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Medicare 101

Understanding Medicare: Your guide to the basics

When you’re just getting started with Medicare, it can feel like there’s so much to keep track of. But at the same time, you want to gather as much information as possible so you can feel confident in picking the right plan for you.

That’s where we come in: We’ve helped thousands of people learn the basics of Medicare to make choosing a plan as simple as possible. We’re here to help you, too.

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.

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.

Most people don’t pay a monthly premium for Part A.

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.

Most people pay a monthly premium for Part B. And when you need care, you’re also responsible for deductibles, copays and coinsurance.

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.

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 (in other words, you’ll be responsible for Original 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 several vaccines plus 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 several opportunities to enroll in Medicare. But if you don’t enroll during 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.

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).

We offer affordable options for every lifestyle and budget. You’ll get the benefits you really need – plus added bonuses for even more value.

Medical coverage with extra perks and benefits – plus drug coverage for most plans

Available in parts of Minnesota and Wisconsin

Medical-only coverage with extra perks and benefits

Available in parts of Wisconsin, North Dakota and South Dakota

Coverage that helps fill 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

Last updated October 2023

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