in a Medicare Prescription Drug plan, Medicare Advantage plan, or Medicare Supplement plan, you may have a separate monthly premium for your Medicare plan. In these situations, you'll send premium payments directly to your Medicare plan, not the federal Medicare program, Medicare.gov, or the Railroad Retirement Board. Many Medicare plans give you the option to make premium payments online or by mail. If you have questions about billing or where to send the payment for your plan premium, contact your Medicare plan for more information.

If you have Medicare Part D, you'll pay the premium for your Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug Plan directly to your Medicare plan. However, in some situations, you may have to pay an extra amount if your income falls above a certain threshold; this extra cost is known as a Part D income-related monthly adjustment amount (Part D-IRMAA). Medicare will notify you if you need to pay the Part D-IRMAA.

Important note: If you need to pay the Part D-IRMAA, you'll pay this directly to Medicare, not your Medicare plan.

Like your Medicare Part A and/or Part B premiums, you can get your Part D-IRMAA bill automatically deducted from your Social Security, Railroad Retirement Board, or Civil Service benefit. Otherwise, you can pay for your Part D-IRMAA bill in the same ways that you pay for your Medicare Part A and/or Part B premiums: By mail through a check, money order, credit card, or debit card; through Medicare Easy Pay; or through your bank's online payment service.

Remember, regardless of the type of Medicare plan you're enrolled in, you'll need to continue to pay your Medicare Part B premium, in addition to any premium required by your Medicare plan.

To take a look at some of the Medicare plans available in your area, just enter your zip code above.

Medicare Advantage vs. Original Medicare. That's a decision that around 10,000 people could face every day. The Centers for Medicare & Medicaid Services (CMS) reported in 2015 that about 10,000 people became eligible for Medicare each day.

Medicare Advantage vs. Original Medicare: the pros and cons, and the differences

Original Medicare, Part A, and Part B is the government health insurance program for those 65 and older, and for people who qualify by disability.

Some quick Medicare Part A facts:

• Part A is hospital insurance - it covers your care as a hospital inpatient.
• You may not need to pay a monthly premium if you've worked at least 10 years (40 quarters) while paying Medicare taxes.
• A deductible applies.
• You also have to pay coinsurance or copayments once you have paid the deductible.

Some quick Medicare Part B facts:

• Part B is medical insurance - it may cover preventive services, doctor visits, lab tests, medical equipment and supplies, and other medically necessary services.
• You typically have to pay a monthly premium.
• An annual deductible applies to many services.
• You typically pay a 20% coinsurance for most services, although some services are free.

Original Medicare comes directly from the government. But you can choose to get your Part A and Part B benefits through the Medicare Advantage program instead.

The Medicare Advantage program (also called Medicare Part C) gives you a way to get these benefits through a private insurance company. These insurance companies contract with Medicare to deliver your Part A and Part B benefits.

Here's a table to help you see - at a glance - the main differences between Original Medicare and Medicare Advantage.

If you have a Medicare Advantage plan, you're still in the Medicare program. You still need to pay your monthly Part B premium - plus the Medicare Advantage premium.

Medicare Advantage vs. Original Medicare: when do you have to choose?

There's no hurry if you can't make up your mind about Medicare Advantage vs. Original Medicare. In most cases, you're automatically enrolled in Original Medicare as soon as you're eligible if you're receiving Social Security benefits. If you want a Medicare Advantage plan, you have to take steps to sign up. And you can't just sign up anytime - it's important to be aware of your Medicare Advantage enrollment periods.

If you know from the get-go that you want a Medicare Advantage plan, you can sign up when you're first eligible for Medicare. Your Medicare Initial Enrollment Period goes for 7 months for most people. 

If you don't enroll in Medicare Advantage during the Initial Enrollment Period, you may have other opportunities.

• The Annual Election Period (AEP), also called Fall Open Enrollment, happens every year from October 15th to December 7th. You can sign up for a Medicare Advantage plan during this period - or you can switch back to Original Medicare if you have a Medicare Advantage plan. You can also switch from one Medicare Advantage plan to another, or make certain other coverage changes.
• In some cases, you might qualify for a Special Enrollment Period (SEP) to sign up for a Medicare Advantage plan. There are a number of different circumstances that may qualify you for a SEP. Many of these involve losing your coverage, like losing employment-based health insurance.

You can usually sign up for a Medicare Advantage plan if you're enrolled in Medicare Part A and Part B and live in the plan's service area. If you have end-stage renal disease (permanent kidney failure), you might not qualify for most types of Medicare Advantage plans – call the plan you want to enroll in, and ask. You can generally enroll in a Special Needs Plan, a specific type of Medicare Advantage plan.

To enroll in a Medicare Advantage plan, you can contact the plan or click Enter Zip Code on this page to display plans in your area. From there, you can enroll online.

Medicare considers home health care to be skilled, in-home nursing care, or outpatient therapy services to treat an illness or injury. Nursing home care services are somewhat similar but delivered in a skilled nursing facility (SNF). Whether Medicare covers these services will depend on the type of nursing care you need and how long you need it.

Medicare Home Health Care

Intermittent or short-term home health services (for example, if you're recovering after a recent hospitalization) are covered under Medicare Part A and Part B. These services must be provided by a Medicare-certified home health agency that works with your doctor to manage your care. 

To be eligible for Medicare coverage:

• Your doctor must order it medically necessary that you receive intermittent skilled nursing care or outpatient therapy services at home. Medicare defines "intermittent" care as care given less than seven days a week or less than eight hours a day, for no longer than 21 days. If you need more than intermittent nursing care, Medicare will generally not cover it except in special circumstances.
• Your doctor must determine that your condition will improve and that your need for home health services is temporary.
• You must be homebound, meaning you can't leave your home without assistance, or it might be dangerous to leave due to your health condition. Homebound doesn't necessarily mean bed-bound. You're still considered homebound if you leave your home occasionally, for short periods of time, even for non-medical purposes like attending religious services.

Medicare covers your home health services over a 60-day period, after which the doctor must review your plan of care. However, there is no limit to the number of times your doctor can reorder this care for you, as long as it remains medically necessary to treat your condition. 

Medicare-covered home health care may include:

• Skilled nursing services are given by a registered nurse or licensed nurse practitioner
• Physical therapy, occupational therapy, or speech pathology services
• Home health aide services
• Medical social services
• Durable Medical Equipment (DME)
• Other supplies needed as part of your home care

Medicare coverage for in-home nursing care doesn't usually include meals, homemaker services, or round-the-clock nursing. Custodial care isn't covered if this is the only kind of care you need. Custodial care refers to personal assistance with daily living activities, such as bathing or getting dressed. These tasks are usually performed by home health aides and don't require a medically trained nursing or rehabilitation team.

If you have Original Medicare, Part A and Part B, you pay nothing for the home health services and 20 percent of the Medicare-approved amount for any durable medical equipment (DME).

Medicare Nursing Home Coverage

Medicare doesn't generally pay for long-term nursing home care. Medicare Part A does cover medically necessary, short-term care in a skilled nursing facility under certain conditions. Part A covers a semi-private room, medical supplies used in the facility, meals, and other items.

To be eligible for nursing home coverage, Medicare requires you to meet criteria such as, but not limited to:

• You have a qualifying inpatient hospital stay of at least three days before entering the SNF.
• The SNF is Medicare-certified.
• Your doctor orders this type of skilled daily care for you, indicating that it can only be delivered by a skilled nursing or rehabilitation staff (or under the staff's supervision).
• You're enrolled in Medicare Part A, with days left in your benefit period.
• You need treatment for a hospital-related medical condition, or for certain medical conditions you develop in the SNF.

If you live in a nursing home, Medicare still covers hospital and medical services under Part A and Part B. If you take medications, pharmacies contract with Medicare Part D Prescription Drug Plans to provide drug coverage for nursing home residents.

Although Original Medicare generally doesn't cover long-term nursing home care, you may be able to get help with costs if you have limited income and qualify for Medicaid. Contact your state Medicaid office to find out if you're eligible.

In addition, some Medicare Advantage plans (offered by private Medicare-approved insurance companies) may include coverage for nursing home services. In most cases, long-term nursing home care is only covered if you live in a nursing home that is contracted with your plan. However, some Medicare Advantage plans have Special Needs Plans (SNPs) that may help you if you live in a nursing home or have certain conditions, such as congestive heart failure.

What Kind Of Care Do I Need?

If you need short-term, skilled nursing care to recover from an illness or injury, Medicare Part A's home health benefit might cover you. If you're recovering from a hospital stay, Part A's skilled nursing facility coverage might cover your needs. Your Medicare-assigned doctor can recommend the kind of care you need and help place you in the appropriate situation.

However, if you need full-time or long-term care, Original Medicare coverage may not be sufficient. The Medicare Resource Centers plan comparison tool can help you find Medicare plan options that may offer nursing home coverage. To see which Medicare plan options are available in your area, simply enter your zip code above. You can also compare plans at Medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227) (TTY users 1-877-486-2048), 24 hours a day, seven days a week.

Many beneficiaries will need long-term care at some point in their lives, whether that takes place at home, in an assisted living facility, or in a nursing home. 

Original Medicare, Part A, and Part B doesn't cover everything. Routine dental care, hearing aids, and eyeglasses are statutorily excluded from Medicare coverage. It would take an act of Congress to include routine dental services, hearing aids, and eyeglasses in Medicare program coverage.

Medicare Coverage Of Dental Care

Medicare doesn't cover routine dental care, such as oral exams, cleanings, fillings, bridges, or crowns. However, there are a few situations where you may be covered for dental services:

• Dental services may be covered if they are an essential part of another Medicare-covered procedure. For example, if you hurt your jaw in an accident, Medicare may cover jaw reconstruction if it is medically necessary to treat your injury.
• Medicare may cover the extraction of teeth to prepare the jaw for radiation treatment for jaw-related neoplastic diseases.
• Medicare may cover dental examinations prior to a complicated procedure (such as a kidney or heart transplant) that requires an oral exam. You'll be covered under Medicare Part A or Part B, depending on whether the oral exam is performed in an inpatient or outpatient setting. 

Some Medicare Advantage plans may include benefits beyond what Original Medicare covers, including routine dental services. Medicare Advantage plans vary in terms of the benefits covered, so check with the specific plan if you're interested in dental coverage.

Medicare Coverage Of Hearing Aids

Medicare doesn't cover hearing aids or exams to get fitted for them. You'll pay 100% of the cost if you have Original Medicare, Part A, and Part B.

You may be able to get coverage for hearing care (including hearing aids) through a Medicare Advantage plan. Since benefits vary, check with the individual Medicare Advantage plan.

Medicare Coverage Of Eyeglasses

Medicare doesn't typically cover eyeglasses or contact lenses. However, Medicare Part B may cover corrective lenses after you have cataract surgery to implant an intraocular lens. You'll be covered for either one set of glasses or contact lenses following your surgery if you get these items from a supplier that is enrolled in the Medicare program. If you upgrade your frames, you'll pay any extra costs.

In most other situations, you'll pay the full cost for eyeglasses and contact lenses. You may be able to get coverage for routine vision services (including glasses or contact lenses) through a Medicare Advantage plan.

If you're a Medicare beneficiary and like to travel, it's a good idea to make sure you have health coverage in case of an emergency. While Original Medicare coverage may not be available outside the United States, some Medicare Supplement (Medigap) plan may include this coverage.

Original Medicare Coverage Outside the U.S.

For the most part, Original Medicare, Part A, and Part B doesn't cover medical services or items you get outside the country. Medicare considers the United States to include the District of Columbia, Puerto Rico, the Northern Mariana Islands, Guam, America Samoa, and the U.S. Virgin Islands.

There are some exceptions:

• If you live in the U.S. and the closest hospital that can treat your condition is outside the country, Medicare might cover in that hospital, even when it's not an emergency.
• If you have a medical emergency while traveling between Alaska and another state by the most direct route possible and as fast as reasonably possible, Medicare might cover care in a Canadian hospital. The Canadian hospital would have to be closer to you than the closest U.S. hospital.
• If you have a medical emergency in the U.S., but the closest hospital is outside the country, Medicare might cover care in the foreign hospital.
• Dialysis may be covered in emergency situations outside the U.S., but not routine dialysis.
• In some situations, Medicare may cover emergency medical treatment on a cruise ship. The ship must be no more than six hours from a U.S. port, and the doctor must be authorized by law to provide treatment.

Medicare Part D (prescription drug coverage) doesn't cover medications purchased outside the U.S.

Medigap Plans and Travel Coverage

Medicare Supplement (Medigap) insurance is optional insurance you can get from a private insurance company. Medigap plans pay some of your Original Medicare (Part A and Part B) costs, such as coinsurance and copayments.

In 47 states, there are 10 standardized Medigap plans, each one named with a letter (such as Plan M). Every plan includes the same benefits as other plans of the same name so that a Medigap Plan M offers the same coverage no matter where you buy it. Massachusetts, Minnesota, and Wisconsin have their own standardized Medigap policies.

Some Medigap plans cover emergency medical services you receive outside the United States. Medigap Plans C, D, F, G, M, and N pay 80% of your costs for certain emergency care in a foreign country if your situation meets all of the following conditions:

• The care you receive is medically necessary.
• The care begins during the first 60 days of your travel.
• Medicare doesn't otherwise cover this care.
• You've met your Medigap deductible for the year.

If you still have a Medigap Plan E, H, I, or J, these plans also cover overseas medical emergencies, but these plans are no longer sold.

A Medigap plan with emergency medical coverage outside the U.S. has a lifetime maximum coverage limit of $50,000.

It's a good idea to contact your Medigap insurance company to ask for details about travel coverage. You may also decide to purchase separate travel insurance.

Would you like to take a look at some of the Medicare plans available in your area? Just enter your zip code above to display a list and start comparing plans.

Summary:

Funeral costs can exceed $7,000, and Original Medicare (Part A and Part B) generally doesn't pay for any of it.

According to the National Funeral Director's Association (NFDA), the median cost of a funeral with a viewing and burial was $7,360 in 2016. This does not include funeral costs for flowers, obituary, monument, or marker costs.

Medicare and Funeral Expenses: What Are Typical Funeral Costs?

Among other things, funeral costs may include:

• Embalming (if you're planning a viewing or visitation)
• Casket
• Burial vaults
• Pickup of body
• Hearse
• Cost of lot or crypt

Opening and closing of garage or crypt.

Does Original Medicare Cover Funeral Costs?

Original Medicare (Part A and Part B) doesn't cover burial or funeral costs in the event of a beneficiary's death. This also applies if the beneficiary was enrolled in a Medicare Medical Savings Account plan, a type of a high-deductible Medicare Advantage plan that includes a savings account used to pay for medical expenses. Funeral or bereavement expenses aren't considered medical expenses and can't be paid for using funds from a Medical Savings Account plan.

