Are Medicare and Medicaid the same?
No. Sometimes they get confused. Click here to learn more about Medicaid.
Medicare Parts A–D
Quick, plain-English overviews of what each part covers and typical costs.
Part A: Hospital Insurance
Helps cover care in a hospital or similar setting. Most people pay no premium because they (or a spouse) paid Medicare taxes.
What Part A Covers
- Inpatient hospital stays (room, meals, nursing, services)
- Skilled nursing facility care (limited time, after a hospital stay)
- Hospice care (for terminal illness)
- Some home health care (when conditions are met)
Costs (2025)
- Premium: Usually $0 with 10+ years (40 quarters) of Medicare-taxed work.
- Deductible: $1,632 per benefit period.
- Coinsurance: After 60 days inpatient, daily coinsurance applies and increases with longer stays.
Part B: Medical Insurance
Helps cover outpatient and preventive care. Most people pay a monthly premium.
What Part B Covers
- Doctor visits (including specialists)
- Outpatient services (no hospital admission required)
- Preventive care (screenings, vaccines, annual wellness visit)
- Durable medical equipment (wheelchairs, walkers, oxygen, etc.)
- Some home health care
Costs (2025)
- Standard Monthly Premium: $174.70 (higher-income individuals may pay more).
- Annual Deductible: $240.
- Coinsurance: After deductible, you typically pay 20% of the Medicare-approved amount for most services.
Part C: Advantage Plans
An alternative to Original Medicare. Offered by Medicare-approved private insurers and often bundles medical, hospital, and drug coverage.
What Part C Covers
- All Part A (Hospital) benefits
- All Part B (Medical) benefits
- Many plans include Part D (drug coverage)
- Often adds extras: vision, hearing, dental, fitness
Costs & How Plans Work
- You still pay your Part B premium (some plans have an additional premium).
- Copays, deductibles, and coinsurance vary by plan.
- Each plan has an annual out-of-pocket maximum for A/B services.
- Usually uses networks (HMO/PPO); in-network care is typically lowest cost.
Part D: Prescription Drug Coverage
Helps pay for outpatient prescription drugs. Available as a stand-alone PDP with Original Medicare or within many Medicare Advantage plans (MA-PD).
What Part D Covers
- Prescription drugs on your plan’s formulary (coverage varies)
- Generic and brand-name medications with tiered cost-sharing
- Many vaccines and insulin products (plan rules apply)
How You Can Get Part D
- Standalone PDP with Original Medicare (A & B)
- Included in many Medicare Advantage plans (MA-PD)
Costs (2025)
- Monthly premium: Varies by plan/area; higher-income individuals may owe an IRMAA.
- Deductible & copays/coinsurance: Set by each plan (by drug tier and pharmacy type).
- Protection: A $2,000 annual cap limits covered Part D out-of-pocket; after that, your plan covers covered drug costs for the rest of the year. You may opt into the Prescription Payment Plan to smooth eligible costs across the year.
Important Notes
- If you don’t enroll when first eligible and lack creditable coverage, a monthly late-enrollment penalty may apply as long as you have Part D.
- Always review a plan’s formulary and preferred pharmacies for your exact medications.
Part B: Medical Insurance
Medicare Part B helps cover outpatient and preventive care. Unlike Part A, most people pay a monthly premium for Part B.
What Part B Covers
- Doctor visits (including specialists)
- Outpatient care (no hospital admission required)
- Preventive services (screenings, vaccines, annual wellness visits)
- Durable medical equipment (wheelchairs, walkers, oxygen equipment, etc.)
- Some home health care
Costs (2025)
- Standard Monthly Premium: $174.70 (higher-income individuals may pay more).
- Annual Deductible: $240.
- Coinsurance: After the deductible, you typically pay 20% of the Medicare-approved amount for most services.
Part D: Prescription Drug Coverage
Medicare Part D helps cover the cost of prescription drugs. These plans are offered by private insurers approved by Medicare and can be added to Original Medicare or included in some Advantage plans.
What Part D Covers
- Helps pay for prescription drugs (generic and brand-name).
- Each plan has its own formulary (list of covered drugs).
- Drugs are placed in “tiers” that affect your cost-sharing.
Costs
- You pay a monthly Part D premium (varies by plan).
- Additional costs may include deductibles, copays, or coinsurance.
- Plans have different coverage stages (deductible, initial coverage, coverage gap, catastrophic coverage).
How Plans Work
- You must be enrolled in Medicare Part A and/or Part B.
