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What is Original Medicare?
Original Medicare consists of Medicare Part A (hospital coverage) and Medicare Part B (medical coverage). It's a federal health insurance program for individuals 65 or older; under 65 who have a qualifying disability; and of any age with a diagnosis of End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, also called Lou Gehrig's disease).
No. Medicare and Medicaid are both government programs that help people pay for health care, but they are not the same thing.
Medicare is a federal program that provides health care coverage for people who are 65 or older or have certain qualifying disabilities.
Medicaid is a joint state and federal program that provides health care coverage for individuals and families with limited incomes. "Dual eligibility" means you qualify for both Medicare and Medicaid.
Can I get my prescription drugs covered under Original Medicare?
No. Original Medicare doesn't cover prescription drugs. Part A may cover some drugs you get as an inpatient. Otherwise, prescription drug coverage, also known as Medicare Part D, is available separately through private insurance companies approved by Medicare. You can get prescription drug coverage either through a stand-alone Part D plan (PDP) or a Medicare Advantage plan (MAPD) that includes prescription drug benefits.
Does Original Medicare cover vision, dental, or hearing care?
Generally, no. Original Medicare doesn't cover routine vision or dental care, eyeglasses, or hearing aids. Part B may cover some dental or vision services if you meet certain conditions and they are considered medically necessary, but you'll have to check with your health care provider and Medicare first. Many Medicare Advantage (Part C) plans, however, do offer these benefits. Be sure to compare the benefits of all plan options to find the coverage that best fits your needs.
Does Original Medicare pay for a nursing home stay?
Original Medicare Part A pays for some skilled nursing services, but doesn't cover long-term or custodial care (daily life activities like eating and bathing). You'd also still be responsible for a portion of the costs, such as deductibles, copays and coinsurance.
What's the difference between a Medicare Advantage plan and a Medicare Supplement plan?
Medicare Advantage and Medicare Supplement plans are very different, and you can't have both at the same time.
A Medicare Advantage (Part C) plan combines Part A, Part B, and often Part D (prescription drug) coverage into one plan. These plans may also include additional benefits, such as hearing, vision, dental, and fitness. Medicare Advantage plans also have an annual limit on out-of-pocket costs on covered services.
A Medicare Supplement (Medigap) plan helps with some of the out-of-pocket costs that Original Medicare doesn't pay, like coinsurance and copayments.
Do Medicare Advantage plans have vision (eye care) benefits?
Most Medicare Advantage (Part C) plans offer routine vision care, such as eye exams, eyeglasses, and corrective lenses. Original Medicare (Parts A and B) alone doesn't cover routine vision care.
Do Medicare Advantage plans have dental care benefits?
Most Medicare Advantage (Part C) plans offer routine dental care, such as dental exams. Original Medicare (Parts A and B) alone doesn't cover routine dental care.
Do Medicare Advantage plans have hearing benefits?
Most Medicare Advantage (Part C) plans offer hearing care, such as hearing tests and hearing aids. Original Medicare (Parts A and B) alone doesn’t cover routine hearing care.
Medicare Part D is prescription drug coverage. Medicare Part D plans (PDP) help pay for medications prescribed by a doctor. Part D plans are offered by private insurance companies approved by Medicare. The types of drugs covered is decided by the U.S. government. Beyond that list, every Medicare Part D plan covers a different set of drugs. When choosing a Part D plan, you need to make sure it covers the drugs you take.
Most Medicare Advantage (Part C) plans already include Part D prescription drug coverage, combined into a single plan with hospital and medical. Another option is to have a separate Part D plan in addition to Original Medicare, a Medicare Supplement Insurance plan, or a Private Fee-For-Service plan.
How do I know if my drugs are covered by the Medicare Part D plan?
All Part D plans have a drug list—also called a formulary—that gives you the information you need about which drugs are covered. The formulary can change, but your plan will let you know ahead of time if it does. The formulary will also tell you if your drug has any special rules or limits. Your plan will send you your formulary and/or give you a way to get all of your drug list information online.
Medicare Supplement insurance plans, offered by private insurance companies, help pay some of the out-of-pocket costs that Original Medicare (which includes Part A and Part B) doesn't pay. Medicare Supplement plans are also known as Medigap plans.
When can I apply for Medicare Supplement insurance?