While Medicare coverage is limited, the Social Security Administration does pay survivor benefits, which you can then use to pay for funeral costs. This death benefit is a one-time payment to the spouse or child of the beneficiary. Eligibility and the benefit amount will depend on how long your loved one worked and paid Social Security taxes.

Reporting a Medicare Beneficiary's Death

If your family member or loved one was a Medicare beneficiary, you'll need to report the death to Medicare. You'll need the person's Social Security number. You can do so by contacting Social Security at 1-800-772-1213, Monday through Friday, from 7 AM to 7 PM. TTY users can call 1-800-325-0778.

If your loved one worked for a railroad, contact the Railroad Retirement Board to report the death at 1-877-772-5772, Monday through Friday, from 9 AM to 3:30 PM. TTY users can call 1-312-751-4701.

If your loved one was enrolled in a Medicare plan from a Medicare-approved private insurer, such as a Medicare Advantage or Medicare Prescription Drug Plan, the Centers for Medicare & Medicaid Services (CMS) will notify the plan after you report the death to Medicare. The beneficiary will be disenrolled from the plan first day of the month after the month of death. This means that if someone dies on June 13th, he will be disenrolled from his plan on July 1st. 

To begin looking for a Medicare plan in your area, enter your zip code above. 

Just the Gist:

SilverSneakers is a fitness program designed for the 65+ crowd that provides access to gym memberships, weight training, aerobics, and group exercise classes. Many Medicare Advantage plans cover SilverSneakers.

Adults should get at least 150 minutes of moderate exercise per week, or 75 minutes per week of vigorous aerobic activity, recommends the American Heart Association. Ideally, this activity should be spread throughout the week. This recommendation is something to pay attention to, knowing that heart disease is the leading cause of death in American from 2016 to 2017. A Harvard study calls exercise an "insurance policy that may offer both short and long term protection for your heart."

Exercise may not be easy if you feel stuck at home with no exercise equipment. That's where SilverSneakers comes in.

SilverSneakers - How Does It Work?

SilverSneakers is a program encouraging older adults to participate in physical activities that will help them to maintain greater control of their health. SilverSneakers sponsors activities and social events designed to keep those 65 and older healthy while encouraging social interaction. As well as keeping you physically healthy, SilverSneakers can contribute to your overall well-being by connecting you to others in fitness classes and helping you stay social. According to SilverSneakers.com, 88% of SilverSneakers members say that SilverSneakers has improved their quality of life.

SilverSneakers is available around the country, and membership provides access to any participating gym location-including all amenities included with basic level access. Each SilverSneakers location is outfitted with an advisor who will introduce you to the program and help get you started. SilverSneakers also includes an invitation to sponsored health education seminars and other fitness-related events. 

What does SilverSneakers include?

SilverSneakers includes a network of fitness facilities that includes access to thousands of gyms. You will be able to use any participating location. With SilverSneakers, you'll be able to use amenities like weight machines, treadmills, ellipticals, pools, walking tracks, and group exercise classes. SilverSneakers also includes an on-demand video library of workout classes. 

How much does SilverSneakers cost?

SilverSneakers may be no-cost to you when included in certain Medicare Advantage plans.

What does SilverSneakers not include?

SilverSneakers does not generally include protein smoothies, massages, or personal training.

Medicare Advantage plans may cover SilverSneakers

SilverSneakers is considered a basic fitness service and Original Medicare, Part A, and Part B, does not cover this benefit. However, Medicare Advantage plans, also known as Medicare Part C, may provide this benefit. To see if your current Medicare Advantage plan includes the SilverSneakers program, contact your health plan directly, or visit the SilverSneakers online health plan finder to check.

If you are looking to enroll in a Medicare Advantage plan with SilverSneakers coverage, take a look at The Medicare Resource Center plan comparison tool above. The tool lets you review a list of Medicare Advantage plans available in your service area and explore your Medicare plan options.

In a Nutshell:

Even though Original Medicare (Parts A and B) may not cover gym memberships, some Medicare Advantage plans cover access to gym memberships and fitness benefits with SilverSneakers. Many Medicare Advantage Plans include SilverSneakers, which covers some gym memberships and fitness benefits for adults 65+.

Exercise has many health benefits, according to the National Institute of Health. If a gym membership helps you stay active, it may also help you improve diseases like diabetes, heart disease, and osteoporosis. Gym memberships and physical activity may also reduce feelings of depression and improve mood and overall well-being.

Original Medicare, Part A, and Part B do not cover any of the costs associated with gym memberships or fitness programs. However,  there are other Medicare plan options that may cover the cost of a gym membership.

Medicare Advantage plans must offer at least the same amount of coverage as Original Medicare (besides hospice care, which is still covered under Medicare Part A), and may also offer additional benefits. These extra benefits could include gym membership. If you sign up for a Medicare Advantage plan, you're still in the Medicare program and need to continue paying your Medicare Part B premium, as well as any premium the Medicare Advantage plan may charge.

Is it hard to find a SilverSneakers location?

SilverSneakers is the name of the health and fitness program designed for adults 65 and older. It may include gym membership and is part of many Medicare Advantage plans. SilverSneakers has over 16,000 fitness locations, including gyms and community centers. That means that there are more participating SilverSneakers locations than there are Starbucks! (If you want a treat after your workout, there are 14, 300 Starbucks in the U.S. according to the Wall Street Journal).

Do Medicare Supplements include SilverSneakers?

Unlike Medicare Advantage plans, Medicare Supplement insurance plans do not typically include gym memberships. Medicare Supplement insurance plans may cover most of your Medicare Part A and Part B coinsurance and copayments, as well as foreign travel emergencies. 

Because these Medicare plan options are offered through private, Medicare-approved insurance companies, their availability and benefits may differ by location. You may want to compare plans to see if one in your area offers coverage for health club membership costs.

Entering your zip code in the form on this page above, you can start comparing Medicare plans in your area instantly.

Summary:

Original Medicare may pay for medical services in domestic waters aboard a cruise ship, but not international waters. To get coverage for foreign travel emergencies, you may want a Medicare Supplement plan.

If you love vacationing aboard a cruise ship, you're part of a growing demographic, according to The Maritime Executive. Over 14.2 million passengers from North America took a cruise in 2018, which represents an increase of nine percent. You may enjoy onboard entertainers, views of whales, formal nights, and room service. The last thing you probably hope to need on your trip is medical services. However, if you fall ill one evening, or suffer a more serious health event, you want to be sure that medical services are covered.

Does Medicare cover cruise ship travel?

The main thing you need to consider is if your cruise is in the U.S., say along the coast of Alaska or Miami, or if your cruise is in international waters, say Mexico or South America.

Medicare may pay for medically necessary services and supplies administered aboard a cruise ship if the ship was within the United States waters when you got this care and the doctor was authorized to provide this care to you. The medical services and supplies must be provided in a United States port or within six hours of departure or arrival to or from a U.S. port.

If you received care within U.S. waters, the doctor should submit a claim to Medicare. If you received care while in international waters, Medicare doesn't generally cover it.

Some Medicare Supplement (Medigap) policies may cover emergency medical care outside the U.S. Medigap plans are available from private insurance companies to cover some of your Original Medicare (Part A and Part B) out-of-pocket costs.

You may also want to ask your travel agent about travel insurance with limited medical coverage. 

To begin looking for Medicare Supplement plans that have coverage for foreign emergencies, enter your zip code above.

If you are a Medicare beneficiary with Original Medicare, Part A, and Part B, you can travel anywhere in the United States and still be covered, as long as you use doctors and hospitals that accept Medicare. If you travel outside of the United States, however, your Medicare coverage is limited.

Please note that when it comes to Medicare coverage, "outside of the United States" includes any location outside of the 50 states, the District of Columbia, Puerto Rico, Guam, American Samoa, Virgin Islands, and the Northern Mariana Islands.

There are a few situations when Medicare may cover you outside of the country if you need medical care in a foreign hospital:

• Medicare will cover health care in a foreign hospital if you live in the United States and have a medical emergency, but the nearest foreign hospital is closer to you than the nearest U.S. hospital.
• Medicare may also provide coverage in Canada if you have a medical emergency while you're traveling on a direct route, without unreasonable delay, between Alaska and another U.S. state, and the closest hospital that can treat you is in Canada. Medicare will determine on a case-by-case basis what qualifies as "without unreasonable delay."
• Medicare will also cover certain health-care services you get in a foreign hospital, regardless of whether it's an emergency if you live in the United States and the foreign hospital is closer to your home than the nearest U.S. hospital. 
• Medicare will also cover you while on a cruise ship if you need to receive medically necessary care while the ship is in U.S. waters or a U.S. port (or within six hours of arrival or departure from a U.S. port). The physician treating you must be legally allowed to provide medical care on a cruise ship.

In the above-limited situations, Medicare may pay for inpatient hospital care, doctor services, and/or ambulance services. Please note that if you're enrolled in a Medicare plan that includes prescription drug coverage (such as a stand-alone Medicare Prescription Drug Plan), these plans don't cover prescription medications you purchase outside of the United States.

Traveling with Medicare Advantage plans

If you receive your Medicare coverage through a Medicare Advantage plan, instead of Original Medicare, the rules for out-of-state coverage are different and will depend on the type of Medicare Advantage plan you're enrolled in. Certain types of Medicare Advantage plans, such as HMOs, have provider networks that you must use to be covered for routine care. You generally need to get health-care services from doctors and hospitals in the plan network, although you'll still be covered if you need emergency medical care, out-of-area urgent care, or out-of-area kidney dialysis.

Other Medicare Advantage plans, such as PPO plans, are more flexible and may let you see health-care providers outside of your plan's preferred provider network. Depending on the rules of your plan, however, you could have to pay a higher copayment or coinsurance to receive non-emergency care from an out-of-network provider. If you will be traveling out of state, contact your Medicare Advantage plan for more information on coverage while out of your plan's service area.

If you are traveling overseas, Medicare Advantage plans must provide at least the same level of coverage as Original Medicare. so you'll be covered in the same limited situations described above. However, some Medicare Advantage plans may provide additional coverage when you are traveling outside of the United States. Check with your Medicare Advantage plan for more information.

Medigap coverage outside of the United States

As another coverage option for Medicare beneficiaries traveling outside of the United States, some Medicare Supplement insurance plans may offer emergency medical coverage when you're out of the country. Also known as Medigap, these plans work alongside Original Medicare and may help with certain costs that Medicare doesn't pay for.

Specifically, Medigap Plans C, D, F, G, M, and N provide some degree of emergency foreign travel coverage (up to plan limits). As mentioned, some Medicare Advantage plans provide coverage for travel abroad also.

If you are interested in enrolling in either a Medicare Supplement or Medicare Advantage plan, then The Medicare Resource Center plan comparison tool above can help you review available Medicare plan options in your area.

If you are a beneficiary of Original Medicare, Part A, and Part B, then you are free to travel anywhere in the U.S. without fear of losing your Medicare coverage. If you travel outside of the country, however, your Part A and Part B coverage options are much more limited. 

For example, Medicare will provide emergency coverage in Canada if you are traveling a direct route, and without unreasonable delay, between Alaska and another U.S. state, and the closest hospital that can treat you is in Canada. Medicare will also cover you while on a cruise ship if you need to receive care while the ship is in U.S. water or port (or within six hours of arrival or departure from a U.S. port).

While in a foreign country, such as Canada or Mexico, Medicare could potentially cover non-emergency inpatient services if foreign treatment is closer to your residence than the nearest U.S.-based hospital. Medicare may cover medically necessary ambulance services to reach the foreign hospital, but only if you are admitted for a medically necessary covered inpatient hospital service.

In these situations, you pay 20% of the Medicare-approved amount and also the Part B deductible.

Traveling with Medicare Advantage

If you receive your Medicare coverage through a Medicare Advantage (MA) plan, instead of Original Medicare, you may be required to stay within the plan service network to receive routine care when traveling inside the U.S. or you could be subject to pay higher costs. If this is the case, you would still be covered for emergency and urgent care as needed. Some MA plans are more flexible than others and may let you see health care providers outside of your network to obtain routine care. Remember, depending on the particulars of your Medicare Advantage plan, however, you could have to pay a higher amount to receive non-emergency care.

Medigap Coverage Outside the U.S.

As another option for foreign travel coverage, you may want to purchase a Medicare Supplement insurance plan, also known as Medigap or MedSup, to receive coverage while traveling outside of the U.S. Specifically, Plans C, D, F, G, M, and N provide some degree of foreign travel coverage up to plan limits. Some Medicare Advantage plans provide coverage for travel abroad also. Please note that Medigap plans are designed to supplement Original Medicare benefits and cannot be used in combination with a Medicare Advantage plan.

If you are interested in joining either a Medicare Supplement or a Medicare Advantage plan, then The Medicare Resource Center plan comparison tool above can help you review available options in your area.

Medicare pays for limited ambulance services. If you go to a hospital or skilled nursing facility (SNF), ambulance services are covered only if any other transportation could be a danger to your life or health. If the care you need is not available locally, Medicare helps pay for necessary ambulance transportation to the closest facility outside your local area that can provide the care you need. 

If you choose to go to another facility farther away, Medicare payment is determined based on how much it would cost to go to the closest facility. All ambulance suppliers must accept the assignment. Medicare does not pay for ambulance transportation to a doctor's office. Air ambulance is paid only in emergency situations, such as when you can't be easily reached by land, or if heavy traffic could prevent you from getting crucial care quickly. If you could have been transported by land ambulance without serious danger to your life or health, Medicare pays only the land ambulance rate and you are responsible for the difference.

If you have end-stage renal disease (ESRD), in some cases Medicare may cover ambulance services to and from a dialysis facility. If you have questions about Medicare coverage of ambulance transportation, contact Medicare at 1-800-MEDICARE (1-800-633-4227; TTY users 1-877-486-2048), 24 hours a day, 7 days a week.

In a Nutshell:

Transportation to doctor appointments is not generally covered by Original Medicare (Part A and Part B). However, Some Medicare Advantage plans may cover transportation to doctor appointments. You may also be able to get non-Medicare transportation to doctor appointments through various organizations, such as your local Area Agency on Aging (AAA).

Original Medicare (Part A and Part B) generally does not cover transportation to get routine health care. However, it may cover non-emergency transportation to and from a health-care provider. You need to have a health condition diagnosed or treated and other forms of transportation could endanger your health. Your doctor must provide a written order verifying that ambulance transportation is medically necessary because of your health condition.

If you use an ambulance company based in New Jersey, Pennsylvania, or South Carolina, you may be affected by prior authorization rules if you need non-emergency, scheduled, medically necessary ambulance services (1) three or more times over a 10-day period or (2) at least once a week for three or more weeks. To find out if these rules affect you, contact Medicare at 1-800-633-4227 (TTY users, dial 1-877-486-2048), 24 hours a day, seven days a week.

What non-Medicare transportation options might be available?

For beneficiaries who do not qualify for non-emergency ambulance transportation, there may be non-Medicare transportation available in their immediate area through local organizations. For instance, you local Area Agency on Aging (AAA) may be able to help you find transportation to and from your health-care provider. To locate a State and/or Area Agency on Aging, you can use the SUA/AAA Finder on the organization's website.

