What are the four parts of Medicare and what do they cover?
Medicare is a federal health insurance program that serves people ages 65 or older, certain people under age 65 with disabilities, and people of any age with End Stage Renal Disease. A beneficiary is someone enrolled in Medicare.
You are eligible for Medicare when you turn 65 or have been receiving Social Security Disability payments for 24 months.
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. Each year, you can choose which way you get your health coverage (and add or switch drug coverage).
Medicare has four parts:
Medicare Part A is hospital insurance. It covers inpatient hospital, skilled nursing facility, hospice, inpatient rehabilitation, and home health care services.
Medicare Part B is medical insurance. It covers physician services, outpatient hospital services, certain home health services, durable medical equipment, certain medications, and other medical and health services not covered by Medicare Part A.
Medicare Part C is a choice of private health care plans called Medicare Advantage.
Medicare Part D is prescription drug coverage.
How does Medicare work?
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.
Original Medicare includes Medicare Part A and Part B. Medicare prescription drug coverage (Part D) is available through purchasing a separate Medicare drug plan. Original Medicare is available anywhere in the United States at any provider who accepts Medicare. Original Medicare does not require you to have a primary doctor but does not cover medical costs incurred outside the United States. Visit How Original Medicare works | Medicare to learn more.
Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private insurance company that works with Original Medicare to help pay your share of costs. There are 10 different types of standard Medigap plans, each named by a letter of the alphabet (Plans A-N). Each plan (A-N) covers different things, but the benefits are the same for plans of the same letter no matter what insurance company you purchase the plan from. Medigap policies do not include prescription drug coverage. You can join a Medicare Prescription Drug Plan (Part D) separately. Medigap policies generally don't cover long-term care, vision, or dental care, hearing aids, eyeglasses, or private-duty nursing.
Medicare Advantage (Part C) is a Medicare-approved private insurance plan sold by a private insurance company that offers an alternative to Original Medicare for health and drug coverage. These bundled plans include Part A and Part B and can have different rules for how you get services. They may cover additional services such as prescriptions (Part D), dental, vision, hearing aids, and other services. You need to use doctors who are in the plan's network. Plans must cover all emergency and urgent care and almost all medically necessary services Original Medicare covers. They may cover emergency medical expenses outside the service area including foreign travel. Some plans tailor their benefit packages to offer additional benefits to treat specific conditions.
How much does Medicare cost?
Part A – If you've paid Medicare taxes for 10+ years, there is no premium for Part A. The Medicare Part A inpatient hospital deductible is $1,632 in 2024.
Part B – In 2024 the monthly premium is $174.70. Higher income beneficiaries will pay a higher Part B premium. Limited income beneficiaries may qualify for Medicare Savings Programs that help pay for Medicare Part A and B costs. The annual deductible for all Medicare Part B beneficiaries is $240 in 2024.
- If you delay in signing up for Part B there is a 10% late enrollment penalty for every 12 months without coverage and, in most cases, the penalty will be paid every month for life.
- You can delay signing up for Part B without penalty if you are actively employed and covered by your Employer Group Health Plan or are covered by your spouse's Employer Group Health Plan.
- Medicare Part B late enrollment penalties can be eliminated by qualifying for one of the Medicare Savings Programs.
Part D – In 2024 the average basic monthly premium is approximately $34.50; prices vary by location and plan and can change every year. Limited income beneficiaries may qualify for Extra Help that helps pay for coverage and prescriptions.
If you delay signing up for a Part D prescription drug plan for 63 days or more, there is a late enrollment penalty. The Part D penalty depends on how long a beneficiary was without creditable drug coverage.
You can delay signing up for Part D without penalty if you have creditable prescription drug coverage from another source like an employer plan or from the Veterans Administration.
Medicare Part D late enrollment penalties can be eliminated by qualifying for Extra Help.
Medicare Advantage (Part C) – The average monthly Medicare Advantage premium is $27.94 in 2024. There are 281 plans available in Pennsylvania; prices vary by location and plan and can change every year.
Medicare Supplement Insurance (Medigap) – In 2024 the monthly premiums range from $90 - $175 in Pennsylvania. Premiums vary based on which policy you buy, where you live, and other factors. The amount can change each year. You must also keep paying your Part B premium to keep your supplement insurance.
For more information visit What does Medicare cost? | Medicare. PA MEDI can help you compare Part C, Part D and Medigap plan costs in your local area. Call your local PA MEDI program or the PA MEDI Helpline at 1-800-783-7067 for assistance.
When and how can I sign up for Medicare, a Medicare health or drug plan?
You can sign up for Medicare A and B starting 3 months before you turn 65 and ending 3 months after the month you turn 65. This is called your Initial Enrollment Period.
You can create a secure Medicare account that lets you access your information anytime. It gives you a summary of your current coverage, you can add your drugs & pharmacies, and use your saved drugs & pharmacies to compare plan costs. Medicare.gov - Log in or create an account
If you are collecting Social Security benefits prior to turning 65, Social Security will automatically enroll you in Medicare A and B and send you a card. If you're not already collecting Social Security benefits before you turn 65, you'll need to sign up for Medicare online with Social Security at Sign up for Medicare | SSA or by calling 800-772-1213. PA MEDI can also help you sign up for Medicare and help you explore your options.