Your acceptance into a Medicare Supplement insurance plan is guaranteed if you apply during the Medicare Supplement Open Enrollment Period. It starts on the first day of the month in which you're both age 65 or older AND enrolled in Medicare Part B. You can apply for a Medicare Supplement insurance plan any time during the year, and some states have additional enrollment periods and guaranteed enrollment situations.
If you apply outside of this timeframe or another guaranteed issue period, you may be denied coverage or charged more based on your health history. This doesn't apply if you live in Connecticut and New York, where guaranteed issue is ongoing and Medicare Supplement plans are guaranteed available.
When can I apply for a Medicare Supplement insurance plan?
The best time to enroll in a Medicare supplement plan is during your Medicare Supplement Open Enrollment period because your acceptance is guaranteed. It starts on the first day of the month in which you're both age 65 or older and enrolled in Medicare Part B. Some states have additional Open Enrollment periods and Guaranteed Issue requirements.
If you apply outside of Open Enrollment or Guaranteed Issue periods, you may be denied coverage or charged more based on your health history. This does not apply to residents of Connecticut and New York where Open Enrollment and Guaranteed Issue is ongoing and Medicare supplement plans are guaranteed available.
How much Medicare Supplement insurance coverage do I need?
There are ten standardized Medicare Supplement insurance plans. All of them pay towards out-of-pocket costs for Medicare-approved services. Some plans pay most or all of your out-of-pocket costs, but have a higher monthly premium. Other plans pay fewer out-of-pocket costs, but have a lower monthly premium. Benefits and costs vary depending on the plan chosen. Plans C and F are only available to individuals who were eligible for Part A or who turned 65 before January 1, 2020.
Does a Medicare Supplement insurance plan replace Original Medicare Part A and Part B?
No. A Medicare Supplement insurance plan works with Original Medicare, which includes Part A and Part B. Medicare supplement insurance helps cover some of the out-of-pocket health care costs that Original Medicare doesn't pay for. For instance, Medicare Part B generally covers about 80% of Part B expenses. You're responsible for paying the rest. A Medicare Supplement insurance plan could help pay your share.
You're eligible for Original Medicare once you turn 65 and are a U.S. citizen or legal resident. If you're a legal resident, you must have lived in the United States for at least five years in a row before you're eligible for Original Medicare.
I'm not 65 yet. Could I still be eligible for Original Medicare?
Even if you haven't turned 65, you may be eligible to get Original Medicare. You need to be a U.S. citizen or legal resident for at least 5 years in a row, and have one of the conditions below:
Under 65 and have a qualifying disability
Any age and have Amyotrophic Lateral Sclerosis (ALS, also called Lou Gehrig's disease) or End-Stage Renal Disease (ESRD).
Am I eligible for a Medicare Advantage or Medicare prescription drug plan?
Yes—but you have to enroll in Medicare Part A and/or Part B.
For a Medicare Advantage (Part C) plan, you must have both Medicare Part A and Part B to apply.
For Medicare Part D prescription drug plans, you need to first enroll in either Medicare Part A or Part B. You cannot be denied enrollment in a Part D plan. You must enroll in a Part D plan during your Initial Enrollment Period to avoid the late enrollment penalty for Part D. The exception to this rule is if you qualify for a Special Enrollment Period.
What if I'm 65, but I'm still working? Do I still need to sign up for Medicare?
If you're still working when you turn 65, you still need to make some decisions around Original Medicare—even if you're covered by your employer's health plan. When you turn 65, you may want to enroll in Medicare Part A, which is premium free. If you have qualified insurance from your employer, you may be able to delay enrolling in Part B and Part D without penalty. Or you may need to enroll when you turn 65. Talk to your employer's benefit administrator to help you learn more about your choices.
What if I get health insurance under my working spouse?
If you're 65 or older and covered by your spouse's employer health insurance plan, you may be able to delay enrolling in Medicare or you may need to enroll at age 65. Employers have certain rules for covered dependents of Medicare age, so talk with the employer's benefits administrator to understand your options.
If you're turning 65 AND are already receiving Social Security or Railroad Retirement Board benefits, you'll be automatically enrolled in Original Medicare Parts A and B. If you're not already receiving these benefits when you turn 65, you'll need to sign up during your Initial Enrollment Period.
How do I enroll in Original Medicare?
If you're not enrolled in Original Medicare automatically, visit the ssa.gov/benefits/medicare website, or call or stop into your local Social Security office. If you're eligible for Medicare due to disability or End-Stage Renal Disease (ESRD), check www.medicare.gov for details on how to enroll.