If you are eligible for Medicaid or Program of All-Inclusive Care for the Elderly (PACE), these organization may also provide transportation for routine medical care. Visit www.Medicaid.gov or www.Pace4you.org for more information.

As of 2020, Medicare Advantage plans are authorized to offer innovation benefits, including Medicare transportation to doctor's appointments. Medicare Advantage is another way to get your Medicare Part A and Part B benefits through a private insurance company approved by Medicare.

To find a Medicare Advantage plan that may cover Medicare transportation, enter your zip code above.

The Social Security Act created a system of payment for the operating costs associated with Medicare Part A hospital inpatient stays. This system is based on set rates and is referred to as the Inpatient Prospective Payment System (IPPS). As a part of this system, each case is categorized into a Medicare Severity - Diagnosis Related Group (MS-DRG).

Who gets put in a Diagnosis Related Group?

Patients who have similar clinical characteristics and similar treatment costs are assigned to an MS-DRG. The MS-DRG is linked to a fixed payment amount based on the average treatment cost of patients in the group. Patients can be assigned to an MS-DRG based on their diagnosis, surgical procedures, age, and other information. Hospitals provide this information on their Medicare claim, and Medicare uses this information to decide how much the hospitals should be paid.

CORF stands for the Comprehensive Outpatient Rehabilitation Facility, a facility that provides outpatient services such as physical therapy, rehabilitation, physicians' services, and social or psychological services.

Medicare provides limited coverage in CORFs. After you pay your Medicare Part B deductible amount, Medicare Part B generally covers 80% of your costs in a CORF, and you pay the remaining 20%.

However, there is a limit, called a cap, on how much Medicare will cover in one year. The cap may vary from year to year.

In some cases, you might qualify for an exception on the therapy cap limit. Your health-care provider must provide documentation that your need for further therapy is reasonable and medically necessary. For more information, contact your State Health Insurance Assistance Program (SHIP). To get the phone number for your state, visit shiptacenter.org, or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Medicare representatives are available 24 hours a day, seven days a week.

Note: The information in this article applies to Original Medicare. If you have a Medicare Advantage plan, contact your plan for coverage details about therapy services.

Yes, the agency may decline you if it doesn't have the ability or resources to meet your medical needs. A Medicare-certified home health agency (HHA) is not required to take you as a patient simply because your doctor has prescribed care for you, and you qualify for Medicare-covered home care.

While most home health agencies will take all Medicare beneficiaries, agencies have the ability to choose the patients they accept. A home health agency may decline a patient if it doesn't believe it can meet the individual's health needs, as long as it does not treat that person differently from other patients. For example, if a home health agency refuses to accept you as a patient because of a medical condition you have, the organization cannot accept other patients who have the same health condition.

If you are in a Medicare health plan, such as a Medicare Advantage plan, your plan may only pay for you to get care from home health agencies within the plan's network. Check with your specific Medicare plan for more information on rules regarding providers.

A home health agency can also limit the kinds of services it provides and the types of conditions it will cover. If you need services that the home health agency does not provide, the agency can choose to reject you as a patient as long as its policies are consistent for all patients. For example, an HHA can decide it will not treat patients with dementia because it doesn't have the resources or trained staff to do so.

In addition, an HHA can refuse to take you as a patient if it does not believe that it can ensure your safety. For example, if you need round-the-clock personal care in addition to services the home health agency provides, but you are opting to go without that care, the agency could find your situation unsafe and not accept you as a patient. Sometimes, the home health agency may decline to take you as a patient because it does not have the staff available to take on new patients. 

Original Medicare is made up of Part A (hospital insurance) and Part B (medical insurance) and includes certain coverage for mental health care when the care comes from a Medicare-assigned health-care provider. Learn more about this Medicare coverage below.

What are Medicare benefits for Mental Health Care?

Medicare Part A covers hospital inpatient mental health care, including room, meals, nursing, and other related services and supplies. This care can be received in a general hospital or a psychiatric hospital.

Medicare has a lifetime limit of 190 days of inpatient care in a psychiatric hospital. 

Medicare uses benefit periods for hospital coverage. A benefit period begins the day you're admitted as a hospital inpatient and ends when 60 days in a row have passed since you have received inpatient care.

Your Medicare Part A costs for mental health care are listed below. Please note that the deductible and coinsurance amounts may vary year to year. You pay:

• The Medicare Part A deductible - $1,408 in 2020 (the full deductible amount is applied for each benefit period)
• No coinsurance ($0) for days 1-60
• $352 coinsurance per day in 2020 for days 61-90
• $704 coinsurance in 2020 per "lifetime reserve day" after the 90th day. Lifetime reserve days are days that you remain an inpatient beyond the 90-day hospital stay that Medicare covers. Medicare pays for your covered costs, charging you a daily coinsurance amount, for up to 60 of these days in your lifetime
• All costs after your lifetime reserve days are used up

In addition to Medicare Part A costs, you may have some costs associated with Medicare Part B even when you're a hospital inpatient (for example, doctor services).

Medicare Part B covers mental health services usually given outside a hospital, including visits with health professionals such as doctors, clinical psychologists, and clinical social workers. Some of the other mental health services that Medicare Part B may cover include, but aren't limited to:

• Annual depression screenings
• Psychiatric evaluation
• Certain diagnostic tests your provider orders
• Partial hospitalization (a structured program of outpatient psychiatric services as an alternative to inpatient mental health care)
• Individual and group psychotherapy by licensed professionals permitted by the state where therapy takes place 
• Medication management
• Family counseling as part of your treatment

Your Medicare Part B costs for mental health care are listed below. Please note that the deductible and coinsurance amounts may vary year to year. The annual depression screenings are free if you get them from a Medicare-assigned health-care provider. For other mental health services, you pay:

• The Medicare Part B deductible - $198 in 2020
• 20% of the Medicare-approved amount of health-care provider services
• A possible additional copayment or coinsurance if you receive your services as a hospital outpatient. The amount you pay depends on the service provided but is generally 20% of the Medicare-approved amount.

If you're enrolled in a Medicare Advantage plan, you still get the same coverage listed above, and your plan might include additional benefits, such as prescription drug coverage. Offered by private Medicare-approved insurance companies, Medicare Advantage plans must provide at least the same coverage as Medicare Part and Part B (except for hospice care, which Medicare still covers). You still continue paying your Medicare Part B premium along with any premium the Medicare Advantage plan may charge.

Would you like to take a look at some of the Medicare plans available in your area? Just enter your zip code above to display a list and start comparing plans.

The only chiropractic service covered by Medicare is the manual manipulation of the spine to correct subluxation. Subluxation of the spine is when one or more of the bones of your spine move out of position. This is covered by Medicare Part B (medical insurance) when it is medically necessary and provided by a chiropractor or other qualified provider. You do not need an X-ray to prove you have a subluxation of the spine.

How might you get Medicare Coverage for Chiropractic Services?

You may be able to get additional Medicare chiropractic coverage through a Medicare Advantage (MA) plan. Some Medicare Advantage plans could provide additional chiropractic coverage benefits. Check with your Medicare Advantage plan directly to see what chiropractic services are covered. You still need to continue paying your monthly Part B premium along with any premium the plan might charge.

Summary:

Two types of shingles vaccines, Zostavax and Shingrix, may help prevent shingles. Original Medicare doesn't cover the shingles vaccine, but Medicare Part D generally does cover it. You must get Medicare Part D coverage from a private insurance company.

Shingles is a viral infection that causes a painful rash, according to the Mayo clinic. Anyone who has ever had chickenpox can later come down with shingles. Your risk of shingles and complications from shingles increases as you get older, according to the Centers for Disease Control and Prevention (CDC). More than 99% of Americans 40 years old and older have had chickenpox, even if they don't remember it, reports the CDC. The shingles shot may help prevent shingles, but it is not 100% effective. According to the CDC, there is no other method of protection against shingles, but the shingles shot.

How does Medicare Cover the Shingles Vaccine?

Original Medicare, Part A, and Part B do not cover the shingles vaccination, but Medicare Part D does. To get this covered, you must enroll in either a stand-alone Medicare prescription drug plan (PDP) or a Medicare Advantage plan that includes prescription drug coverage (MAPD). You may have a copayment for the shingles vaccine.

What are my options for the shingles shot?

The two options for the shingles shot are Zostavax and Shingrix. Zostavax, according to the Mayo Clinic, protects against shingles for about five years. It's a live vaccine given as a single shot in the upper arm. The Zostavax shingles shot is recommended to adults age 60 and over which reduces the risk of developing shingles by 51%, according to the Centers for Disease Control and Prevention (CDC).

Studies suggest that Shingrix offers protection against shingles for more than five years. It's a nonliving vaccine given in two doses. The Shingrix shingles shot is recommended for adults age 50 and older. 

The Shingrix shingles vaccine is more effective than Zostavax. Shingrix is more than 97% effective in preventing shingles in adults 50 to 69 years old after two doses. The Shingrix shingles vaccine is 91% effective in preventing shingles in adults age 70 and older, according to the CDC.

Medicare prescription drug plans and Medicare Advantage plans that provide prescription drug coverage generally cover all commercially-available vaccinations. These plans will cover the vaccination medication and the administration of the shot by your doctor or physician. Depending on your plan benefits, you may have to pay a copayment or coinsurance amount. Make sure to follow your plan's guidelines for this vaccination to be covered.

You will pay the least amount of money out of pocket if you are vaccinated at a pharmacy in your drug plan's network. If you have questions about which pharmacies are included in your plan's network, contact your Medicare prescription drug plan or Medicare Advantage prescription drug plan for more information. 

To find a Medicare Part D plan in your area, enter your zip code above.

The first fact you need to know is that you must be enrolled in Medicare Part B for Medicare to cover your diabetic services or supplies. If you have a Medicare Advantage plan, you're required to be enrolled in both Medicare Part A and Part B, so as long as you continue paying your Part B monthly premium, you should be covered as described below.

If you're not sure whether you're enrolled in Medicare Part B, look at your red, white, and blue Medicare card, or contact your current health insurance provider. 

Medicare Part B covers the following diabetic services, generally requiring your Medicare-participating doctor's order:

• Diabetes screening: Medicare covers tests to check for diabetes if you're considered at risk for the disease. These screenings may include tests such as a fasting plasma glucose test or other Medicare-approved tests your doctor may order for you. Medicare may cover these screenings up to twice a year, depending on your risk factors.
• Diabetes self-management training: For qualified beneficiaries, Medicare offers a training program that teaches you how to manage your diabetes. It includes education about self-monitoring of blood glucose, diet, exercise, and prescription medications. IF you meet certain conditions, Medicare may cover 10 hours of initial diabetes self-management training, complete within a year, and two hours of follow-up training each following year.

A portion of the training is individual, with you and your health instructor, but most of the training occurs in a group setting. Some exceptions might qualify you for 10 hours of individual training: if you're blind or deaf, have language limitations, or if no group classes have been available within two months of your doctor's order for the training.

If you live in a rural area where you might have difficulty finding diabetes management training, it's possible that you could get this training at a Federally Qualified Health Center (FQHC). For more information, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227; TTY users call 1-877-486-2048) 24 hours a day, seven days a week.

• Yearly eye exam: Medicare covers annual eye exams to screen for diabetic retinopathy once every 12 months. These exams must be done by an eye doctor who is legally allowed to provide this service in your state.
• Glaucoma screening: Medicare covers glaucoma screening once every 12 months for people at high risk for glaucoma: those with diabetes or a family history of the disease; African Americans age 50 and older; and Hispanic Americans age 65 and older. The test must be given or supervised by an eye doctor authorized to administer the test in your state.
• Medical Nutrition Therapy (MNT) services: Medicare covers Medical Nutrition Therapy services if you have diabetes or renal disease. To be eligible for this service, your fasting blood glucose has to meet certain criteria, and your doctor must prescribe these services for you. These services can be given by a registered dietitian or Medicare-approved nutrition professional. They include a nutritional assessment and counseling to help you manage your diabetes or kidney disease. Medicare covers 3 hours of one-on-one medical nutrition therapy services the first year the service is provided, and 2 hours each year after that. You may qualify for additional MNT hours of services if your doctor determines a change in your diagnosis, medical condition, or treatment regimen related to diabetes or renal disease and orders additional MNT hours during that episode of care.
• Foot exam: Medicare may cover a foot exam every six months for people with diabetic peripheral neuropathy and loss of protective sensations, as long as you haven't seen a foot care professional for another reason between visits. Medicare may cover more frequent visits to a foot care specialist if you've had a non-traumatic (not because of an injury) amputation of all or part of your foot, or if your feet have changed in appearance, which may indicate serious foot disease.
• Hemoglobin A1c Tests: Your doctor might order a hemoglobin A1c test. This test measures how well your blood glucose has been controlled over the past 3 months. Medicare may cover this test for anyone with diabetes if it is ordered by his or her doctor.

About Diabetes Tests

Medicare covers diabetic screenings or tests if you have any of the following risk factors.

• High blood pressure
• Dyslipidemia (history of abnormal cholesterol and triglyceride levels)
• Obesity (with certain conditions)
• High blood sugar
• Impaired glucose tolerance

Based on these tests' results, you may be eligible for up to two diabetes screenings every year.

You typically pay 20% of Medicare-approved amounts for outpatient facility charges or doctor services. You pay nothing for preventive diabetes screenings.

Original Medicare Part B covers some diabetic supplies, including:

• Blood sugar (glucose) test strips
• Blood glucose monitors, lancet devices, and lancets
• Glucose control solutions for checking the accuracy of tests strips and monitors
• Insulin if you are using a medically necessary insulin pump (see below)
• Therapeutic shoes or inserts (see below)

There may be coverage limits on the quantity and frequency you can get these supplies.

Original Medicare Part B does not cover these diabetic supplies:

• Insulin (unless used with an insulin pump)
• Insulin pens, syringes, or needles
• Alcohol swabs or gauze

Diabetic Supplies: Insulin

• If you use a Medically necessary external insulin pump, the insulin, and the pump could be covered as Durable Medical Equipment (DME).
• If you do not use a pump, you pay for all of your insulin costs.
• If you have Medicare prescription drug coverage (Medicare Part D), insulin and certain medical supplies used to inject insulin are covered.

Diabetic Supplies: Therapeutic Shoes and Inserts

Medicare Part B coverage includes therapeutic shoes or inserts for diabetics who have certain conditions - ask the doctor who treats your diabetes if you need them. To make sure Medicare covers these supplies, please note:

• A qualified doctor (such as a podiatrist) must prescribe the shoes or inserts.
• A qualified doctor (such as an orthodontist) must provide and fit you for the shoes or inserts.
• Medicare Part B covers one pair of custom-molded shoes (including inserts) or one pair of depth-inlay shoes per calendar year.
• Medicare also covers two additional pairs of inserts each calendar year for custom-molded shoes and three pairs of inserts for depth-inlay shoes.
• In certain cases, shoe modifications may be substituted for inserts. 
• The supplier must have an order (prescription) on file signed and dated by the treating doctor; if you switch to a different supplier, you may need to have your prescription transferred or get a new prescription from your doctor. Make sure your supplier is enrolled in Medicare.

