Frequently Asked Questions

 Medicare’s annual election period is October 15 – December 7. During this period, anyone with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs.

Medicare health and drug plans can make changes each year to cost, benefits, coverage, and the plan’s network of providers and pharmacies. Therefore, materials sent from the plan, like the “Evidence of Coverage” (EOC) and “Annual Notice of Change” (ANOC) should be reviewed to find out if the plan is changing. Make sure your plan will still meet your needs for the following year. Nothing needs to be done if the current plan will continue to meet your needs for next year.

Medicare is a federal health insurance program in the United States that primarily provides health coverage to individuals aged 65 and older, as well as certain younger individuals with disabilities or specific medical conditions. It was established in 1965 under the Social Security Administration and is funded through payroll taxes and premiums.  

 Medicare is health insurance for people 65 or older. You’re first eligible to sign up for Medicare 3 months before you turn 65. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease).  

Original Medicare covers most, but not all of the costs for approved health care services and supplies. After you meet your deductible, you pay your share of costs for services and supplies as you get them. There’s no limit on what you’ll pay out-of-pocket in a year unless you have other coverage (like Medigap, Medicaid, or employee or union coverage). Get details on cost saving programs.

Services covered by Medicare must be medically necessary.  Medicare also covers many preventive services, like shots and screenings. If you go to a doctor or other health care provider that accepts the 

Medicare-approved amount, your share of costs may be less. If you get a service that Medicare doesn’t cover, you pay the full cost.

With Original Medicare, you can:

• Go to any doctor or hospital that takes Medicare, anywhere in the U.S. Find providers that work with Medicare.
• Join a separate Medicare drug plan (Part D) to get drug coverage.
• Buy a Medicare Supplement Insurance (Medigap) policy to help lower your share of costs for services you get.

If you have other insurance, learn how Original Medicare works with your other coverage.

If you're not lawfully present in the U.S., Medicare won't pay for your Part A and Part B claims, and you can't enroll in a Medicare Advantage Plan or a Medicare drug plan.

 Medicare is divided into several parts, each covering different aspects of healthcare:

1. Medicare Part A (Hospital Insurance): Helps cover inpatient hospital care, skilled nursing facility care, hospice care, and some home health care services.
2. Medicare Part B (Medical Insurance): Covers medically necessary services like doctor visits, outpatient care, preventive services, and certain durable medical equipment.
3. Medicare Part C (Medicare Advantage): This is an alternative to Original Medicare (Part A and Part B) and allows beneficiaries to receive their Medicare benefits through private insurance plans approved by Medicare. These plans often include additional benefits like prescription drug coverage and may have different costs and provider networks.
4. Medicare Part D (Prescription Drug Coverage): Provides coverage for prescription medications through private insurance plans that are approved by Medicare. 

When you have Medicare and other health insurance (like from your job), one will pay first (called a “primary payer”) and the other second (called a “secondary payer”).

If you have other insurance, who pays first depends on a number of items, like if you’re still working, the type of insurance you have, and if you have a special situation, like End-Stage Renal Disease (ESRD).

Get details if you’re working past 65, or getting ready to retire.

Find out who pays first in your situation.