Medicare
Medicare is government health insurance for those aged 65 and older or for those with disabilities. People can enroll in either Original Medicare or a Medicare Advantage Plan. Medicare is different from private insurance — it doesn’t offer plans for couples or families.
Original Medicare
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Part A Hospital Coverage is usually free to individuals and their spouses who have worked for 10 years, although there is a deductible. Part B covers non-hospital medical expenses and has a premium. Learn more about Part A and B costs and coverage .
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Part D is the optional prescription drug benefit.
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Individuals can see any medical provider who accepts Medicare
Medicare Advantage Plans (MA Plans) also known as Part C
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MA Plans include Part A and B and usually include prescription drug plans. They may also include other supplemental services such as dental, vision, transportation, meals and other supportive services.
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MA plans are often less expensive than Original Medicare; however, individuals must see providers within the plan’s network.
Medicare Supplemental Plans (Medigap)
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Medicare Supplement Insurance (Medigap) is extra insurance bought from a private health insurance company to help pay out-of-pocket costs in Original Medicare.
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There are rules about when a policy can be bought or changed, and once cancelled, it may not be possible to add another plan. Learn more.
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Medicare Savings Plans (MSP) and Extra Help
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MSPs can assist with covering the cost of Medicare premiums and copays. MSPs are administered by each state under their Medicaid program.
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​Extra Help is a Medicare program to help people with limited income and resources pay Medicare drug coverage (Part D) premiums, deductibles, coinsurance, and other costs.
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Enrollment
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Generally, people are eligible to enroll in Medicare the 3 months before or after their 65th birthday.
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If someone does not enroll during their eligibility period, they will incur penalty fees. This applies to Part D as well.
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Open enrollment is from October 15th to December 7th each year. This is the time when people can change plans or add a drug plan. There is no need to re-enroll in Part A or B. There is an additional Medicare Open Enrollment period from January 1 to March 31.
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Understanding your Medicare Plan or Choosing a New Plan
The State Health Insurance Assistance Program provides unbiased individual counseling and assistance and can assist with choosing a new plan (including a drug plan), as well as understanding Medicare benefits and out-of-pocket costs. You can also compare plans at Medicare.gov.
What Does Medicare Cover?
Medicare covers health care services, treatment, hospice care, and equipment that are considered medically-necessary. It will pay for short-term medical care (home health) in the home when ordered by a medical provider and rehabilitation stays. It does not cover non-medical in-home care, long-term skilled nursing facilities, or assisted living.
Appeals
If a person disagrees with a coverage or payment decision, they have the right to appeal. The process varies depending on the specific plan: How To File an Appeal.