Other Useful Information on Diabetic Supplies

• Generally, you pay 20% of Medicare-approved amounts for your supplies, and the Medicare Part B deductible applies.
• Make sure you refill your supplies on time and only accept the supplies you have requested. Medicare won't pay for supplies you didn't order; for example, if a supplier automatically sends you items, you cannot get reimbursed by Medicare.
• You may rent or purchase certain diabetic supplies. For more information, call 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048. Customer service representatives are available 24 hours a day, seven days a week.
• Ask if the supplier is a participating supplier in the Medicare program before you get durable medical equipment (DME) for diabetes. If the supplier is a participating supplier, he or she must accept assignment or not. If a DME supplier doesn't accept assignment, there is no limit to what you can be charged. You also may have to pay the entire bill (your share and Medicare's share) at the time you get the DME.
• All Medicare-enrolled pharmacies and suppliers must submit claims for diabetic testing supplies. You can't send in the claim yourself.

No. Original Medicare does not cover dentures. In general, Medicare does not cover any routine dental care, including cleanings or check-ups, and never pays for dentures. It may cover the cost of teeth extractions before an inpatient procedure, but will not cover the cost of the denture after the procedure. FOr example, if you broke your jaw, then Original Medicare would cover any teeth extraction related to the jaw injury.

Do Medicare Advantage Plans Cover Dentures?

Certain Medicare plan options offered by private Medicare-approved insurance companies - such as Medicare Advantage plans - might offer dental coverage. Our free, no obligation Medicare Resource Center plan comparison tool on this page can help you find available Medicare Advantage and Medigap plans in your area. Enter your zip code above to review a list of plans. If routine dental care is covered, it will be shown by a tooth icon beneath the "coverage included" area on the result page. 

Even if several Medicare plans offer routine dental coverage, the specific details may vary across plans. You may want to compare all the ones in your area, calling each one if necessary, to determine which plan offers the dental coverage you need.

Original Medicare, Part A, and Part B do not generally cover routine eye exams for eyeglasses or contact lenses. However, Medicare Part B will cover an annual eye exam every 12 months if you have diabetes or are at high risk for glaucoma. Part B coverage also includes diagnostic tests and treatment for certain eye diseases, such as Lucentis, Aflibercept, and Ocular Photodynamic Therapy.

Medicare Advantage plans might cover routine eye exams.

Because Medicare Advantage plans must offer at least the same coverage as Original Medicare, these plans (offered by private, Medicare-approved insurance companies) also cover the circumstances described above. However, some Medicare Advantage plans may offer additional coverage, which could include routine vision benefits. Certain Medicare Supplement (Medigap) plans may also cover vision-related costs or provide additional eye coverage for an extra cost.

You can type your zip code above to see a list of Medicare plans in your vicinity. 

Generally, Original Medicare does not cover routine eyeglasses or contact lenses. However, following cataract surgery that implants an intraocular lens, Medicare Part B helps pay for corrective lenses, one pair of eyeglasses, or one set of contact lenses provided by an ophthalmologist.

Does Medicare ever cover eyeglasses?

Post-cataract services provided by an optometrist may be covered, if the optometrist is licensed to provide this service in your state, and:

• Medicare will pay only for standard frames.
• Eyeglasses and contact lenses are covered even if you had the surgery before you had Medicare.
• Both eye lenses may be covered even if you had your cataract surgery on one eye only.

A prescription order signed by your doctor (ophthalmologist or optometrist) must be on file with the supplier. Suppliers must be enrolled in Medicare and must meet strict standards to qualify for a Medicare supplier number. Medicare won't pay your claim if your supplier doesn't have a number, even if your supplier is a large chain or department store that sells more than just durable medical equipment (DME).

After each cataract surgery with an intraocular lens, you pay 20% of Medicare-approved amounts for one pair of eyeglasses or one set of contact lenses after the Part B deductible, if applicable.

Medicare will only reimburse or pay for the standard eyeglass frame amount. You pay an additional cost for upgraded frames.

For more information about Medicare eye care, you may also call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week.

Note: Ask if the supplier is a participating supplier in the Medicare program before you get durable medical equipment. If the supplier is a participating supplier, it must accept assignment. If the supplier is enrolled in Medicare but isn't "participating," it has the option to accept assignment.

If the supplier isn't enrolled in Medicare, Medicare won't pay your claim.

Does Medicare cover Glaucoma screening?

Medicare Part B covers a glaucoma screening test once every 12 months for people at high risk for glaucoma. This includes people with diabetes, a family history of glaucoma, African Americans aged 50 or older, and Hispanic Americans who are age 65 or older. The screening must be done or supervised by an eye doctor who is legally allowed to do this service in your state.

You pay 20% of Medicare-approved amounts, and the Part B deductible applies.

Does Medicare cover routine eye exams?

Routine eye exams are not covered by Medicare, including eye refractions. However, some preventive eye tests and screenings, such as glaucoma screening and macular degeneration treatment, are covered.

You pay 100% out-of-pocket under Original Medicare for routine eye exams.

Does Medicare cover the treatment of Macular Degeneration?

Medicare Part B will cover certain diagnostic tests and treat diseases and conditions of the eye, including treatment with certain injected drugs. Medicare covers some people with age-related macular degeneration (AMD). You would be responsible for 20% of Medicare-approved amounts for diagnosis and treatment of the eye's diseases and conditions after the Part B deductible.

Does Medicare cover Eye Prostheses?

Eye prostheses are covered for patients with an eye's absence or shrinkage due to congenital disabilities, trauma, or surgical removal. Medicare covers the polishing of the artificial eye and typically covers replacement every five years.

You pay 20% of Medicare-approved amounts after the Part B deductible is applied.

Medicare Advantage plans and Vision Coverage

While Original Medicare coverage of routine vision care is limited, some Medicare Advantage plans may include additional vision benefits. Medicare Advantage plans are required to provide at least the same coverage level as Medicare Part A and Part B. Still, many plans also cover additional benefits beyond Original Medicare, which may include routine dental or eye care.

Under a Medicare Advantage plan, vision benefits may include:

• Preventive eye exams covered under Original Medicare
• Routine eye exams
• Eyeglasses (frames and lenses)
• Contact lenses

Remember that specific benefits may vary depending on the Medicare Advantage plans available in your service area. For more information, check with the individual health plan you're considering. If you'd like help finding a Medicare Advantage plan that includes vision benefits, you can visit Medicare.gov or call Medicare at 1-800-MEDICARE (1-800-633-4227). 24 hours a day, seven days a week (TTY users, call 1-877-486-2048. You can also contact The Medicare Resource Center to speak with a licensed insurance agent about your Medicare plan options.

Durable Medical Equipment (DME) is reusable medical equipment, such as walkers, wheelchairs, or crutches. If you have Medicare Parat B, Medicare covers certain medically necessary durable medical equipment if your physician or treating practitioner prescribes it for you to use in your home.

To be covered, the prescribed medical equipment must be:

• Durable
• Used for a medical purpose
• Not typically useful if you aren't sick or hurt
• Used in your home*

*If you are currently residing in a hospital or nursing home that provides you with Medicare-covered cared, these facilities don't qualify as your "home." However, a long-term care facility does qualify as your home. If you're staying in a skilled nursing facility, and the facility provides you with durable medical equipment, the nursing facility is responsible for the durable medical equipment. 

Some examples of durable medical equipment that Medicare covers may include, but aren't limited to, Hospital beds, infusion supplies, oxygen equipment, patient lifts, and blood sugar monitors. If you have questions about whether a particular item or supply is covered, call 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048. Medicare customer service representatives are available 24 hours a day, seven days a week.

Where can I get Durable Medical Equipment?

If you're enrolled in Original Medicare, you need to get your durable medical equipment from a supplier that is enrolled in the Medicare program, or Medicare won't pay for the equipment. For the lowest costs, find suppliers that are "participating," meaning they accept the Medicare-approved cost for the equipment and will not charge you above that amount. To find Medicare-participating suppliers, visit the Medicare.gov Supplier Directory. If you live in an area that is part of Medicare's Competitive Bidding Program, you'll need to get equipment from suppliers that are contracted by Medicare.

Medicare Advantage plans (like HMOs or PPOs) must cover at least the same level of coverage as Original Medicare. However, costs may vary, depending on your Medicare Advantage plan. If you are in a Medicare Advantage plan and you need durable medical equipment, call your plan directly to find out if the equipment is covered and to see how much you will have to pay.

Medicare Part A, also known as hospital insurance, is part of Original Medicare, which is federal Medicare health insurance for qualified Americans aged 65 and older or those of any age who enter their 25th month of receiving disability benefits through Social Security the Railroad Retirement Board. You may also qualify at any age if you have certain health conditions, such as end-stage renal disease or amyotrophic lateral sclerosis (or Loud Gehrig's disease). To be eligible for Medicare, you must be a U.S. citizen or a legal permanent resident of at least five continuous years.

Here's what Medicare Part A Covers

Medicare Part A generally covers medically necessary services and supplies needed to treat a certain disease or condition and care when you're a hospital inpatient in a Medicare-enrolled hospital. The following list describes some of the main services and supplies Part A specifically covers (this is not necessarily a complete list).

• Hospital Care: If you're admitted as an inpatient, Medicare covers semi-private rooms, prescription drugs given as part of your inpatient treatment, meals, general nursing, and more.
• Long-Term Care (LTC) Hospitals: Medicare covers long-term care hospital services if you were transferred from an acute-care hospital or admitted to the long-term care hospital within 60 days of being discharged from an inpatient hospital stay. 
• Skilled Nursing Facility (SNF) care: If your doctor determines that you need care in a Medicare-certified skilled nursing facility, Medicare Part A covers certain services and supplies, generally for a limited time.

Medicare may cover services and supplies including, but not limited to: semi-private rooms, meals, skilled nursing care, medications, medical supplies and equipment, and ambulance transportation. Several qualifying factors determine whether Medicare will cover your stay in such a facility.

• Nursing Home Care: Medicare might cover care in a skilled nursing facility (described above) as long as you need skilled nursing care and not just custodial care (help with eating, dressing, bathing, etc.).
• Hospice: Medicare covers doctor services, nursing care, medical equipment, medical supplies, and more. To qualify, your doctor must certify that you're terminally ill and expected to live six months or less; you must agree to accept palliative care (aimed at easing your pain instead of delivering a cure), and you must sign an agreement stating that you're accepting hospice care instead of other Medicare-covered treatments for your health condition.
• Home Health Services: Medicare may cover certain home health services, generally for a limited time while you recover from a hospital stay. Medicare may cover intermittent at-home skilled nursing care, physical therapy, occupational services, and more for beneficiaries whose doctors certify that they need this care at home. The home health agency caring for the beneficiary must be Medicare-certified.

Medicare Part B helps cover preventive services (like medical checkups and screenings) and medically necessary services (like supplies or services you need to treat a medical condition). See the table below for an overview of some of Medicare Part B benefits and services.

Note that there may be limits and restrictions to these covered services (such as how much of a supply you can get, and how often you can get it). Your Medicare Part B deductible often applies to these services. In some cases, you might need to make a 20% copayment or coinsurance, depending on what other coverage you might have (such as a Medicare Advantage plan or a Medicare Supplement insurance plan).

Ambulance services:

If you need transportation for a medical emergency or special condition, Medicare Part B covers it in many cases.

• Medicare Part B covers ground ambulance transportation when you need to be taken to a hospital or skilled nursing facility for medically necessary services, and when transportation in any other vehicle could endanger your health.
• Medicare may pay for ambulance transportation in an airplane or helicopter to a hospital if you need emergency transit that ground transportation can't provide.
• Medicare may pay for limited non-emergency ambulance transportation if you have ordered from your doctor saying that it's medically necessary.
• Medicare will only cover services to the nearest appropriate medical facility to give you the care you need.

Cardiac Rehabilitation:

Medicare Part B covers approved exercise, education, and counseling programs for patients who meet certain conditions. Medicare Part B also covers intensive cardiac rehabilitation programs that are more rigorous than regular cardiac rehabilitation programs.

Chiropractic Services (limited):

These services can help correct a subluxation (when one or more of your spine's bones move out of position) using manipulation of the spine. You have to pay all costs for any other services or tests ordered by a chiropractor.

Diabetes self-management training:

This class shows you how to manage your diabetes and reduce the risk of complications.

Diabetes supplies:

Covered supplies can include blood sugar test strips and testing monitors, lancet devices and lancets; blood sugar control solutions; and therapeutic shoes and inserts (in some cases). Medicare Part B covers insulin only if used with an external insulin pump.

You need to order your diabetes supplies from a National Mail-Order Program if you buy them at a store or outside this program, in most cases, you will pay for the supplies. 

Medicare Part D may cover insulin and certain medical supplies used to inject insulin, such as syringes and some oral diabetic drugs. 

Durable Medical Equipment (DME) (such as walkers):

Durable Medical Equipment (DME) refers to things such as oxygen equipment and supplies, wheelchairs, walkers, and hospital beds ordered by a Medicare doctor for use in the home. You might need to rent some items. 

You must get your covered equipment or supplies and replacement or repair services from a Medicare-approved supplier.

Medicare has a program called "competitive bidding" to ensure better cost and quality control for DME. In some areas of the country, you must use specific suppliers, or Medicare won't pay for the item. It's important to see if you're affected by this program to ensure Medicare payment and avoid service disruption. In those areas, you need to use specific suppliers for Medicare to pay for certain DME, such as:

• Oxygen supplies and equipment
• Standard power wheelchair, scooter, and related accessories
• Certain complex rehabilitative power wheelchairs and related accessories
• Mail-order diabetes supplies
• Enteral nutrients, equipment, and supplies
• Hospital beds and related accessories
• Continuous Positive Airway Pressure (CPAP) devices and Respiratory Assist Devices (RADs) and related supplies and accessories
• Walkers and related accessories
• Support surfaces, including certain mattresses and overlays

To find an approved supplier, visit the Medicare-approved Supplier Directory page. Follow the instructions to display a list of approved DME suppliers for your needs. 

In some cases, you may continue to get DME from a supplier you've been using for a long time. If you have any questions about what's covered or about suppliers, you can call:

• Call 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, seven days a week. TTY users should call 1-877-486-2048.
• Your State Health Insurance Assitance Program (SHIP).

Emergency room services:

When you have an injury, a sudden illness, or an illness that quickly gets much worse, Medicare Part B pays for some or all of most emergency room services.

Eyeglasses (limited):

Generally, glasses and contact lenses are not covered. Medicare Part B does cover one pair of eyeglasses with standard frames (or one set of contact lenses) after cataract surgery.