- Coverage and costs vary by plan and by pharmacy network.
- You may owe a late enrollment penalty if you sign up after you’re first eligible.
Part C: Advantage Plans
Medicare Advantage (Part C) is an alternative to Original Medicare. These plans are offered by Medicare-approved private insurers and bundle your hospital, medical, and often prescription drug coverage into one plan.
What Part C Covers
- All Part A (Hospital Insurance) benefits
- All Part B (Medical Insurance) benefits
- Most plans include Part D (Prescription Drug Coverage)
- Extra benefits not in Original Medicare, such as:
- Vision
- Hearing
- Dental
- Fitness or wellness programs
Costs
- You must still pay your Part B premium (and sometimes an additional premium for the Advantage plan).
- Out-of-pocket costs (copays, deductibles, coinsurance) vary by plan.
- Each plan has an annual out-of-pocket maximum for Part A/B services.
How Plans Work
- Most plans use provider networks (HMO, PPO, etc.).
- You may need to use in-network doctors and hospitals for the lowest costs.
Advantage Plan or Supplement (Medigap)?
When you enroll in Medicare Part B at 65, you choose how to receive your coverage. Here’s a clear, side-by-side look at your two main paths.
How it works
- Offered by Medicare-approved private insurers; you’re still in Medicare, but the plan administers your benefits.
- Includes everything Parts A & B cover; most plans also include Part D (drugs) and extras (dental, vision, hearing).
- Usually lower monthly premiums, but you pay copays/coinsurance/deductibles as you use care.
- Uses provider networks (HMO/PPO); lowest costs in-network.
- Each plan has an annual medical out-of-pocket maximum for Part A/B services.
Good fit if you want
- Bundled medical + drug coverage in one plan (MA-PD).
- Lower premiums and extra benefits (varies by plan).
- OK with provider/pharmacy networks and plan rules.
How it works
- Offered by private insurers but works alongside Original Medicare (Parts A & B).
- You keep all Medicare rights/coverage; Medigap helps pay what Medicare doesn’t (deductibles, coinsurance, copays).
- Higher monthly premium than many MA plans, but little to no out-of-pocket when you use care (depends on plan letter).
- See any doctor/hospital nationwide that accepts Medicare—no networks or referrals.
- Does not include Part D; add a stand-alone drug plan for prescriptions.
Good fit if you want
- Maximum provider freedom and predictable costs.
- Travel flexibility across the U.S. with broad acceptance.
- Separating medical coverage (A/B + Medigap) from drug coverage (Part D).
Quick Comparison
| Feature | Medicare Advantage (Part C) | Medicare Supplement (Medigap) |
|---|---|---|
| How coverage works | All-in-one private plan manages your Medicare benefits | Original Medicare pays first; Medigap helps cover leftovers |
| Provider access | Networks (HMO/PPO); lowest costs in-network | Any provider nationwide who accepts Medicare |
| Drug coverage | Often included (MA-PD) | Not included; add stand-alone Part D |
| Monthly premium | Often lower | Often higher |
| Costs when you use care | Copays/coinsurance/deductibles apply | Typically little to none (by Medigap plan) |
| Annual OOP max (A/B) | Yes, set by the plan | No plan OOP max; Medigap can cover most costs |
When Should I Sign Up?
The best time to enroll depends on your age, work status, and whether you already have health coverage. Here’s a simple breakdown.
Initial Enrollment Period (IEP)
- You’re first eligible at age 65.
- Your window is 7 months: 3 months before your birth month, your birth month, and 3 months after.
- Enrolling during IEP helps you avoid late penalties and coverage gaps.
Special Enrollment Period (SEP)
- If you’re still working at 65 and covered under an active employer group plan (yours or your spouse’s), you can delay Part B (and often Part D) without penalty.
- When that coverage ends, you have an 8-month SEP for Part B to sign up without a late penalty.
- For drug coverage, you generally have up to 2 months (63 days) after losing creditable coverage to enroll in a Part D plan without penalty.
General Enrollment Period (GEP)
- If you miss your IEP and don’t qualify for a SEP, enroll Jan 1–Mar 31 each year.
- Coverage starts the month after you enroll (updated rule; no longer fixed to July 1).
- Late-enrollment penalties may apply for Part B and/or Part D if you went without creditable coverage.
How To File for Medicare
Applying for Medicare is a straightforward process, but it helps to know what to expect. You can apply in one of three ways:
Online
Apply at the official Social Security site. This is typically the fastest and most convenient way to enroll.