If you are under 65 and receiving Social Security Disability payments, you will automatically be enrolled in Medicare at the at the beginning of the 25th month you receive a Social Security Disability payment.
What if I am still working when I turn 65?
If you (or your spouse) are still working when you turn 65, Medicare works a little differently. Ask the employer that provides your health insurance if you need to sign up for Part A and Part B when you turn 65. Visit Working past 65 | Medicare for more information.
The best time to buy a Medigap policy (Medicare Supplement) is during your Medigap Open Enrollment Period. This is a one-time 6-month period that starts the first day of the month you're 65 or older and signed up for Part B. During that time, you can buy any Medigap policy sold in your state, even if you have pre-existing conditions. After this period, your options to buy a Medigap policy may be limited, the policy may cost more, and you may be subject to medical underwriting.
If you miss your 7-month Initial Enrollment Period, you can sign up during the Medicare General Enrollment Period, January 1 – March 31, and your coverage will start the following month.
During Medicare Annual Open Enrollment Period, October 15 – December 7, you can join, switch, or drop Medicare Advantage, or Prescription Drug Plans for new coverage starting January 1. Open Enrollment is the time to think about what benefits will matter to you and compare your options for the next year.
During Medicare Advantage Open Enrollment Period, January 1 – March 31, you have one chance to switch Medicare Advantage Plans or drop a Medicare Advantage Plan and return to Original Medicare with or without a Part D plan. Coverage will begin the month after the plan receives your enrollment.
During Special Enrollment Periods (SEP) you can make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life, like if you move or you lose other insurance coverage. Rules about when you can make changes and the type of changes you can make are different for each SEP. More information can be found here Special Enrollment Periods | Medicare
PA MEDI can help you year-round and during enrollment periods. Call your local PA MEDI program or the PA MEDI Helpline at 1-800-783-7067 for assistance.
How do I shop for a Medicare Supplement (Medigap)?
Medigap is extra insurance you can buy from a private insurance company that works with Original Medicare to help pay your share of costs and can be used anywhere in the United States that accepts Medicare. Under federal law, you get a one-time 6-month Medigap Open Enrollment period. It starts the first month you have Medicare Part B and you're 65 or older. During this time, you can enroll in any Medigap policy and will generally get better prices and more choices among policies. After this period, you may not be able to buy a Medigap policy, it may cost more, and you may be subject to medical underwriting.
Medigap policies do not include prescription drug coverage. You can join a Medicare Prescription Drug Plan (Part D) separately. Medigap policies generally don't cover long-term care, vision, or dental care, hearing aids, eyeglasses, or private-duty nursing.
There are 10 Medigap plan options available, A, B, C, D, F, G, K, L, M, and N. Each lettered plan has different, yet standardized, benefits and coverage that must follow federal and state laws. Compare the coverage of each lettered plan and choose the plan letter that covers what you need. Once you've decided on a plan letter, compare the price of that plan letter offered by different insurance companies. PA MEDI can help you compare plan benefits and costs or you can also visit Find a Medigap policy that works for you (medicare.gov) to compare plans.
How do I shop for a Medicare Advantage Plan?
Medicare Advantage (Part C) is a Medicare-approved private insurance plan sold by a private insurance company that offers an alternative to Original Medicare for health and drug coverage. You need to use doctors who are in the plan's network. Medicare Advantage plans vary by insurance company and location. Some plans may cover additional services such as prescriptions (Part D), dental, vision, hearing aids, and other services. Keep in mind television commercials and mailings for Medicare Advantage plans may showcase special perks and benefits and that may not be available in your area.
Take the time to shop and compare. Ask these questions:
- What are my health needs? Does the plan provide good coverage for those conditions?
- What are the plan's co-pays, monthly premium, and maximum out-of-pocket costs?
- Are my doctors and hospitals in the plan's network?
- Do I plan to travel frequently? Does the plan have a national network of doctors and hospitals? Does the plan cover international travel?
- Does the plan's formulary cover my medications? Can I use my local pharmacy?
- Does the plan cover services like physical rehabilitation, ambulance use, prescription drug coverage, dental care, and vision services? Does the plan provide extra benefits? Are those benefits and services available in my area?
- Every year, Medicare evaluates plans based on a 5-star rating system. What is the plan's star rating?
Read the plan documents carefully before you choose a plan and make sure you understand any coverage rules that may affect your costs. PA MEDI can help you understand what is covered and compare available plans in your area, or you can visit Explore your Medicare coverage options to compare.
How can I save money on my Medicare costs?
Medicare Savings Programs (MSP) help with Medicare Part A and B costs. If you have limited income and resources, you may qualify for one of these programs potentially saving you over $1,900 each year. These programs are administered by the Pennsylvania Department of Human Services. You can apply online: www.compass.state.pa.us, by phone: 1-866-550-4355 or call PA MEDI for help at 1-800-783-7067.