Hearing and balance exams:

These exams are covered if your doctor orders hearing and balance tests to see if you need medical treatment. Medicare Part B doesn't cover hearing aids or exams for fitting hearing aids.

Kidney dialysis services and supplies:

For beneficiaries with End-State-Renal Disease (ESRD), Medicare covers dialysis either in a facility or at home when your doctor orders it.

Mental Health Care (outpatient):

For help with mental health conditions such as depression or anxiety, these services might include visits with a provider such as a:

• Psychiatrist 
• Licensed alcohol and drug counselor
• Clinical psychologist
• Nurse practitioner
• Clinical nurse specialist
• Clinical social worker

These services generally are given outside a hospital or in a hospital outpatient setting (Medicare Part A covers inpatient mental health care).

Medicare also covers substance abuse services and lab tests, but certain limits and conditions apply.

What you pay will depend on whether you're being diagnosed and monitored or whether you're getting treatment - and on what other coverage you might have besides Original Medicare, Part A, and Part B.

Talk to your doctor if you feel sad, have little interest in things you used to enjoy, feel dependent on drugs or alcohol, or have thoughts about ending your life.

Occupational Therapy:

These services involve evaluation and treatment to help you return to usual activities (such as dressing or bathing) after an illness or accident when your doctor certifies you need it.

Outpatient Medical and Surgical Services and Supplies:

Medicare Part B covers approved services and procedures (like X-rays, casts, and stitches).

For each service, you will probably have to pay at least some of the costs.

• You pay the doctor 20% of the Medicare-approved amount for the doctor's services.
• You pay the hospital a copayment for each service you get in a hospital outpatient setting. 
• For each service, the copayment can't be more than the Medicare Part A hospital stay deductible.

Physical Exams:

Medicare covers routine physical or "wellness" exams.

• A "Welcome to Medicare" physical exam is a one-time review of your health. It includes education and advice about preventive services and referrals for other care if needed. Medicare will cover this exam if you get it within the first year that you have Medicare Part B. You pay nothing for the exam if the doctor accepts assignment.
• A yearly "Wellness" exam is covered once a year after your first year of Medicare Part B coverage. At this visit, the doctor works with you to develop or update a personalized prevention plan based on your current health and risk factors. You pay nothing for the Wellness exam if the doctor accepts Medicare assignment.

Physical Therapy:

Physical therapy is evaluation and treatment for injuries and diseases that change your ability to function when your doctor orders it for you. Medicare Part B covers a limited number of physical therapy sessions.

Prescription drugs (limited):

Medicare Part B covers a limited number of prescription drugs, such as:

• Injections you get in a doctor's office. 
• Certain oral cancer drugs
• Drugs used with some durable medical equipment (like a nebulizer or external infusion pump)
• Under very little circumstances, certain drugs you get in a hospital outpatient setting.

If the covered medications you get in a hospital outpatient setting are part of your outpatient services, you pay the services' copayment. However, if you get other types of prescription drugs in a hospital outpatient setting (sometimes called "self-administered drugs" or drugs you would normally take on your own), what you pay depends on whether you have Medicare Part D or other prescription drug coverage, whether your prescription drug plan covers the drug, and whether the hospital's pharmacy is in your prescription drug plan's network. Contact your prescription drug plan to find out what you pay for drugs you get in a hospital outpatient setting that aren't covered under Medicare Part B.

Other than the examples above, you pay 100% for most prescription drugs, unless you have Part D or other drug coverage.

Prosthetic and Orthotic Items: 

These items include things like arm, leg, back, and neck braces; artificial eyes; artificial limbs (and their replacement parts); some types of breast prostheses (after mastectomy); and other prosthetic devices. They are generally considered to be durable medical equipment (DME).

Pulmonary Rehabilitation:

Medicare covers a comprehensive pulmonary rehabilitation program if you have moderate to very severe chronic obstructive pulmonary disease (COPD) and have a referral from the doctor treating your chronic respiratory disease.

Rural Health Clinics and free or low-cost Health Clinics:

The government sets up clinics to make sure health care is available in areas that don't have many options. These clinics serve beneficiaries in rural and low-income areas. They are called Federally Qualified Health Centers.

Screenings (tests and scans):

Medicare covers many screenings that can prevent common serious illnesses or conditions. Some examples of the covered screenings are:

• Abdominal Aortic Aneurysm
• Bone Mass Measurement (bone density)
• Cardiovascular Disease
• Colorectal Cancer
• Diabetes
• Glaucoma
• HIV/AIDS
• Mammograms
• Prostate Cancer

Medicare Part B also covers X-rays, MRIs, CT scans, EKGs, and other diagnostic tests. If you get the test at a hospital as an outpatient, you all pay the hospital a copayment that may be more than 20% of the Medicare-approved amount, but it can't be more than the Medicare Part A hospital stay deductible.

There are some limitations and restrictions on these screenings (for example, how often Medicare will pay for them). Some screenings are free. For others, you might pay 20% of the Medicare-approved amount, and the Part B deductible applies for the doctor's visit. In a hospital outpatient setting, you also pay the hospital a copayment. The amount you pay also depends on what other coverage you may have, such as a Medicare Supplement insurance plan.

Second Surgical Opinions:

For non-emergency surgery, Medicare Part B covers some second opinion consultations. In some cases, Medicare covers third surgical opinions. 

Shots:

Medicare Part B pays for the following vaccinations:

• Flu shot once per flu season (fall or winter).
• Pneumonia shot (usually needed only once in a lifetime).
• Hepatitis B shot, for those at risk for the disease.

Smoking Cessation (help to quit smoking):

If you're diagnosed with an illness caused or complicated by tobacco use or take a medicine that is affected by tobacco, this service includes up to eight face-to-face visits in a 12-month period.

If you haven't been diagnosed with an illness caused or complicated by tobacco use, this is now considered a covered preventive service. Medicare Part B benefits cover up to eight face-to-face visits with a Medicare-recognized practitioner in a 12-month period.

Speech Therapy:

Also known as speech-language pathology services, these benefits involve evaluation and treatment to regain and strengthen speech and language skills. They can include cognitive and swallowing skills when your doctor certifies you need them.

Telehealth:

In certain situations, you can visit with a doctor who's in a different location than you are, using an interactive two-way telecommunications system (like real-time audio and video). Telehealth services are available in some rural areas, if you're located at one of the following places: a doctor's office, hospital, rural health clinic, federally qualified health center, hospital-based dialysis facility, skilled nursing facility, or community mental health center.

Transplants and Immunosuppressive Drugs:

In some situations, Medicare Part B coverage includes doctor services for organ transplants and cornea transplants under certain conditions.

Immunosuppressive drugs are covered if Medicare paid for the transplant, or an employer or union group health plan was required to pay before Medicare paid for the transplant. You must have been entitled to Medicare Part A at the time of the transplant, and you must be entitled to Medicare Part B at the time you get immunosuppressive drugs. 

Medicare Part A covers other transplant services, including some organ transplants. 

If you need a transplant or are on a transplant waiting list:

• Talk with your provider about making sure the services are covered.
• If you're thinking about joining a Medicare Advantage plan and are on a transplant waiting list or believe you need a transplant, check with the plan before joining in making sure your doctors and hospitals are in the plan's network. 
• Check the plan's prior authorization requirements.

Medicare Prescription Drug plans (Part D) may cover immunosuppressive drugs, even if Medicare or an employer or union group health plan didn't pay for the transplant.

Travel (health care needed when traveling outside the United States):

Medicare generally doesn't cover health care while you're traveling outside the U.S. The U.S. includes:

• The 50 states
• The District of Columbia (Washington, D.C.)
• Puerto Rico
• The Virgin Islands
• Guam
• The Northern Mariana Islands
• American Samoa

There are some exceptions, including some cases where Medicare may pay for services you get while on board a ship within U.S. territorial waters.

Medicare may pay for inpatient hospital, doctor, or ambulance services you get in a foreign country if the hospital is closer than the nearest U.S. hospital that can treat your medical condition.

Medicare may cover medically necessary ambulance transportation to a foreign hospital, but only if you're admitted for Medicare-covered inpatient hospital services.

Urgently Needed Care:

Medicare Part B covers the treatment of a sudden illness or injury that isn't a medical emergency.

The list of services Medicare Part B covers is long and is subject to change. The list above is not complete. Medicare.gov maintains this information at www.medicare.gov/coverage.

In brief:

Medicare now covers coronavirus testing. Medicare also covers coronavirus treatment in outpatient clinics, hospitals, and skilled nursing facilities.

You probably see coronavirus (COVID-19) on the news every day. COVID-19 symptoms are similar to flu and include fever, cough, and shortness of breath, according to the Centers for Disease Control and Prevention (CDC). There is no need to panic over coronavirus. It can be avoided, tested, and the symptoms can be treated. 

Does Medicare cover coronavirus testing? 

Medicare Part B (medical insurance) now covers a test to see if you have coronavirus. A doctor or other health care provider must order it. You pay nothing for Medicare-covered clinical diagnostic laboratory tests, such as the coronavirus test.

If you have a Medicare Advantage plan, you also will be covered for the coronavirus test.  

Does Medicare cover the coronavirus vaccine? 

As of March 10, 2020, there is no coronavirus vaccine. However, your doctor may recommend the flu vaccine, which is covered by Medicare.

The severity of the flu should not be underestimated. The Centers for Disease Control and Prevention (CDC) estimates up to 45 million flu illnesses in the current season alone and at least 18,000 flu deaths. According to the CDC, it’s estimated that up to 85% of seasonal flu-related deaths have occurred in people aged 65 and older.

How can I protect myself from coronavirus?

Medicare covers adults over age 65 and those younger than 65 with disabilities or serious health problems.  According to the Centers for Disease Control and Prevention (CDC), data suggests that older adults and persons with underlying health conditions might be at greater risk for severe illness from the coronavirus. People with compromised immune systems may also be extra vulnerable. 

To avoid the coronavirus and other illnesses such as the flu, the CDC recommends: 

• Avoiding close contact with people who are sick,
• Avoiding touching your eyes, nose, and mouth,
• Staying at home when you are sick,
• Covering your cough or sneeze with a tissue, then throwing the tissue in the trash,
• Washing your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.

Will Medicare cover me if I get the coronavirus? 

If you get the coronavirus, Medicare will cover your care as if you were sick with any other illness. The CDC says that “supportive care to relieve symptoms” is the current medical treatment for coronavirus.

Medicare Part A will generally cover your inpatient care in a hospital or skilled nursing facility. Medicare Part B will generally cover your outpatient care. According to the World Health Organization, Medicare Part D will generally cover any prescription medication you must take, although there is no specific medicine recommended to treat the new coronavirus. You may wish to have a Medicare Supplement plan to cover out-of-pocket costs associated with your care. 

This article is for general information and should not be relied on as medical advice. Check with a medical professional for medical advice.

Summary:

Your Medicare effective date depends on when you sign up for Medicare, determined by your initial enrollment period. When you're first eligible for Medicare, you have a 7-month open enrollment period. It includes 3 months before your 65th birthday, your birthday month, and three months after your 65th birthday. 

You know you are eligible for Medicare at age 65 or the 25th month of receiving disability benefits, but when exactly does your Medicare coverage start?

When will my Medicare coverage start?

For Original Medicare, Part A, and Part B, a simple way to determine your exact Medicare effective date is to refer to your Medicare card's lower right corner or refer to your letter from either the Social Security Administration or the Railroad Retirement Board (RRB).

If you have any questions about when your Medicare coverage starts, you can contact Social Security at 1-800-772-1213, Monday through Friday, from 7 Am to 7 pm. For TTY services, call 1-800-325-0778.

If you worked for a railroad, you could call the Railroad Retirement Board at 1-877-772-5772, Monday through Friday, from 9 AM to 3:30 PM. For TTY services, call 1-800-325-0778.

If you enroll in a Medicare Advantage or Medicare Prescription Drug Plan, the date your coverage starts can vary, depending on when you enroll and which election period you qualify for. For questions about your effective date on these types of Medicare plan options, you can contact the Medicare health or drug plan directly or refer to mail you may have received from them.

Can I start Medicare before my 65th birthday?

You will have a Medicare Initial Enrollment Period (IEP). If you sign up for Medicare Part A and Part B during the first three months of your initial enrollment period, your coverage will start on the first day of the month you turn 65.

For example, say your birthday is August 31st. Your initial enrollment period will begin three months before your birthday month, or in this case, May. If you sign up in May, June, or July, your coverage will start on August 1st.

When does Medicare start?

When your Medicare coverage starts depends on when you sign up. You may be automatically signed up if you are already receiving Social Security benefits.

Notice that signing up after your 65th birthday month creates a delay in when your Medicare coverage starts. 

To look for a Medicare Advantage, Medicare Part D, or Medicare Supplement insurance plan in your area, enter your zip code above.

Understanding what employment quarters are and how they are calculated is useful because this can determine whether or not you need to pay a premium for Medicare Part A. This part of Medicare covers many hospital services and is typically premium-free for people over 65 years of age if they are also eligible for retirement benefits from Social Security or the Railroad Retirement Board.

Employment quarters are a period of time used as part of the calculation for your Social Security or Railroad Retirement Board benefits when you retire. In general, you may qualify for these benefits by earning credits when you work in a job and pay Social Security or Railroad Retirement Board taxes.

Most of the time, you are also paying Medicare taxes, so the same employment quarters or credits add up to your contribution towards Medicare when you reach age 65. Medicare Part A is funded largely by payroll taxes paid by employees, employers, people who are self-employed, and Medicare Part A premiums.

What are the employment quarters for Social Security?

The Social Security Administration calls employment quarters by several names, such as “quarter of coverage” and “Social Security credits” or simply “credits.”

How credits for Social Security retirement benefits (and thus, Medicare benefits) have been calculated has changed over the years. Today, Social Security credits are based on your total income during the year, and the year is divided into four employment quarters.

The dollar amount needed to earn credits may go up slightly each year, according to the Social Security Administration, as average earnings increase. For more information on the current earnings needed to earn Social Security or Medicare work credit, visit the Social Security website.

There are special rules for certain types of jobs, such as domestic work, farm work, and work for a church or similar organization that does not collect Social Security and Medicare taxes. Employment of this sort may count towards your employment quarters for retirement and Medicare benefits, but you should contact the Social Security Administration to confirm. Conversely, some people may not qualify for Social Security retirement credits, such as federal employees hired before 1984, railroad employees with more than 10 years of service, and employees of some state and local governments. Other factors may be used to determine their eligibility for premium-free Medicare Part A.

What are the employment quarters for the Railroad Retirement Board?

If you worked for a railroad, your retirement benefits are calculated by how many calendar months you worked. Beginning at age 60 and with a minimum of 360 months of railroad service, you may qualify for a retirement annuity.

How many employment quarters do you need to have worked to get premium-free Medicare Part A?

