About Medicare

Medicare is a federal government program that provides health insurance coverage to eligible beneficiaries. You're eligible to join Medicare if you are:

  • A United States citizen or legal resident who has lived in the U.S. for at least five consecutive years, AND
  • Age 65 or older, OR
  • Under age 65 and qualify on the basis of disability or other special situation, OR
  • Any age, but have end-stage renal disease (permanent kidney failure requiring dialysis or kidney transplant).

Who administers Medicare plans?

Medicare Parts A and B (sometimes known as "Original Medicare") is run by the federal government. With Medicare Parts A and B, the government pays fees for your health care directly to the doctors and hospitals you visit.

Other types of Medicare plans, such as Medicare Part C (also known as Medicare Advantage), Medicare Supplement Insurance and prescription drug plans (Part D), are operated by private insurance companies that are contracted by the government. The government pays a fixed fee to your plan for your care, and your plan then pays your doctors and hospitals.

What are my Medicare coverage choices?

You can choose the type of Medicare plan you want, based on what's available in your area and your coverage needs. Here's an overview of what each coverage plan offers:

Medicare Part A and Part B (sometimes known as "Original Medicare")

  • Helps cover hospital stays, preventive care, doctor visits and other medical services.
  • Run by the federal government.
  • Can be paired with a Medicare Supplement Insurance plan to help pay your share of costs.
  • Can be paired with a stand-alone prescription drug plan (Medicare Part D), to help pay for medications.

Medicare Part C (Medicare Advantage)

  • Provides the same coverage and services as Medicare Parts A and B, often with additional benefits that vary by plan.
  • Most plans include Medicare Part D prescription drug coverage.
  • Run by private insurance companies that are contracted by the government.
  • Works similarly to an employer-sponsored health plan.

Medicare Part D (prescription drug plans)

  • Helps cover the costs of your prescription drugs.
  • Run by private insurance companies that are contracted by the government.
  • Can be added to Medicare Parts A and B or a Medicare Advantage Private Fee-for-Service (PFFS) plan that does not include prescription drug coverage.

Medicare Supplement Insurance

  • Helps pay your cost of Medicare-covered services, such as copays and deductibles.
  • Some plans offer additional benefits not covered by Medicare Parts A and B.
  • Run by private insurance companies. These plans are regulated by the state in which you reside, and are not a benefit offered by the federal government.
  • Can be added to Medicare Parts A and B.

To get a better understanding of these coverage options, learn how the parts of Medicare work together.

How to enroll in Medicare

See if you're eligible, and learn about the Medicare enrollment process and when you can enroll.

Learn more about enrolling in Medicare

Questions? Call UnitedHealthcare at:
1-877-699-5710
(TTY 711)
Hours: 8 a.m.-8 p.m. local time,
7 days a week

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Optional supplemental service (rider)

Additional coverage you can add to your Medicare Advantage plan. Examples of optional plan services covered with riders include: dental coverage and fitness programs.

Optional supplemental service (rider)

Additional coverage you can add to your Medicare Advantage plan. Examples of optional plan services covered with riders include: dental coverage and fitness programs.

Optional supplemental plan (rider)

Additional coverage you can add to your Medicare Advantage plan. Examples of optional plan services covered with riders include: dental coverage, vision and hearing coverage and fitness programs.

Creditable Coverage

Refers to prescription drug coverage that offers benefits the same as or better than coverage available through Medicare.

Tier 1: Preferred Generic. Lowest Copay.

This tier includes lower-cost, commonly used generic drugs. Use Tier 1 drugs for the lowest out-of-pocket costs.

Tier 2: Non-Preferred Generic. Low Copay.

This tier includes most generic drugs. Use Tier 2 drugs, instead of Tier 3 or 4, to help reduce your out-of-pocket costs.

Tier 5 : Specialty Tier. Coinsurance.

This tier includes unique and/or very high-cost drugs. You pay a percentage of the total drug cost, called coinsurance.

Tier 4: Non-Preferred Brand. Highest Copay.

This tier includes non-preferred generic and non-preferred brand drugs. Many Tier 4 drugs have lower-cost options in Tier 1, 2 or 3. Ask your doctor if you can switch to one of these drugs to help reduce your out-of-pocket costs.

Tier 3: Preferred Brand. Medium Copay.

This tier includes many common brand name drugs, called preferred brands, and some higher-cost generic drugs. Many Tier 3 drugs have lower-cost options in Tier 1 or 2. Ask your doctor if they could work for you.

Tier 4: Non-Preferred Brand. Highest Copay.

This tier includes non-preferred generic and non-preferred brand drugs. Many Tier 4 drugs have lower-cost options in Tier 1, 2 or 3. Ask your doctor if you can switch to one of these drugs to help reduce your out-of-pocket costs.

Drug List tool tip

A list of drugs covered by your Medicare Part D plan. A drug list may also be referred to as a covered prescription drugs list (CML), a preferred drug list (PDL), a select drug list or a formulary. These drugs are dispensed through participating network pharmacies to covered members. Drug lists may differ between Medicare prescription drug plans.


Carefully weigh the differences in drug lists against the plan costs and other features when choosing a plan that may best meet your needs. A drug list may change during the year.

Tier 2: Low Copay

This tier includes most generic drugs. Use Tier 2 drugs, instead of drugs in Tiers 3 or 4 to help reduce your out-of-pocket costs.

Coverage Gap Stage:

During the Coverage Gap Stage, you (or others on your behalf) will pay no more than 72% of the total cost for generic drugs or 47.5% of the total cost for brand name drugs, for any drug tier until the total amount you (or others on your behalf) have paid reaches $4,550 in year-to-date out-of-pocket costs.

You may pay less if your plan has better coverage in the gap.

Always use your Medicare Part D member ID card during the coverage gap to get the plan's discounted drug rates. The money you spend using your card counts toward your out-of-pocket costs.

Out-of-Pocket Costs:

The amount you (or others pay on your behalf) pay for prescription drugs starting January 1, 2013 not including premiums.

Premium (or monthly premium)

The monthly fee you pay for Medicare coverage.

Deductible/annual deductible

The pre-set, fixed amount you must pay for healthcare or prescription drug costs before Medicare or the plan begins to pay.

Deductible/Annual deductible

The pre-set, fixed amount you must pay for healthcare or prescription drugs costs before the insurance company or Medicare begins to pay.

Coinsurance

A kind of cost sharing where you pay a percentage of the cost of a service. For example, a plan might pay 75% and you would pay 25%. In Medicare Advantage, coinsurance varies depending on the plan.

Copay

A kind of cost sharing where you pay a predictable, pre-set amount for a service, such as an annual check-up.

Copay

A kind of cost sharing where you pay a predictable, pre-set amount for a service, such as an office visit.

Primary Care Physician's name and ID

Your primary care physician (PCP) plays an important role in your health care, and we want you to have the opportunity to select one you are comfortable with. Your PCP can:

  • Help you make good lifestyle choices to maintain and improve your health.
  • Serve as a direct point of contact in case of an emergency.
  • Manage the drugs prescribed to you and identify potential adverse interactions.
  • Coordinate the care of specialists who may diagnose and treat your conditions.
  • Help ensure that you are getting the care you need while helping to minimize your out-of-pocket costs.

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