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Medicare 101

Understanding Medicare: Your guide to the basics

With Medicare, sometimes it’s hard to know where to start. It can be complex, and you want to gather as much information as possible to feel confident in selecting coverage that meets your needs. We make learning about Medicare as simple as possible.

On this page, you can find information about:

Get to know Medicare

Medicare is a federal health insurance program that helps cover health care costs for those who qualify. The coverage you can receive directly from the U.S. government is called Original Medicare – also known as Medicare Parts A and B.

Most people don’t pay a monthly premium for Part A. However, most people do pay a monthly premium for Part B. And when you need care, you’re also responsible for deductibles, copays and coinsurance.

Medicare Part A

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

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 and a limited number of outpatient prescription drugs under certain conditions.

Original Medicare covers the basics but not much more. There are many important services that Original Medicare doesn’t include, like prescription drug coverage, routine hearing exams and eye care.

When you need more coverage than Original Medicare, consider enrolling in a plan that includes additional coverage from a private insurer like HealthPartners.

Here are some things to keep in mind about private Medicare plans:

  • Your choice of plans will depend on where you live. Different plans are offered in different counties.
  • Each plan has its own premium, deductible, copay and out-of-pocket maximum amounts. It’s a good idea to compare plans to make sure you choose one that meets your needs.
  • Once you enroll in a private Medicare plan, you don’t need to renew it each year, but you’ll have opportunities to switch plans if your needs change.

Medicare Advantage plans

Medicare Advantage plans combine the coverage of Original Medicare Parts A and B into one plan (often called Part C), giving you the convenience of one plan for all your coverage. They usually offer additional benefits and perks on top of Original Medicare, such as dental, and most plans typically include Part D prescription drug coverage.

All HealthPartners Medicare Advantage PPO plans received an overall Medicare Star Rating of 5 out of 5 for 2023. That’s the highest score possible, and it all comes back to our commitment to great customer service and helping members reach their best health.

Medicare Cost plans

Medicare Cost plans also offer additional benefits and perks on top of Original Medicare. While Medicare Advantage plans take the place of Original Medicare, Cost plans work alongside Original Medicare. In addition, if you go out of network for care, your Original Medicare benefits will kick in for covered services (you’ll be responsible for the Medicare cost-sharing amounts).

Medicare Supplement plans

Medicare Supplement plans help bridge the gaps between what Original Medicare covers and your total expenses for deductibles, copays and coinsurance. When you receive care, Original Medicare will pay its share for covered services, then your Medicare Supplement plan will pay its share. You’ll be responsible for any remaining cost not covered by your Supplement plan. (Medicare Supplement plans don't include Part D coverage.)

Medicare Part D plans

Medicare Part D helps cover the cost of outpatient prescription drugs, like the ones you take at home. You can enroll in a stand-alone Part D plan to add drug coverage to Original Medicare, a Medicare Cost plan or a few other types of plans. But remember: If you want the convenience of one plan for all your coverage, most Medicare Advantage plans include Part D coverage.

Medicare eligibility

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 (eligible for Medicare Advantage plans only)

Starting when you turn 65, you’ll have an opportunity to enroll in 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) or a private Medicare plan.

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. You can also sign up for most private Medicare plans at this time.

This enrollment period is usually 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 the month after you sign up. 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 or most private Medicare plans 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. 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.

How to enroll in Medicare

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 in Original Medicare 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:

  1. Enroll online through the Social Security Administration
  2. Call the Social Security Administration at 800-772-1213 (TTY 800-325-0778), 8 a.m. to 7 p.m., Monday - Friday
  3. Enroll in person at your local Social Security office

For private Medicare plans, you can enroll at the same time as your automatic enrollment or self-enrollment in Original Medicare. If you first enrolled in Original Medicare but later want to enroll in a private Medicare plan, you’ll have an opportunity to do so every year during the Annual Enrollment Period (AEP).

With more than 60 years of experience and service, we’re here to help you find a Medicare plan that works for you.

Medical and drug coverage with extra perks and benefits

Available in select counties in Minnesota and Wisconsin

Medical-only coverage with extra perks and benefits

Available in select counties in Wisconsin, North Dakota and South Dakota

Medical-only coverage that fills the gaps in Original Medicare

Available statewide in Minnesota

Looking for plans in Iowa or Illinois? Our friends at HealthPartners UnityPoint Health are ready to help.

Legal information

Every year, Medicare evaluates plans based on a 5-star rating system.

Last updated January 2023

H2422_002804 Approved
H2462 H4882_002804 Accepted