What is the Medicare Initial Enrollment Period?
The Medicare Initial Enrollment Period (IEP) is a seven-month period that includes your 65th birthday month, the three months before and the three months after. You can enroll in Medicare Part A, Part B, Part C, Part D and Medigap during this time.
What is a Medicare Special Enrollment Period?
Medicare grants a Special Enrollment Period (SEP) when you're working past 65 with creditable employer coverage and for certain qualifying situations and life events.
With the SEP for working past 65, you are granted eight months to enroll in Medicare Part A and Part B. However, you only get the first two months of this time to get a Medicare Advantage (Part C) and Part D plan without penalty.
For people who already have Medicare coverage, there is a special 2-month SEP that Medicare offers for people who experience a qualified life event. For example, if you move to a different state and your Medicare Advantage plan is not offered there, you would qualify for this SEP. During this two-month period, you can change Medicare Advantage or Part D plans, or if you choose, you can also return to just Original Medicare.
What is the Medicare Advantage Open Enrollment Period?
The Medicare Advantage Open Enrollment Period (MA OEP) runs from January 1 to March 31 every year. During this period, you can make a one-time election to leave a Medicare Advantage plan, switch to a different Medicare Advantage plan, or leave a Medicare Advantage plan and go back to Original Medicare (Part A and Part B). If you do that, you can also then enroll in a stand-alone Part D plan.
What if I want to change plans?
The Medicare Annual Enrollment period (AEP) happens at the same time every year, from October 15 to December 7. During this time you can join, switch or drop a Medicare plan—including Medicare Advantage (Part C) and Medicare prescription drug coverage (Part D).
How much does Original Medicare Part A and Part B cost?
It's important to understand the basics of Medicare costs. Most people pay no premium for Original Medicare Part A. The premium for Original Medicare Part B depends on your income and may change each year. For both Part A and Part B, there are also deductibles and coinsurance. You may also qualify for help paying for Medicare costs.
How much do I have to pay for Medicare Part D plans?
There are some costs associated with Medicare Part D plans. Stand-alone Part D plans offered through a private insurance company, like UnitedHealthcare, charge a monthly premium. You could also consider Medicare Advantage (Part C) that includes Part D coverage under a single plan. Some plans also require you to pay an annual deductible and coinsurance or copayment amounts.
Extra Help is a Medicare financial assistance program for people with low incomes and limited assets. It helps pay prescription drug costs. It is also called Low Income Subsidy or LIS.
What is the Donut Hole?
The Donut Hole is also known as the Coverage Gap. This is one of four drug payment stages in Medicare Part D plans. In the Coverage Gap, you pay a percentage of the drug cost—instead of copay or coinsurance—until you reach your out-of-pocket limit.
For 2021, it begins when your total drug costs have reached $4,130. In the Coverage Gap (Donut Hole), you pay 25% of the cost for brand name drugs and 25% of the cost of generic drugs, until you reach $6,550 in out-of-pocket costs.
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AARP® Medicare Supplement Insurance Plans
AARP endorses the AARP Medicare Supplement Insurance Plans, insured by UnitedHealthcare.
Insured by UnitedHealthcare Insurance Company, Horsham, PA or UnitedHealthcare Insurance Company of America, Schaumburg, IL (for ND residents) or UnitedHealthcare Insurance Company of New York, Islandia, NY (for NY residents). Each insurer has sole financial responsibility for its products. Policy form No. GRP 79171 GPS-1 (G-36000-4).
In some states, plans may be available to persons under age 65 who are eligible for Medicare by reason of disability or End-Stage Renal Disease.
Not connected with or endorsed by the U.S. Government or the federal Medicare program.
This is a solicitation of insurance. A licensed insurance agent/producer may contact you.
You must be an AARP member to enroll in an AARP Medicare Supplement Plan.
THESE PLANS HAVE ELIGIBILITY REQUIREMENTS, EXCLUSIONS AND LIMITATIONS. FOR COSTS AND COMPLETE DETAILS (INCLUDING OUTLINES OF COVERAGE), CALL A LICENSED INSURANCE AGENT/PRODUCER AT THE TOLL-FREE NUMBER ABOVE.
Medicare Advantage plans and Medicare Prescription Drug plans
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. Enrollment in these plans depends on the plan's contract renewal with Medicare. You do not need to be an AARP member to enroll in a Medicare Advantage plan or Medicare Prescription Drug plan.
This information is not a complete description of benefits. Contact the plan for more information.