For the Social Security Administration, the number of employment quarters that qualify you for retirement and premium-free Medicare Part A depends on your date of birth. If you were born in 1929 or later, you need 40 credits (equal to 10 years of work). If you were born in 1928, you need 39 credits, and the amount decreases as the date goes further back — those born in 1927 need 38 credits, etc.

If you were a railroad employee and you qualify for the minimum railroad retirement annuity noted above, you’re likely to qualify for premium-free Medicare Part A. That length of service should provide equivalent employment quarters and Medicare taxes.

Qualifying for premium-free Medicare Part A through your spouse’s employment

If you have never worked or have not worked enough employment quarters to qualify for premium-free Part A and you’re married, you might gain this benefit through your spouse’s employment history. If your spouse receives Social Security retirement benefits or Railroad Retirement Board benefits, you can apply to Medicare when you’re eligible, and you may get Part A without paying a premium.

While Part A often has no premium, Medicare Part B usually does, whether you apply based on your employment history or your spouse’s. Together, Part A and Part B make up Original Medicare. You can get these benefits through the federal program or through private insurance companies that offer Medicare Advantage plans, also called Medicare Part C. There is also Medicare Part D prescription drug coverage (Medicare Prescription Drug Plans) and Medicare Supplement insurance (Medigap) sold by private insurance companies, and you can add these to your Original Medicare if you wish.

Because Medicare has many parts, it’s important to understand how they work together and what benefits may be right for you. To get help choosing a Medicare plan option that might be right for you, contact a Medicare Resource Center licensed insurance agent today.

First, a quick rundown on what Medicare Part C and Part D refer to.

Medicare Part C refers to Medicare Advantage, an option that provides an alternative way to get your Medicare benefits. Offered by private insurance companies approved by Medicare, Medicare Advantage plans must provide the same coverage that Original Medicare, Part A, and Part B cover — but many Medicare Advantage plans offer extra benefits (such as routine vision services).

Most Medicare Advantage plans include prescription drug coverage. These plans are known as Medicare Advantage Prescription Drug plans.

Medicare Part D refers to prescription drug coverage that’s available as a stand-alone plan. Because Original Medicare (Part A and Part B) doesn’t cover prescription drugs except in limited situations, you might consider enrolling in a stand-alone Medicare Part D Prescription Drug Plan to augment your Original Medicare coverage. These plans are available from private, Medicare-approved insurance companies.

Usually, if you have Medicare prescription drug coverage, you’re either enrolled in Original Medicare and a Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan.

If your Medicare Advantage plan doesn’t have prescription drug coverage, you might be allowed to add a Medicare Prescription Drug Plan. But you may want to contact your Medicare Advantage plan before making any changes.

Bottom line: If your Medicare Advantage plan includes prescription drug coverage, you cannot be enrolled in a stand-alone Medicare Part D Prescription Drug Plan at the same time.

You might want to consider the following options if your Medicare Advantage plan does not include prescription drug coverage:

• Change to a different Medicare Advantage plan that includes prescription drug coverage.
• Drop your Medicare Advantage plan, go back to Original Medicare (Part A and Part B), and add a Medicare Part D Prescription Drug Plan.

You cannot add or drop Medicare plans anytime; you can do this only during certain time periods. 

Summary:

If you’re disabled and received Medicare Part A before age 65 but did not accept Part B at that time, you may be automatically enrolled in Medicare Part B when you reach your 65th birthday. You will receive a new Medicare card showing the Part A entitlement date based on disability and the Part B entitlement date based on aging into the program.

You will receive the card about three months prior to the month you turn age 65. You won’t have to pay a late-enrollment fee for Medicare Part B, but you will be responsible for paying the Part B monthly premium if you choose to keep that coverage. The package you receive before your 65th birthday will explain how you can decline Part B if you don’t want it.

Keep in mind that you need to be enrolled in Medicare Part B to qualify for certain Medicare plan options, such as Medicare Advantage and Medicare Supplement (Medigap) insurance. If you delay Part B enrollment, you might face a late-enrollment penalty when you enroll later on.

To qualify for Medicare, whether by age or disability, you must be an American citizen or permanent legal resident of at least five years in a row.

Qualifying for Medicare under 65 if you have a disability

If you’re under age 65 with a disability and receive disability benefits from the Social Security Administration (SSA) or the Railroad Retirement Board (RRB) for 24 straight months, then you will automatically be enrolled in Original Medicare, Part A and Part B.

There are some other situations where you may qualify for Medicare before age 65:

• If you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig’s disease), then you will automatically get Medicare Part A and Part B on the month that your SSA or RRB disability benefits begin.
• If you have end-stage renal disease (ESRD), you may qualify for Medicare, but you’re not enrolled automatically. Contact the SSA (information below) to apply for Medicare.

Once you qualify for Original Medicare, Part A and Part B, you may want to consider additional or alternative Medicare coverage. For example, you can receive your Medicare benefits through a Medicare Advantage plan from a private insurance company that contracts with Medicare. There are several types of Medicare Advantage plans, and in addition to providing your Medicare Part A and Part B benefits, many plans offer additional benefits, such as prescription drug coverage. You continue paying your Part B premium, as well as any Medicare Advantage plan premium.

Not every Medicare Advantage plan accepts applicants with ESRD. Those with ESRD may be able to enroll in a Medicare Advantage Special Needs Plan tailored to that disease, provided one is available in your coverage area. There may be other exceptions, so call any plan you’re considering and ask if it would cover you.

If you need prescription drug coverage, and you’re not enrolled in a Medicare Advantage Prescription Drug plan, you can sign up for a stand-alone Medicare Part D Prescription Drug Plan once you have Medicare Part A and/or Part B and live in the plan’s coverage area.

How can I be eligible for Medicare at 65?

To be eligible for Medicare at age 65, you must be either:

• An American citizen
• A permanent legal resident of at least five continuous years.

If you satisfy residency and age requirements, you could be:

• Single
• Married
• Divorced
• Widowed
• Separated

And still, qualify for Medicare.

Does my marital status affect my Medicare payments?

Whether you have worked and paid Medicare taxes, and for how long, can affect whether you’re automatically enrolled in Medicare and whether you pay a premium for Medicare Part A. Generally, you don’t pay a monthly Medicare Part A premium if you’ve worked for 40 quarters (10 years) while paying Medicare taxes. You typically pay a monthly premium for Medicare Part B.

Can I get Medicare for my non-working spouse?

If you are at least 62 and have worked for at least 10 years in Medicare-covered employment, your spouse can get Medicare, Part A premium-free when he or she is age 65 or older.

If you have worked at least 10 years in Medicare-covered employment but are not yet age 62 when your spouse turns age 65, he or she will not be eligible for premium-free Medicare Part A. In this case, your spouse can still enroll in Part A but will have to pay a premium until you are age 62.

Can I delay Medicare enrollment if my spouse’s job covers me?

Some beneficiaries choose to delay enrollment in Medicare Part B, but if your spouse doesn’t enroll when first eligible for Medicare, he or she might pay a late-enrollment penalty. However, if you are still working and your spouse is covered under your group health plan, your spouse may be able to delay enrollment in Part B without a late-enrollment penalty. Check with your group health plan to see how it works with Medicare.

Summary:

In a nutshell:

When you get Medicare at age 65, that doesn’t include Medicare for your spouse. In this way, Medicare is not like employer group coverage. Your Medicare insurance doesn’t cover your spouse.

How Medicare works if your age 62 spouse is still working and you’re on Medicare

To qualify for Medicare, your spouse must be age 65 or older. If your spouse is age 62 (or any age under 65), he or she could only qualify for Medicare by disability.

When you’re eligible for Medicare at 65, you might be automatically enrolled in traditional Medicare, also called Original Medicare. That includes Part A, hospital insurance, and Part B, medical insurance. Medicare for your spouse will happen later when she or he turns 65.

If you’re aging into Medicare at age 65, you can still help with Medicare planning for your spouse.

Medicare at age 65 if your younger spouse is still working

Even if you can get Medicare at 65 before your younger spouse, you might be able to save money by delaying Medicare enrollment, as described below.

Here’s a key question: Do you have employer-based health insurance through your spouse? If so, you might want to delay enrollment in Medicare Part B when you’re age 65.

You generally pay a monthly premium for Medicare Part B. Most people don’t pay a Part A premium. So, if you’re covered under your working spouse’s plan at age 65, you might want to save money by delaying Part B enrollment.

Check with your spouse’s health plan to make sure it will cover you, and ask how it works with Medicare.

Medicare at age 65: help your spouse plan for Medicare

When you qualify for Medicare at age 65, you’d be wise to learn about Medicare so you can have the best possible coverage for you. Then, you can use that wisdom to help guide Medicare planning for your spouse. Read this article on planning and budgeting for Medicare.

You might already know that your Medicare at age 65 doesn’t have to stop at Medicare Part A and Part B coverage. You have other Medicare coverage choices, and you can compare plans. You and your spouse have to enroll in Medicare coverage separately.

So, when you get Medicare at age 65, get the coverage that works best for you. Then, when your spouse turns 65, together, you can figure out the best coverage for him or her.

Summary:

Some states allow Medicare Supplement for the disabled under 65, usually with restrictions.

 Federal law does not require a private company to sell Medicare Supplement insurance plans (also known as Medigap or MedSup) for disabled under 65, although some states require it. Because of this, Medigap insurers may choose to deny you a policy before you turn 65. They may also significantly reduce the number of available plans.

No, but in some cases, when one spouse turns 62, the other spouse may qualify for premium-free Medicare Part A even if he or she hasn’t worked.

What’s the usual Medicare eligibility age?

Medicare benefits start once you reach the age of 65 (unless you qualify by disability). You’re automatically enrolled at age 65 if you’re already receiving Social Security or Railroad Retirement Board benefits.

If you’ve worked at least 10 years (40 quarters) while paying Medicare taxes, there is no monthly premium for your Medicare Part A (hospital insurance) benefits. But if you haven’t worked, or worked less than 10 years, you may qualify for premium-free Part A when your spouse turns 62, if she or he has worked at least 10 years while paying Medicare taxes. However, to be eligible for Medicare, you need to be 65 years old. You also need to be an American citizen or legal permanent resident of at least five continuous years.

So, to summarize with an example:

• Bob is 65 years old. He’s on Medicare, but he pays a monthly premium for his Medicare Part A benefits. He only worked for seven years and no longer works.
• His wife, Mary, has worked for over 30 years.
• Mary turns 62. Now, Bob no longer has to pay a Medicare Part A monthly premium.
• Mary still has to wait until age 65 to be eligible for Medicare (unless she qualifies by disability).

If you retire at age 62, you may be able to continue to get medical insurance coverage through your employer, or you can purchase coverage from a private insurance company until you turn 65. While waiting for Medicare enrollment eligibility, you may contact your State Health Insurance Assistance Program to discuss your options.

Medicare and employer coverage: do you have to apply for Medicare?

If you are turning 65 and still working, you might still be covered by your employer’s health insurance plan. Or, perhaps you get benefits through a spouse’s employer coverage.

Before you apply for Medicare, be aware that you might have several insurance options. For example, you may be able to:

• Drop your employer coverage and enroll in Original Medicare, Part A and Part B. If you take this route, you might want to think about signing up for prescription drug coverage under Medicare Part D, and/or buying a Medicare Supplement plan. Medicare Supplement insurance can help pay the out-of-pocket costs of Medicare Part A and Part B.

Alternatively, you may have the option to receive your Medicare benefits from a Medicare Advantage plan.

• Have both Medicare and your employer coverage?. Medicare and employer coverage will need to coordinate benefits, which means that either Medicare or the employer plan pays first for covered care. The other insurance is “secondary” and may also pay a portion of the costs. More on who pays first below.
• Stay with your employer coverage and apply for Medicare later. Keep in mind that being eligible for Medicare doesn’t mean you have to take it. However, you might want to enroll in Medicare Part A (hospital insurance) as soon as you’re eligible, especially if you qualify for premium-free Part A. You generally qualify for Part A without paying a premium if you’ve worked at least 10 years (40 quarters) while paying Medicare taxes.

Later, when your employer coverage ends, you can apply for Medicare Part B. To avoid a late enrollment penalty for enrolling in Medicare, make sure you apply for Medicare during your Special Enrollment Period.

It’s important that you contact your employer-based health plan administrator to find out how the plan works with Medicare.

To get the best value and health insurance coverage for your situation, learn about your employer coverage costs, and your costs if you apply for Medicare. You’ll need to do a little research to determine the best arrangement for you. A Medicare Resource Center licensed insurance agent would be happy to help you figure this out.

If you apply for Medicare, and keep employer coverage, what your the out-of-pocket costs?

If you apply for Medicare, be aware that it’s not free. Most people pay a monthly premium for Medicare Part B (medical insurance). However, you may be eligible to receive premium-free Medicare Part A (hospital insurance), as explained above. You may want to apply for Medicare Part A if you want when you are first eligible, and apply for Medicare Part B later when you lose your employer coverage. That might be a cost-conscious way to increase your insurance coverage if you decide to have both Medicare and employer coverage.

Medicare Part A and Part B have deductibles, co-payments and coinsurance costs. For example, you’ll typically pay 20% after you’ve met your annual Part B deductible for medical services and supplies covered under Part B.

What about the other “parts” of Medicare – Part C (Medicare Advantage) and Part D (prescription drug coverage)? These Medicare coverage options might charge monthly premiums. And you still need to keep paying your Part B premium as well – if you have Part B. You must be enrolled in Medicare Part A and Part B to qualify for a Medicare Advantage plan under Medicare Part C.

It’s usually simple to find out your employer coverage costs. You can probably see the deduction in your paycheck for your health plan premium. If you’re happy with the coverage, and feel the costs are affordable, you may want to keep it.

Review the deductibles and coinsurance cost-sharing amounts of your employer coverage. Increasingly, employer coverage might also include deductibles and coinsurance or co-payment amounts.

Deciding whether to apply for Medicare or keep employer coverage

You’ll probably want to consider what additional benefits, if any, your employer coverage includes, beyond coverage for doctor visits and hospital stays. For example, does it include routine dental, vision, and/or prescription drug coverage? You generally don’t get these benefits under Medicare Part A and Part B. Part A and Part B have limited coverage for prescription drugs, but generally don’t cover medications you take at home.

Also consider whether your cost for employer coverage includes coverage for your spouse. If it does, you’ll want to factor in the cost for your spouse to get coverage elsewhere before you decide to drop your employer coverage for Medicare. Medicare coverage is for individuals, not married couples or families.

On the other hand, you may be able to get the benefits listed above – routine dental care and prescription drug coverage, for example – through a Medicare Advantage plan.

Medicare and employer coverage: coordination of benefits

Let’s say you’re going to keep your employer coverage and also apply for Medicare. Medicare coordinates benefits with your employer coverage. Which insurance pays first? That is – which is the primary payer?

The size of the employer helps determine who pays first.