Extra Help works with any Medicare Part D prescription drug plan to lower the costs of premiums and prescription drug costs. If you have limited income and resources, you may qualify for Extra Help. Also known as Low Income Subsidy or LIS, Extra Help is administered by the Social Security Administration. You can apply online Apply for Medicare Part D Extra Help program | SSA or call PA MEDI for 1-800-783-7067.
You can reapply for these programs even if you have been denied in the past!
For additional information and resources about the Medicare Savings Programs and Medicaid/Medicare Dual Eligibly, visit Pennsylvania Health Law Project's Resource Library: Self-Help Materials | PHLP.
If I don't qualify for Medicare Savings Programs or Extra Help, are there other ways to save money on Medicare costs?
You can look for cost savings by comparing Medicare Advantage and Part D prescription drug plans available in your area Explore your Medicare coverage options when you first sign up for Medicare or during the Medicare Annual Open Enrollment Period (October 15 – December 7) or the Medicare Advantage Open Enrollment Period (January 1 – March 31). PA MEDI can also help explore your options and look for ways to save money.
Pennsylvania's prescription assistance programs for older adults, PACE and PACENET, offer low-cost prescription medication to qualified residents, age 65 and older. The program works with Medicare Part D plans and other prescription drug plans such as retiree/union coverage, employer plans, Medicare Advantage, and Veterans Benefits to lower out-of-pocket costs for medications. Visit PACE Program for more information.
Using your Medicare Preventive Benefits can save you money by keeping you healthy! Many preventive care services are covered at a low or no cost:
Screenings – COVID-19 testing, cervical cancer, prostate cancer, diabetes, depression, HIV, Hepatitis C and more
Wellness – One-time "Welcome to Medicare" preventive visit and yearly "Wellness" visit
Counseling – Obesity, alcohol & tobacco use cessation, STIs and mental health
Shots – COVID-19 vaccines and boosters, Flu, Pneumococcal, Hepatitis B and Shingles
Nutrition – Diabetes self-management training and nutrition therapy services
Talk to your doctor about preventive services available to you through Medicare or visit preventive services (medicare.gov).
What do my Medicare notices mean?
Medicare & You Handbook – Arrives in September and gives you a summary of Medicare benefits, rights, and protections; lists of available health and drug plans; and answers to frequently asked questions about Medicare. Medicare & You | Medicare
Annual Notice of Change (ANOC) – Arrives in September and tells you about upcoming changes in your Medicare Advantage or prescription drug plan's coverage, costs, and more.
Evidence of Coverage (EOC) – Arrives in September and gives you details about what your Medicare Advantage or prescription drug plan covers, how much you pay, and more.
Medicare Summary Notice (MSN) – Arrives every 3 months if you have Original Medicare and got medical services or supplies during that 3-month period.
Explanation of Benefits (EOB) – Arrives after you received medical services through a Medicare Advantage Plan.
For specific billing questions and questions about your claims, medical records, or expenses, log into your secure Medicare account, or call PA MEDI at 1-800-783-7067 for assistance.
How can I file a Medicare appeal?
An appeal is the action you can take if you disagree with a coverage or payment decision by Medicare or your Medicare Advantage plan. For example, you can appeal if Medicare or your plan denies:
You can also appeal:
A request for a health care service, supply, item, or drug you think Medicare should cover.
A request for payment of a health care service, supply, item, or drug you already got.
A request to change the amount you must pay for a health care service, supply, item, or drug.
- If Medicare or your plan stops providing or paying for all or part of a health care service, supply, item, or drug you think you still need.
- An at-risk determination made under a Drug Management Program that limits access to coverage for frequently abused drugs, like opioids and benzodiazepines.
Medicare & You | Medicare Section 8 "Your Medicare Rights & Protections" contains more in-depth, detailed information regarding appeals and how to file a complaint. PA MEDI certified counselors can assist you with questions and help you through the appeal process, call your local PA MEDI program or the PA MEDI Helpline at 1-800-783-7067 for assistance.
How do I protect myself from Medicare fraud?
Scammers use many ways to steal your identity and commit health care fraud. Here are tips to protect yourself:
Protect – Never give any personal information such as your Medicare ID or social security number to callers, people who come to your door, or vendors at a health fair offering for a "free" service or health care screening. Also remember that Medicare and Social Security do not call you and ask for personal information, nor do they sell products. Also protect your personal information when you are placing calls.
Detect – Keep a personal health care journal or calendar of all your health care visits and services (tests, hospital stays, equipment, etc.) Compare these records to your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) statements to detect any inaccuracies.
Report – If you suspect Medicare Fraud or you question something on your statements, please contact your provider. If you require further assistance, please contact Pennsylvania Senior Medicare Patrol at 800-356-3606 or Senior Medicare Patrol - CARIE Elderly Advocates.
If you believe you made the wrong plan choice because of inaccurate or misleading information, including using Plan Finder on Medicare.gov, PA MEDI can help you throughout the year with options for making changes.
Remember, the best source of information is from Medicare itself (Medicare.gov, 1-800-MEDICARE) and its trusted partners, PA MEDI at 1-800-783-7067, and Pennsylvania Senior Medicare Patrol at 800-356-3606.