How does Medicare work?

Generally, you only need to sign up for Part A and Part B once. Each year, you can choose which way you get your health coverage (and add or switch drug coverage).

Medicare is different from private insurance — it doesn’t offer plans for couples or families. You don’t have to make the same choice as your spouse.

2 steps to set up your Medicare coverage:

1. Sign up for Part A (Hospital Insurance) and Part B (Medical Insurance)
   You can sign up at certain times. Check when and how to sign up.
2. Choose which way you want to get your Medicare health coverage
   You can choose either Original Medicare or Medicare Advantage (Part C) for your health coverage. If you choose Original Medicare, you’ll also decide if you want drug coverage (Part D) and supplemental coverage, like Medigap .

You’ll have Original Medicare unless you join a Medicare Advantage Plan.

How does Original Medicare work?

Original Medicare includes two parts: Part A (Hospital Insurance) and Part B (Medical Insurance) . 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'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.

How does Medicare Advantage work?

Medicare Advantage bundles your Part A, Part B, and usually Part D coverage into one plan. Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.

You join a plan offered by Medicare-approved private companies that follow rules set by Medicare. Each plan can have different rules for how you get services, like needing referrals to see a specialist. Costs for monthly premiums and services you get vary depending on which plan you join.

Plans must cover all emergency and urgent care, and almost all medically necessary services Original Medicare covers. Some plans tailor their benefit packages to offer additional benefits to treat specific conditions.

With Medicare Advantage, you:

• Need to use doctors who are in the plan’s network (for non-emergency or non-urgent care).
• May pay a premium for the plan in addition to the monthly Part B premium. Plans may have a $0 premium or may help pay all or part of your Part B premiums.
• Can’t buy separate supplemental coverage (like Medigap).

You must have both Part A and Part B to join a Medicare Advantage Plan.

How does Medicare work with my other insurance?

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).