• If you work for a company that employs 20 employees or more, your employer coverage usually pays first. Medicare is the secondary payer, paying its portion for covered services your employer’s group health coverage did not pay. You might still have to pay a deductible and/or co-payment or coinsurance amount.
• If you work for a small company of fewer than 20 employees, Medicare usually pays first and your employer coverage is the secondary payer. Be mindful, however, of employer coverage that has a Health Savings Account (HSA) feature – you typically can only contribute to your HSA for the portion of the year when you aren’t covered by Medicare. 
• The product and service descriptions, if any, provided on these Medicare Resource Center's web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

Summary:

Medicare Part D is optional but can help cover your prescription drugs. There are certain times when you can sign up for it. If you delay signing up for Medicare Part D coverage at the Medicare age 65, you may face a late enrollment penalty.

Medicare and employer coverage: do you have to apply for Medicare?

If you are turning 65 and still working, you might still be covered by your employer’s health insurance plan. Or, perhaps, you get benefits through a spouse’s employer coverage.

Before you apply for Medicare, be aware that you might have several insurance options. For example, you may be able to:

• Drop your employer coverage and enroll in Original Medicare, Part A, and Part B. If you take this route, you might want to think about signing up for prescription drug coverage under Medicare Part D and/or buying a Medicare Supplement plan. Medicare Supplement insurance can help pay the out-of-pocket costs of Medicare Part A and Part B.

Alternatively, you may have the option to receive your Medicare benefits from a Medicare Advantage plan.

• Have both Medicare and your employer coverage?. Medicare and employer coverage will need to coordinate benefits, which means that either Medicare or the employer plan pays first for covered care. The other insurance is “secondary” and may also pay a portion of the costs—more on who pays first below.
• Stay with your employer coverage and apply for Medicare later. Keep in mind that being eligible for Medicare doesn’t mean you have to take it. However, you might want to enroll in Medicare Part A (hospital insurance) as soon as you’re eligible, especially if you qualify for premium-free Part A. You generally qualify for Part A without paying a premium if you’ve worked at least 10 years (40 quarters) while paying Medicare taxes.

Later, when your employer coverage ends, you can apply for Medicare Part B. To avoid a late enrollment penalty for enrolling in Medicare, make sure you apply for Medicare during your Special Enrollment Period.

You must contact your employer-based health plan administrator to find out how the plan works with Medicare.

To get the best value and health insurance coverage for your situation, learn about your employer coverage costs and your costs if you apply for Medicare. You’ll need to do a little research to determine the best arrangement for you. An eHealth licensed insurance agent would be happy to help you figure this out.

If you apply for Medicare and keep employer coverage, what are your out-of-pocket costs?

If you apply for Medicare, be aware that it’s not free. Most people pay a monthly premium for Medicare Part B (medical insurance). However, you may be eligible to receive premium-free Medicare Part A (hospital insurance), as explained above. You may want to apply for Medicare Part A if you want when you are first eligible and apply for Medicare Part B later when you lose your employer coverage. That might be a cost-conscious way to increase your insurance coverage if you decide to have both Medicare and employer coverage.

Medicare Part A and Part B have deductibles, copayments, and coinsurance costs. For example, you’ll typically pay 20% after you’ve met your annual Part B deductible for medical services and supplies covered under Part B.

What about the other “parts” of Medicare – Part C (Medicare Advantage) and Part D (prescription drug coverage)? These Medicare coverage options might charge monthly premiums. And you still need to keep paying your Part B premium as well – if you have Part B. You must be enrolled in Medicare Part A and Part B to qualify for a Medicare Advantage plan under Medicare Part C.

It’s usually simple to find out your employer coverage costs. You can probably see the deduction in your paycheck for your health plan premium. If you’re happy with the coverage and feel the costs are affordable, you may want to keep it.

Review the deductibles and coinsurance cost-sharing amounts of your employer coverage. Increasingly, employer coverage might also include deductibles and coinsurance or copayment amounts.

Deciding whether to apply for Medicare or keep employer coverage

You’ll probably want to consider what additional benefits, if any, your employer coverage includes, beyond coverage for doctor visits and hospital stays. For example, does it include routine dental, vision, and/or prescription drug coverage? You generally don’t get these benefits under Medicare Part A, and Part B. Part A and Part B have limited coverage for prescription drugs, but generally don’t cover medications you take at home.

Also, consider whether your cost for employer coverage includes coverage for your spouse. If it does, you’ll want to factor in the cost for your spouse to get coverage elsewhere before you decide to drop your employer coverage for Medicare. Medicare coverage is for individuals, not married couples or families.

On the other hand, you may be able to get the benefits listed above – routine dental care and prescription drug coverage, for example – through a Medicare Advantage plan.

Medicare and employer coverage: coordination of benefits

Let’s say you’re going to keep your employer coverage and also apply for Medicare. Medicare coordinates benefits with your employer coverage. Which insurance pays first? That is – which is the primary payer?

The size of the employer helps determine who pays first.

• If you work for a company that employs 20 employees or more, your employer coverage usually pays first. Medicare is the secondary payer, paying its portion for covered services your employer’s group health coverage did not pay. You might still have to pay a deductible and/or copayment or coinsurance amount.
• If you work for fewer than 20 employees, Medicare usually pays first, and your employer coverage is the secondary payer. Be mindful, however, of employer coverage that has a Health Savings Account (HSA) feature – you typically can only contribute to your HSA for the portion of the year when Medicare doesn’t cover you. 

Do you have questions about your Medicare coverage options and how to compare costs with your employer coverage? You can call us and speak with a licensed Medicare Resource Center insurance agent. You can also begin exploring your Medicare plan options right now by entering your zip code above.

The product and service descriptions, if any, provided on The Medicare Resource Center are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

Whether you qualify for Medicare by turning 65 years of age, through disability, or by having a condition like Lou Gehrig’s disease, you may have the option to enroll in Medicare Part A and/or Part B. You also need to be a U.S. citizen or permanent legal resident of at least five continuous years to qualify for Medicare.

Depending on your work history and how you qualify, you may be automatically enrolled or need to manually enroll. But one thing people often wonder about is how they obtain Medicare Part D, which is prescription drug coverage and doesn’t automatically come with Original Medicare.

Medicare Part D benefits are available from either a stand-alone Medicare Prescription Drug Plan or a Medicare Advantage Prescription Drug plan, which combines Original Medicare (Part A and Part B) benefits with prescription drug coverage. Both types of plans are administered by private insurance companies that have a contract with Medicare, and specific benefits and prices vary depending on the service area you live in.

Is Medicare Part D Mandatory?

It is not mandatory to enroll in a Medicare Part D Prescription Drug Plan. However, if you go without creditable prescription drug coverage for 63 or more days in a row after you’re first eligible, you may have to pay a late-enrollment penalty if you enroll in a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan later.

Read below to find out more about what kinds of coverage can help you avoid this penalty, when you can enroll in a Medicare Part D Prescription Drug Plan or Medicare Advantage Prescription Drug plan, and other information regarding the late-enrollment penalty.

What is creditable prescription drug coverage?

If you have health insurance in addition to Medicare, this might include creditable prescription drug coverage. The plan must tell you each year whether or not the prescription drug coverage is creditable, meaning it covers at least as much, on average, as Medicare’s standard prescription drug coverage does. Some common examples of creditable coverage include (but are not limited to) health insurance from:

• Employer group coverage or union plans
• United States Department of Veterans Affairs (VA)
• TRICARE
• Indian Health Service (IHS)

You can continue to use this prescription drug coverage alongside your Medicare benefits without penalty, as long as it’s creditable.

When can you enroll in Medicare Part D?

To enroll in a Medicare Part D Prescription Drug Plan, you need to have either Medicare Part A or Part B, and you have to live in the service area of the plan you choose. If you’re eligible for Medicare because of age, your seven-month Initial Enrollment Period for Part D usually takes place at the same time as your Initial Enrollment Period for Part B, starting three months before your 65th birthday, including your birthday month, and ending three months later. If you qualify for Medicare through disability, you’ll get a subsequent Initial Enrollment Period for Part D when you turn 65 years of age.

The Medicare Part D late-enrollment penalty may apply if you enroll any time after your Initial Enrollment Period for Part D and go without creditable prescription drug coverage for more than 63 days in a row. If you don’t enroll in Medicare Part D when you’re first eligible, your next opportunity will be during the Annual Election Period that occurs from October 15th to December 7th of every year. During this time, you can enroll in a stand-alone Medicare Prescription Drug Plan if you have Original Medicare or get prescription drug coverage through a Medicare Advantage Prescription Drug plan. You can also use this period to switch plans or disenroll from your plan.

During the Medicare Advantage Open Enrollment Period (OEP), you may be able to make certain coverage changes. The OEP runs from January 1st - March 31st each year.

• You can generally switch from one Medicare Advantage plan to another, regardless of whether the plans include prescription drug benefits.
• You can drop your Medicare Advantage plan and return to Original Medicare.
• You can enroll in a stand-alone Medicare Part D prescription drug plan if you drop your Medicare Advantage prescription drug plan during the OEP.
• However, you can’t switch from one stand-alone Medicare Part D prescription drug plan to another during this time.
• You cannot generally enroll in a Medicare Advantage plan for the first time during this period.
• You also cannot disenroll from a Medical Savings Account plan during the Medicare Advantage OEP.

Outside of these periods, you can’t make changes to your Medicare Part D coverage unless you qualify for a Special Election Period. Certain situations allow you to make changes outside of the regular periods and may include, but aren’t limited to, moving out of your plan’s service area, losing Medicaid eligibility, or moving into a nursing home.

What is the Medicare Part D late-enrollment penalty?

If you’ve gone 63 consecutive days without creditable prescription drug coverage, either because you didn’t enroll when you were first eligible or because you lost your creditable coverage and didn’t get new coverage in time, then you may have to pay a late-enrollment penalty when you do enroll into Medicare Part D.

The Medicare Part D late-enrollment penalty is added to the premium of the Part D Prescription Drug Plan you enroll in. Your Medicare Prescription Drug Plan determines this penalty by first calculating the number of uncovered months you were eligible for Medicare Part D but didn’t enroll under Part D or have creditable coverage. Your Medicare Prescription Drug Plan will then ask you if you had creditable prescription drug coverage during this time. If you didn’t have creditable prescription drug coverage for 63 or more days in a row after you were first eligible, the Medicare Prescription Drug Plan must report the number of uncovered months to Medicare.

For example, let’s say you disenrolled from your Medicare Prescription Drug Plan effective February 28, 2020, and then decided to enroll in another Medicare Prescription Drug Plan during the Annual Election Period, with an effective date of January 1, 2021. This means you didn’t have creditable prescription drug coverage from March 2020 through December 2020, which adds up to 10 uncovered months.

Currently, the late-enrollment penalty is calculated by multiplying 1% of the “national base beneficiary premium” ($32.74 in 2020) times the number of full, uncovered months that you were eligible but didn’t join a Medicare prescription drug plan and went without other creditable prescription drug coverage. This number is then rounded to the nearest $.10 and added to your Medicare Prescription Drug Plan monthly premium cost. The “national base beneficiary premium” may increase each year, so the total of your late-enrollment penalty can also increase each year.

As your healthcare needs evolve, you may need to change Medicare plans to receive the coverage that best fits your health requirements. Changing Medicare plans can be relatively easy if you understand when and how often you can switch from one Medicare plan to another.

Change Medicare plans during Annual Election Period.

If you want to change Medicare Advantage or Medicare Part D Prescription Drug Plans, the best time to do so is during the Annual Election Period (also called Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage), which runs from October 15th to December 7th each year. During that period, you can:

• Change from Original Medicare, Part A, and Part B, to a Medicare Advantage plan.
• Change from a Medicare Advantage plan back to Original Medicare, Part A, and Part B.
• Switch from one Medicare Advantage plan to another.
• Switch from a Medicare Advantage plan that doesn’t offer drug coverage to a Medicare Advantage plan that does.
• Switch from a Medicare Advantage plan offers drug coverage to a Medicare Advantage plan that doesn’t.
• Switch from one Medicare Prescription Drug Plan (Part D) to another.

When you change Medicare plans during the Annual Election Period, your new coverage begins on January 1st of the following year.

Change Medicare plans during Medicare Advantage Open Enrollment Period.

If you’re enrolled in Medicare Advantage and want to switch back to Original Medicare, Part A, and Part B, you can do so during the Medicare Advantage Open Enrollment Period (OEP), which runs from January 1st - March 31st each year. You will also have until March 31st to join a stand-alone Medicare Prescription Drug Plan (Part D), and your coverage will go into effect the first day of the month after your new plan gets your enrollment form.

Change Medicare plans during Special Election Period.

Medicare has certain provisions to help you deal with unexpected happenings. If you go through certain special circumstances, you may change Medicare plans during Special Election Periods. These events may include, but aren’t limited to:

• moving to a new address
• losing your current coverage
• qualifying for other coverage such as Medicaid, Employer Group Coverage and State Pharmaceutical Assistance Program
• becoming qualified for Extra Help to pay for Medicare Part D coverage through the Social Security Administration

The dates and types of changes you can make vary according to the Special Election Period.

How to change Medicare plans

Be aware that if you want to disenroll from a Medicare Advantage plan and don’t want to enroll in another Medicare Advantage plan, you have to notify your plan in writing. However, if you want to change from one Medicare Advantage plan to another or from one Medicare prescription drug plan to another, all you have to do is join the new plan, and you will automatically be disenrolled from the old one.

Also, understand that you can generally only change Medicare plans during the Medicare Advantage Open Enrollment Period, Annual Election Period, or a Special Election Period (whichever applies).

Suppose you’ve recently enrolled in Original Medicare, congratulations! Now is a good time to learn about the different parts of Medicare to understand what your benefits include and decide if you want to sign up for additional coverage.

Why would I need more health insurance if I have Medicare?

It’s important to understand that Original Medicare, Part A, and Part B, doesn’t include most prescription drug coverage. If you’d like Medicare prescription drug coverage, you can get it from a private health insurance company that contracts with Medicare.

Besides getting prescription drug coverage, you may have other options when you’re first eligible for Medicare.

Here’s a quick rundown of your Medicare coverage options beyond Original Medicare:

• You can have Original Medicare and enroll in a stand-alone Medicare Part D Prescription Drug Plan.
• You can have Original Medicare and purchase a Medigap (Medicare Supplement) plan. There are 10 standardized Medigap policies in most states. They cover varying amounts of your Medicare Part A and Part B costs (such as coinsurance and deductibles), depending on the Medigap policy.
• Or you can enroll in a Medicare Advantage plan. With a Medicare Advantage plan, you get your Medicare Part A, and Part B benefits through a private, Medicare-approved insurance company. Many Medicare Advantage plans include prescription drug coverage so that you can get all your Medicare health and drug benefits in a single plan.

You typically continue paying your monthly Medicare Part B premium with any of these options.