By Phone
Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778). A representative can take your application and answer questions.
In Person
Schedule an appointment at your local Social Security office and bring the required documents to complete your application.
Documents You May Need
- Social Security card or record of your number
- Proof of age (birth certificate or equivalent)
- Proof of U.S. citizenship or lawful immigration status
- Current health insurance information (if applicable)
- Employment information if applying under a Special Enrollment Period
How To File for Medicare
Applying for Medicare is a straightforward process, but it helps to know what to expect. You can apply in one of three ways:
Online
Apply at the official Social Security site. This is typically the fastest and most convenient way to enroll.
By Phone
Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778). A representative can take your application and answer questions.
In Person
Schedule an appointment at your local Social Security office and bring the required documents to complete your application.
Documents You May Need
- Social Security card or record of your number
- Proof of age (birth certificate or equivalent)
- Proof of U.S. citizenship or lawful immigration status
- Current health insurance information (if applicable)
- Employment information if applying under a Special Enrollment Period
When Can You Get Medicare?
Most people first become eligible at age 65, but there are other paths. Here’s a simple, up-to-date breakdown.
Age 65 and Older
- You qualify at 65 if you’re a U.S. citizen or a lawful permanent resident who has lived in the U.S. for at least 5 years.
- You may qualify for premium-free Part A if you or a spouse worked and paid Medicare taxes for 10 years (40 quarters).
Under Age 65
- SSDI: Eligible after 24 months of Social Security disability benefits.
- ESRD: Eligible with end-stage renal disease (dialysis or transplant).
- ALS: Eligible the same month disability benefits begin.
Enrollment Periods
- Initial Enrollment Period (IEP): 7 months — 3 before your birth month, your birth month, and 3 after.
- Special Enrollment Period (SEP): If covered by active employer insurance (yours/spouse’s) at 65, you can delay Part B (and often Part D) without penalty; enroll when that coverage ends.
- General Enrollment Period (GEP): Jan 1–Mar 31 if you missed earlier windows. Coverage starts the month after you enroll. Late penalties may apply.
Can You Say No to Part B?
Yes — you can choose not to enroll in Medicare Part B (Medical Insurance) when you first become eligible. But here’s what you need to know before making that choice.
When It Might Make Sense
- If you’re still working at 65 and covered by an employer health plan (yours or your spouse’s), you may be able to delay Part B without penalty.
- Many in this situation wait until retirement or loss of employer coverage to sign up.
Risks of Saying No
- If you don’t have creditable coverage and decline Part B, you could face a late enrollment penalty later.
- The penalty is 10% added to your monthly premium for every 12 months you went without Part B after becoming eligible.
- You may also face coverage gaps, since enrollment is only allowed during certain periods.
Bottom Line
You can say no to Part B — but it’s usually smart to have a strategy in place to avoid lifelong penalties and lapses in coverage.
You Get Six Months to Decide
When you first enroll in Medicare Part B, you begin a six-month Medigap Open Enrollment Period. Here’s why that matters.
Your 6-Month Open Enrollment
- The window begins the month your Part B coverage takes effect.
- During this time, you can buy any Medigap plan sold in your state.
- Companies cannot deny coverage or charge more due to pre-existing conditions.
After the 6 Months
- You can still apply for Medigap later, but you may face medical underwriting.
- Coverage could be denied based on health history.
- Premiums may be higher if you have health conditions.
Key Point: Your six-month Medigap Open Enrollment Period is the best time to get coverage — it’s your one guaranteed window without health questions or extra costs.
How to Choose between Advantage and Supplemental Plans?
When you enroll in Medicare, you’ll face an important decision. Should you choose a Medicare Advantage Plan (Part C) or a Medicare Supplement (Medigap) Plan? The right choice depends on your health, budget, and lifestyle.
Medicare Advantage (Part C)
- Lower monthly premiums (sometimes $0).
- Includes Parts A, B, and often D in one plan.
- May offer extras: dental, vision, hearing, fitness.
- Uses provider networks (HMO, PPO); referrals may be needed.
- You’ll pay copays and coinsurance as you use services.
- Includes an annual out-of-pocket maximum for protection.
Medicare Supplement (Medigap)
- Works alongside Original Medicare (Parts A & B).
- Higher monthly premiums, but very low or no costs when you use care.
- No provider networks — any doctor/hospital in the U.S. that accepts Medicare.
- Does not include drug coverage (Part D must be purchased separately).
- No extras like dental or vision, but offers predictable costs and broad flexibility.
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