What is Medicare?

If you would rather watch a video, click the one above to see how Medicare works.
Medicare is the federal health insurance program administered by the Centers for Medicare and Medicaid Services (CMS) for:

  • People who are 65 or older and have paid Medicare taxes, which should have been deducted from your paycheck, for at least 10 years during their lifetime
  • Certain younger people with disabilities
  • People with End-Stage Renal Disease (ESRD)

Parts of Medicare and what Medicare covers:

hospital clipart
  • MEDICARE PART A (Hospital Insurance)
    Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, as well as some home health care. Part A is administered and managed by the government.
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  • MEDICARE PART B (Medical Insurance)
    Part B – certain doctors’ services, outpatient care, medical supplies, and preventive services. Part B is administered and managed by the government.
  • MEDICARE PART C (Advantage Plans)
    Part C -Medicare Advantage is an “all in one” alternative to Original Medicare. These bundled plans include Part A, Part B, and usually Part D. Advantage plans are run by private insurance companies, although they are regulated by the government.
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  • MEDICARE PART D (Drug Coverage)
    Part D -Helps cover the cost of prescription drugs.
    Medicare drug coverage plans are run by private insurance companies, although they are regulated by Medicare.

The 2 Main Ways To Get Medicare are:

ORIGINAL MEDICARE
and
MEDICARE ADVANTAGE

medigap original medicare pictograph advantage plans part c pictograph

Costs

Medicare Advantage plan costs vary from plan to plan and from one geographic area to another. Speak with your sales representative about costs for Advantage plans in your area.

Original Medicare costs are standardized by the government and some of the costs can be seen just below.

Click to see: A Quick Look at some of the 2023 Original Medicare Costs

Part A Premium – Most people don’t pay a monthly premium for Part A (sometimes called “premium-free Part A”), such as paying FICA taxes for 40 quarters (10 years) or more. If you buy Part A, you’ll pay up to $506 each month ($505 in 2024) . If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $506. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $278.

Part A Hospital Inpatient Deductible and Coinsurance –

  • $1,600 deductible for each benefit period ($1,632 in 2024)
  • Days 1-60: $0 coinsurance after you pay your Part A deductible, for each benefit period
  • Days 61-90: $400 coinsurance per day ($408 in 2024) of each benefit period
  • Days 91-150: $800 copayment each day ($816 in 2024) while using your 60 lifetime reserve days
  • After day 150: You pay all costs

Part B Premium – The standard Part B premium amount is $164.90 ($174.70 in 2024)(or higher depending on your income).

Part B Deductible and Coinsurance – $226 Deductible ($240 in 2024). After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you’re a hospital inpatient), outpatient therapy, durable medical equipment (DME).

Part C Premium – The Part C monthly premium varies by plan. You should compare costs for specific Part C plans.

Part D Premium – The Part D monthly premium varies by plan (higher-income consumers may pay more). The 2023 Part D national base beneficiary premium (Medicare’s estimate of the Part D average premium) is $32.74. You should compare costs for specific Part D plans.

Source: www.medicare.gov/basics/costs/medicare-costs and www.medicare.gov/Pubs/pdf/11579-medicare-costs.pdf

Let’s Compare Original Medicare to Medicare Advantage (Part C):

Original
Medicare
Medicare
Advantage
You can go to any doctor or hospital that takes Medicare, anywhere in the U.S.
In many cases, you’ll need to use doctors and other providers who are in the plan’s network and service area for the lowest costs. Some plans won’t cover services from providers outside the plan’s network and service area.
In most cases, you don’t need a referral to see a specialist.
You may need to get a referral to see a specialist.
For Part B-covered services, you usually pay 20% of the Medicare-approved amount after you meet your deductible. This is called your coinsurance.
Out-of-pocket costs vary—plans may have lower out-of-pocket costs for certain services.
You pay a premium (monthly payment) for Part B. If you choose to join a Medicare drug plan (Part D), you’ll pay that premium separately.
You may pay the plan’s premium in addition to the monthly Part B premium. (Most plans include drug coverage (Part D).) Plans may have a $0 premium or may help pay all or part of your Part B premiums.
There’s no yearly limit on what you pay out of pocket, unless you have supplemental coverage—like Medicare Supplement Insurance (Medigap).
Plans have a yearly limit on what you pay out of pocket for services Medicare Part A and Part B covers. Once you reach your plan’s limit, you’ll pay nothing for services Part A and Part B covers for the rest of the year.
You can get Medigap to help pay your remaining out-of-pocket costs (like your 20% coinsurance). Or, you can use coverage from a former employer or union, or Medicaid.
You can’t buy and don’t need Medigap.
Original Medicare covers most medically necessary services and supplies in hospitals, doctors’ offices, and other health care settings. Original Medicare doesn’t cover some benefits like eye exams, most dental care, and routine exams.
Plans must cover all of the medically necessary services that Original Medicare covers. Most plans offer extra benefits that Original Medicare doesn’t cover—like some vision, hearing, dental, routine exams, and more. Plans can now cover more of these benefits.
You can join a separate Medicare drug plan (Part D) to get drug coverage.
Drug coverage (Part D) is included in most plans. In most types of Medicare Advantage Plans, you don’t need to join a separate Medicare drug plan.
In most cases, you don’t have to get a service or supply approved ahead of time for Original Medicare to cover it.
In some cases, you have to get a service or supply approved ahead of time for the plan to cover it.
Original Medicare generally doesn’t cover care outside the U.S. You may be able to buy a Medicare Supplement Insurance (Medigap) policy that covers care outside the U.S.
Plans generally don’t cover care outside the U.S.
Source – “Medicare and You Handbook 2021”