If you’re content with Original Medicare, Part A, and Part B, and you don’t need prescription drug coverage now, and you don’t want to add Medicare Supplement insurance–then you don’t have to make any coverage changes now. Do be aware that if you go without creditable prescription drug coverage for more than 63 days, you might have to pay a late-enrollment penalty if you decide to sign up for a Medicare drug plan later. Creditable prescription drug coverage is other coverage (such as a state pharmaceutical assistance prescription drug program, some employer group coverage, etc.) that provides prescription drug coverage as good as a standard Medicare prescription drug plan. If you have other prescription drug coverage, the company you get coverage from is required to inform you if it is considered creditable.

You’ll still have other chances to make changes to your Medicare coverage later on. 

No matter how you decide to get your Medicare coverage, keep in mind that costs and benefits may change from one year to the next, so it’s a good idea to review your coverage annually to make sure, it’s still meeting your needs. Premiums, cost-sharing expenses, and specific benefits are all subject to change, whether you’re enrolled in Original Medicare, a Medicare prescription drug plan, or a Medicare Advantage plan.

If you’re enrolled in a Medicare Advantage plan or a Medicare Prescription Drug Plan, it’s a good idea to review your plan’s Annual Notice of Change carefully and Evidence of Coverage notices every fall to keep up with any coverage or cost changes. You can make coverage changes during the Annual Election Period (from October 15th to December 7th).

The Medicare program may charge a late-enrollment penalty if you don’t enroll in certain Medicare programs or plans when you’re first eligible. Delaying enrollment could increase your out-of-pocket costs for your coverage. There are late-enrollment penalties for Medicare Part A, Medicare Part B, and Medicare Part D plans.

It’s important to understand the period when you’re first eligible for Medicare. This period is called your Medicare Initial Enrollment Period (IEP), and if you qualify for Medicare by age, it starts three months before you turn 65, includes the month you turn 65, and ends three months later. It lasts for a total of seven months.

Original Medicare refers to Medicare Part A (hospital insurance) and Part B (medical insurance). It is the government-sponsored health care program for those who qualify by age (usually 65 and over). You may also qualify for Medicare before age 65 if you receive Social Security disability benefits. Medicare Part D is optional prescription drug coverage available from private Medicare-approved insurance companies.

Note that another eligibility requirement for Medicare is U.S. citizenship or permanent legal residence for at least five years in a row.

Medicare enrollment penalty: Medicare Part A

Most Medicare beneficiaries get Medicare Part A premium-free. You won’t be charged a premium for Part A if you or your spouse worked at least 10 years (40 quarters) while paying Medicare taxes. And you’re automatically enrolled in Medicare Part A if you’re already collecting Social Security or Railroad Retirement benefits when you turn 65 or qualify through disability.

If you don’t qualify for premium-free Medicare Part A, and you’re not automatically enrolled, then you may be required to pay a 10% higher monthly premium if you do not enroll when you are first eligible. You will have to pay this higher premium for twice the number of years that you could have had Part A coverage, but did not enroll. The Part A premium can be as high as $458 in 2020 (without the penalty).

For example, if you delayed enrollment in Medicare Part A for one year after your IEP was over, you could pay a 10% higher monthly premium for two years.

Medicare enrollment penalty: Medicare Part B

Medicare Part B may also have a late-enrollment penalty if you don’t sign up when first eligible, depending on your situation. Your monthly premium may go up 10% for each full 12-month period that you went without Part B coverage after your IEP ended. You may have to pay this enrollment penalty for the remainder of the time you are enrolled in Medicare.

For example, suppose your IEP ended August 6, 2017, and you delayed Medicare Part B enrollment until the Medicare General Enrollment Period (January 1st - March 31st) in 2020. This would only include one full 12-month period of delay, so in this case, you’d pay a 10% penalty on top of your Medicare Part B premium — but you’d pay this penalty for as long as you’re enrolled in Medicare Part B.

Some people choose to defer enrollment in Medicare Part B — such as those still working and covered by an employer’s group plan. This is an example of a situation that could qualify you for a special enrollment period for Part B, and you might not have to pay the late-enrollment penalty.

Medicare enrollment penalty: Medicare Part D

Medicare prescription drug coverage (Medicare Part D) is optional. If you decide to get this coverage:

• You may have to pay a higher monthly premium for your Medicare Part D Prescription Drug Plan if you go 63 or more consecutive days without creditable prescription drug coverage after your Initial Enrollment Period (IEP). Creditable prescription drug coverage is coverage that is expected to pay at least as much as standard Medicare prescription drug coverage, on average.
• Medicare calculates the late-enrollment penalty by multiplying the 1% penalty rate of the “national base beneficiary premium” ($32.74 in 2020) by the number of full, uncovered months you were eligible to enroll in a Medicare Prescription Drug Plan but did not (assuming you didn’t have other creditable prescription drug coverage). The final amount is rounded to the nearest $0.10 and added to your monthly premium.

For example, suppose you signed up for a Medicare Part D Prescription Drug Plan in 2020, eight months after your IEP ended. One percent of $32.74 is $0.32 x 8 months = about $2.56. So, about $2.56 would be added to your monthly Medicare Part D premium.

The “national base beneficiary premium” may go up each year, so the penalty amount may also go up every year. In addition to your premium each month, you may have to pay this penalty for as long as you have a Medicare Prescription Drug Plan.

Retired federal employees are entitled to Medicare under the same rules as all other retirees.

How does federal health insurance work with Medicare Part B?

You don’t have to take Medicare Part B coverage if you don’t want it, and your Federal Employee Health Benefits (FEHB) plan can’t require you to take it. However, there are some advantages to enrolling in Part B:

• You have the advantage of coordination of benefits between Medicare and your FEHB plan, reducing your out-of-pocket costs.
• If you want to join a Medicare Advantage plan, you must be enrolled in Medicare Part A and Part B.

Some HMOs waive payment of their copays and deductibles when Medicare is primary. Check your FEHB plan’s brochure for details.

• Some services covered under Part B might not be covered or only partially covered by your FEHB plan. This includes orthopedic and prosthetic devices, durable medical equipment, home health care, and medical supplies. Check your FEHB plan brochure for details.
• If you are enrolled in an FEHB HMO and Medicare is the primary payer, you may go outside of the plan’s network for Part B services and receive reimbursement by Medicare.
• FEHB plan contracts are renewed yearly, so your current plan’s coverage, cost, or benefits may change next year. Your FEHB plan can also terminate their contract with the Office of Personnel Management.*

*Source:

“The Federal Employees Health Benefits Program and Medicare,” United States Office of Personnel Management.

If you are or were a federal employee, you’re probably familiar with the Medicare eligibility requirement that you’re an American citizen or permanent legal resident of at least five continuous years. You are first eligible to enroll in Part B during your Initial Enrollment Period (IEP), which in most cases begins three months before you turn age 65 and ends three months after you turn age 65. (In some cases, such as if you have a disability, you may be eligible before age 65. If you do not enroll in Part B during your IEP, you may only enroll during the General Enrollment Period, which is from January 1 through March 31 of each year. Part B coverage is effective July 1, of the year of enrollment. You may have to pay higher Part B premiums if you did not enroll when you were first eligible.

The Social Security Administration handles Medicare eligibility and enrollment. To sign up for Medicare or to add Medicare Part B, call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778. You can use their automated services anytime, or speak with a live representative between 7 AM to 7 PM, Monday through Friday. If you visit an office in person, Social Security Administration office hours are 9 AM to 4 PM Monday, Tuesday, Thursday, and Friday, and 9 AM to 12 noon on Wednesday. They are closed Saturday and Sunday.

The Office of Personnel Management provides useful information to retiring Federal employees on their website.

Summary:

You are not required to have Medicare Part B coverage if you have employer coverage. You can drop Medicare Part B coverage and re-enroll in it when you need it.

Maybe you’re 65 but enjoying your career and want to work a few more years. You’re eligible for Medicare but you also have employer coverage. Do you have to be dually covered with Medicare Part B coverage and employer health insurance?

If you’re a Medicare beneficiary and want to drop Medicare Part B coverage while you’re working and covered by your employer’s group health insurance, you may do so. You also may choose to defer enrollment in Medicare Part B coverage if you are employed at age 65 or older and eligible for Medicare.

What is Medicare Part B coverage?

Medicare Part B coverage extends to things like:

• Outpatient care
• Preventative treatments and screenings such as cardiovascular screenings, diabetes screenings, mammograms, and prostate cancer screenings
• Ambulance services
• Durable medical equipment
• Physical therapy and occupational therapy
• Outpatient mental health care

Your employer coverage may also cover all of the above.

What does Medicare Part B cost?

Medicare Part B coverage (medical insurance) comes with a monthly premium, so some beneficiaries prefer to delay or drop Part B enrollment when they have other coverage. (The standard Medicare Part B premium was $144.60 in 2020.) However, it makes sense to keep Medicare Part A if you get it premium-free as most people do after working a minimum number of quarters.

You should contact your employer or union benefits administrator before delaying Medicare Part B coverage. In some cases, your employer may require you to enroll in Medicare Part A and Part B in order to get your full coverage.

What if I decide I want Medicare Part B and employer coverage?

If you drop Part B coverage while covered by an employer’s plan, you can sign up for Part B again during your Special Enrollment Period (SEP). You can enroll in Part B anytime that you’re working (or your spouse is working) and covered by the employer – or union-based health insurance plan.

Your SEP extends for eight months after you or your spouse stop working, or the group coverage based on current employment ends, whichever occurs first.

A SEP lets you enroll in Medicare Part B outside of your Initial Enrollment Period. As long as you enroll in Part B during your SEP, you typically won’t have to pay a Part B late-enrollment penalty in the form of a higher premium.

To begin looking for a Medicare plan in your area, enter your zip above.

Yes, in certain situations, you can delay your Medicare Part B enrollment without paying higher premiums (also known as a late-enrollment penalty). If you didn’t enroll in Medicare Part B when you were first eligible because you or your spouse was working and had group coverage through an employer or union, you can choose to sign up for Medicare Part B during a Special Enrollment Period (SEP) without paying a late-enrollment penalty.

You can sign up for Medicare Part B at any time that you have coverage through current or active employment. Or you can sign up for Medicare during the eight-month Special Enrollment Period that starts when your employer or union group coverage ends or you stop working (whichever happens first). If you get COBRA or retiree benefits after you stop working, keep in mind that this doesn’t count as coverage based on current employment; make sure you don’t wait until your COBRA benefits end to enroll in Medicare Part B.

Remember that if you do not enroll in Medicare Part B during your Special Enrollment Period, you’ll have to wait until the next General Enrollment Period, which occurs from January 1st to March 31st each year. You may then have to pay a late-enrollment penalty for Medicare Part B because you could have had Part B and did not enroll. If you owe a late-enrollment penalty, you’ll pay a 10% higher premium for every 12-month period that you were eligible for Medicare Part B but didn’t sign up for it. You may have to pay this higher premium for as long as you’re enrolled in Medicare.

Medicare Part B enrollment – avoiding the Part B penalty

There are a few situations when you may be able to delay Medicare Part B without paying a late-enrollment penalty. For example, if you were volunteering overseas or if you were living out of the country when you turned 65 and weren’t eligible for Social Security benefits, you may be eligible for a Special Enrollment Period when you return to the United States. The length of your SEP will depend on your situation. If you aren’t sure if you qualify for a Special Enrollment Period, call Medicare to confirm at 1-800-633-4227 (TTY users 1-877-486-2048), 24 hours a day, seven days a week.

Have more questions about Medicare coverage? You can talk to one of The Medicare Resource Center licensed insurance agents – you’ll find contact information below.

Original Medicare, the government-sponsored health insurance program, includes Medicare Part A (hospital insurance) and Part B (medical insurance). Because Medicare Part B typically comes with a monthly premium, some beneficiaries delay enrollment in Part B (for example, if they have health coverage through employment), and may want to enroll in Part B later.

Medicare Part B enrollment – sometimes automatic, sometimes not

U.S. citizens and legal permanent residents of at least five continuous years may be eligible for Medicare coverage. You’re usually enrolled in Medicare Part A and Part B automatically when you turn 65 or qualify by disability at any age and you receive Social Security Administration (SSA) or Railroad Retirement Board (RRB) benefits. For details about how you qualify for automatic enrollment, see Medicare Enrollment.

You’re not automatically enrolled in Medicare Part B in all situations. Here are a few examples of when you may qualify for Part B, but you need to sign up manually:

• If you live in Puerto Rico, you’re typically signed up for Medicare Part A automatically when you turn 65 if you’re collecting SSA or RRB benefits. However, you need to sign up for Part B manually.
• If you have end-stage renal disease (ESRD, a type of kidney failure), regardless of your age, you may qualify for Medicare but you generally have to apply manually.
• If you’re not receiving SSA or RRB benefits when you turn 65, if you want to enroll in Medicare Part B, you need to sign up for it.

You can sign up for Medicare Part B during the following enrollment periods:

• The Initial Enrollment Period (IEP) for Part B, when you’re first eligible for Medicare. Your IEP typically starts 3 months before you turn age 65, includes your birth month, and lasts for 3 months after your birth month. That’s a total of 7 months. If you’re under 65 and disabled, you generally qualify for Medicare after receiving Social Security (or certain disability benefits from the Railroad Retirement Board) for 24 months. In this case, your 7-month IEP goes from the start of your 22nd month until the end of your 28th month of receiving disability benefits. If you sign up for Medicare Part B during your IEP, you won’t face a Part B late-enrollment penalty.
• The General Enrollment Period (GEP), which runs from January 1st to March 31st of each year. You may enroll in Medicare Part B coverage if you are eligible. If you enroll in Part B during a GEP, it will be effective July 1st of the year in which you apply. You may have to pay a late-enrollment penalty. Your Part B premium may go up 10 percent for each 12-month period that you could have had Medicare Part B but did not sign up it. If you didn’t take Medicare Part B when you were first eligible because you or your spouse were working and had group health plan coverage through your employer or union, you can add Medicare Part B coverage during a Special Enrollment Period (SEP). You can sign up during the following periods under the Part B SEP:
• While you’re still covered by the employer or union group health plan
• During the 8 months following the month the employer or union group health plan coverage ends, or when the employment ends — whichever is first.

To add Medicare Part B, contact the Social Security Administration at 1-800-772-1213 (TTY users 1-800-325-0778), 7 AM-7 PM, Monday to Friday. For additional information, contact Medicare at 1-800-MEDICARE (TTY users 1-877-486-2048), 24 hours a day, 7 days a week.

Medicaid is a joint federal and state program that helps pay medical bills for people with low income and limited resources. Eligibility for Medicaid depends on income level and family size.

Medicaid coverage differs from state to state. In all states, Medicaid pays for basic home health care and medical equipment. Medicaid may pay for a homemaker, personal care, and other services that are not covered by Medicare. There are Medicaid programs that pay some or all of Medicare’s premiums and may also pay deductibles and coinsurance for certain people who qualify for Medicare and need financial assistance.

For more information about Medicaid coverage in your state and to see whether you qualify, call your state medical assistance office.