When you’re new to Medicare, it can be difficult to know where to start. It’s complex, and you want to gather as much information as possible to feel confident in selecting the right coverage for you.
Before you dive too far into the details, it’s important to understand some basic information about Original Medicare and how it can help you cover the costs of your health care. Then, we'll take a look at how private Medicare plans can expand on Original Medicare to give you more options.
Medicare is a federal health insurance program that helps cover health care costs for those who qualify. The basic coverage you can receive directly from the U.S. government is called Original Medicare – also known as Medicare Parts A and B.
Medicare Part A covers certain hospital-related expenses you may be charged during a traditional hospital stay, through home health care or in a skilled nursing facility. These can include costs like room fees, meals and more. Part A also covers necessary medical supplies and drugs that are provided in these circumstances.
Medicare Part A does not cover doctor fees, or hospital fees considered medically unnecessary, such as private duty nursing, the television or telephone in your room (if separate charges apply), or personal care items such as razors and slippers.
Medicare Part B covers medical expenses like routine doctor visits, outpatient services and some diagnostic screenings. Part B may cover some medication administered during your visit but not drugs that are prescribed for you to take after the visit.
Most people don’t pay a monthly premium for Part A. However, everyone pays a monthly premium for Part B. And when you need care, you’re also responsible for deductibles, copays and coinsurance.
To be eligible for Medicare, you must be a United States citizen or lawfully present in the United States. You must also:
- Be age 65 or over, OR
- Be under age 65 with certain disabilities, OR
- Have end-stage renal disease
Many people are automatically enrolled in Original Medicare (Part A and Part B) once they're eligible. But not everyone is.
You'll be automatically enrolled in Original Medicare if:
- You're receiving Social Security benefits or Railroad Retirement Board benefits when you turn 65, OR
- You're eligible for Medicare because of a disability or medical condition
You must enroll yourself if you're not receiving Social Security benefits when you become eligible for Medicare.
There are three ways you can enroll yourself in Original Medicare:
Starting when you turn 65, you’ll have an opportunity to enroll in Original Medicare. But if you wait until after your first enrollment window around your 65th birthday, you may have to pay a late-enrollment penalty for Part B or Part D.
It’s a good idea to learn about all enrollment windows so you can take action when the time is best for you.
Your Initial Enrollment Period is your opportunity to enroll in Original Medicare (Parts A and B).
Your IEP is a seven-month window around your 65th birthday:
- The three months before the month you turn 65
- The month of your birthday
- The three months after the month you turn 65
For example, if your birthday falls on June 10, your IEP would start on March 1 and end on September 30. For coverage to start the month you turn 65, you must sign up in the three months before the month of your birthday.
If you don’t enroll in Original Medicare Part B during your IEP, you may have a late-enrollment penalty if you enroll later. The late-enrollment penalty takes the form of higher premiums and lasts for as long as you have Part B.
If you don’t sign up for Medicare Part A and/or Part B when you’re eligible, you can apply for Medicare for the first time using the General Enrollment Period from January 1 through March 31 every year.
This enrollment period is only available to people who didn’t sign up during their Initial Enrollment Period and who aren’t eligible for a Special Enrollment Period (see below). Coverage would begin July 1 of the same year. You may have to pay a higher premium for Part A and/or Part B due to late enrollment.
A Special Enrollment Period lets you enroll in Original Medicare outside of your IEP and the GEP due to certain circumstances, such as losing your employer coverage after the age of 65.
If you qualify for an SEP, you have a certain amount of time to enroll in Original Medicare. The length of time is determined by the type of SEP you are qualified for, but it’s generally between two and three months.
If you or your spouse work past the age of 65, you may not need Medicare until your employer health coverage ends. Every situation is unique, and it’s important to weigh your options to ensure you’re getting the coverage you need.
For example, you might consider:
- Combining an employer health plan and Medicare – It’s possible to have both Medicare and an employer health plan after age 65. One type of plan does not replace the other. Instead, they can work together to ensure your health care needs and expenses are covered.
- Delaying Medicare Parts A and B – Depending on the size of your employer(s), you may be able to delay both Medicare Parts A and B without penalty as long as you or your spouse have employer health coverage. When you do enroll in Medicare, it must be within eight months of losing your health coverage or your last day of work, whichever comes first (see SEPs above).
- Enrolling only in Part A – Most people don’t pay a monthly premium for Medicare Part A, so you could enroll while you or your spouse is still working. However, if you have a health savings account (HSA), be aware that once you enroll in any part of Medicare, you can no longer make contributions to it.
Original Medicare covers the basics. But there are many important health care services that aren’t included, like prescription drug coverage, dental care, hearing exams, eye care and more.
When Original Medicare doesn’t cover all you need, you can explore other parts of Medicare and purchase plans with additional coverage from private insurers – like HealthPartners.
- Medicare Advantage plans – Provide the same coverage as Original Medicare, and they often offer extra benefits like dental and Part D prescription drug coverage
- Medicare Cost plans – Also offer additional perks and benefits, and they work alongside Original Medicare
- Medicare Supplement plans – Help bridge the gaps between what Original Medicare covers and your total expenses for deductibles, copays and coinsurance
- Medicare Part D plans – Help cover the cost of your prescriptions
Some private Medicare plans also have an Annual Enrollment Period (AEP), which gives you an annual opportunity to change your plan if your health care needs evolve.
Last updated October 2021
H2422_001601 Approved 10/1/2021
H2462 H4882_001601 Accepted