Open enrollment beginsNovember 1Start shopping for plans October 1.
View key datesMedicare is usually explained as four letters. Start somewhere more useful: there are two routes, and the letters are the pieces that make them up.
Medicare is federal health coverage, mostly for people 65 and older. There are two ways to receive it, and nearly everything else is a detail of those two.
People 65 and older. Also people under 65 who have had Social Security disability benefits for 24 months, and people with end-stage renal disease or ALS. Turning 65 does not sign you up automatically unless you already receive Social Security.
Route one is Original Medicare: Part A and Part B, straight from the government, usually with a drug plan added. Route two is Medicare Advantage: a private plan runs your Medicare for you. You pick one. Everything below is a piece of one route or the other.
Hospital stays, skilled nursing after a qualifying stay, hospice, and some home health care. Most people pay no monthly premium for it, because they paid Medicare taxes while working.
Doctor visits, outpatient care, preventive services, lab work and equipment. Part B has a monthly premium. Most people have it taken out of their Social Security payment, and people with higher incomes pay more.
Drug coverage, sold by private insurers. You either buy it alongside Original Medicare or get it built into a Medicare Advantage plan. Every plan has its own list of covered drugs, and that list can change each year.
A private policy that pays some of what Original Medicare leaves you to pay. It only works with Original Medicare, so it cannot be combined with Medicare Advantage. It does not include drug coverage, so Part D is bought separately.
Neither, in general. They are two routes, not a good option and a bad one. Original Medicare lets you see any provider in the country who accepts Medicare, and you usually add a drug plan and often a Medigap policy. Medicare Advantage bundles it into one private plan, usually with drug coverage included and a yearly cap on what you pay, but usually inside a network and with prior authorization rules. Which one fits depends on your doctors, your prescriptions and how much you travel. There is no answer that is right for everyone.
Often not. If you have coverage through your own or your spouse's current employer, and that employer is large enough, you can usually delay Part B without a penalty and pick it up later. Be careful here: retiree coverage, COBRA and marketplace coverage do not count as current employer coverage. Treating them as if they do is one of the more expensive mistakes people make.
If you delay Part B or Part D without a qualifying reason, Medicare adds a surcharge to your premium. For Part B it generally stays there for as long as you have the coverage. The longer you waited, the bigger it is. That is why the seven-month window around your 65th birthday matters even if you feel perfectly healthy.
Two federal programs exist for that. Extra Help lowers what you pay for drug coverage. Medicare Savings Programs, run through the state in Pennsylvania, can help with your Part B premium and other costs. Both have income and resource limits, and both have to be applied for. PA MEDI counselors will check your eligibility free of charge.
Mostly no, and this is the most common misunderstanding about the program. Medicare pays for a short skilled nursing stay after a qualifying hospital admission. It does not pay for ongoing custodial care, meaning help with bathing, dressing or eating. That is paid for by long-term care insurance, by personal savings, or by Medical Assistance for those who qualify financially.
Enough to tell you which system you are dealing with and which official source to read. It is not advice about your situation, and nobody should treat it as such.
Under 65, buying your own coverage
PennieThis is the main case the marketplace was built for. Start a Pennie application and it will tell you what help you qualify for.
Turning 65 within the next year
MedicareYour seven-month window opens three months before your birthday month. If you are on a Pennie plan now, sort out the switch before it closes.
Under 65, on Social Security disability for 24 months
MedicareMedicare is not only about age. Enrollment is usually automatic at the 25th month.
Offered coverage at work
Usually your employer's planIf the offer counts as affordable under the law, premium help is generally off the table, which usually makes the work plan cheaper even when it is unremarkable.
Low income, or you have children
Medical Assistance or CHIPPennsylvania's Medicaid program and CHIP take applications all year. A Pennie application screens you for both automatically.
Between jobs, or you just lost coverage
Pennie, on the clockLosing coverage opens a special enrollment period, generally 60 days from the day it ends. That clock runs whether or not you have decided anything.
None of this is our opinion about how the program works. It is what the agencies that run it publish. If this page and one of these disagree, believe them.
We are a broker, and a broker earns a commission when you enroll. These organizations do not, and every one of them will help you for nothing.
