Medicare

Understand the main parts of Medicare

Medicare is federal health insurance mainly for people age 65 and older, and for some younger people with qualifying disabilities or conditions. Its parts cover different needs.

• Part A helps with inpatient hospital care and certain other services.
• Part B helps with doctor visits, outpatient care and many preventive services.
• Part D provides prescription drug coverage through private plans.
• Part C, or Medicare Advantage, is a private-plan way to receive your Medicare benefits.

Original Medicare and Medicare Advantage

Original Medicare includes Parts A and B. You can add a separate Part D drug plan. Medicare Advantage provides Part A and Part B benefits through a Medicare-approved private plan, usually with drug coverage included.

When comparing the two routes, check which doctors you can use, referrals and prior authorization, costs when you receive care, and coverage while traveling. A Medicare Advantage plan may use a provider network. Additional benefits should be weighed alongside your everyday medical and prescription needs.

Where does Medigap fit?

Medigap is separate insurance that helps with some of your share of costs under Original Medicare. It is not a way to pay Medicare Advantage copayments. Buying rights and available policies depend on your circumstances and state.

Check your Medigap enrollment rights before changing coverage. Leaving a Medicare Advantage plan does not always mean you can later buy any Medigap policy you want without health-related conditions. Medicare.gov explains how Medigap works.

Compare your real yearly costs

Write down all the premiums you would pay, then the deductibles, copayments and coinsurance for the care you use. A plan advertised with a $0 plan premium can still have other costs. Ask which Medicare premiums you must continue paying.

Use your own list of medicines, strengths, refill frequency and pharmacies when comparing drug coverage. Check the cost for each prescription and any approval rules. Repeat this check when reviewing coverage for a new year; do not rely on an old list.

Get the timing right

Enrollment rules depend on whether you are first becoming eligible, changing a plan or qualifying for a special enrollment opportunity. Employer coverage and retirement dates can also affect the questions you need to ask.

Before making a change, confirm your enrollment window, effective date and any effect on existing coverage. Ask about potential late-enrollment penalties if you are thinking of delaying. Use official guidance for the dates that apply to you rather than assuming one deadline fits everyone.

Prepare for a helpful plan conversation

• List your doctors, hospitals, prescriptions and preferred pharmacies.
• Have your current coverage details and intended start date ready.
• Note time spent in another state or overseas.
• Ask for a written breakdown of premiums and costs for your usual care.
• Check which plans the person helping you can actually compare.

You can compare Medicare plans on Medicare.gov and get independent local help through your State Health Insurance Assistance Program at SHIPhelp.org. Here4Insurance is an independent information site, not Medicare or a government agency.