Medicare
Overview

Home » Medicare » What Does Medicare Cover? How Does Medicare Work?

This is an overview of information and topics related to Medicare. We also provide in-depth articles on most of these topics, which will provide more specific details and actionable information. Just click through the links if you have questions about any of the programs or plans covered on this page.

Mature man sitting in tan armchair with laptop

What is Medicare? How does Medicare work?

Medicare is a health insurance program provided through the federal government of the United States. It is managed by a government agency called the Centers for Medicare & Medicaid Services (CMS). Medicare coverage is divided into “parts,” which are bundles of related healthcare coverage. Original Medicare, the coverage offered by CMS rather than private carriers, consists of two parts.

  • Part A – Medicare Part A covers hospital-related care and costs
  • Part B – Medicare Part B covers doctor visits, durable medical equipment, and medically-necessary care

Medicare Made Easy Part One: How Medicare Works

Could You Get a Medicare Advantage Plan with Extra Benefits?
Find Out with Our Medicare Plan Comparison Tool.

Who qualifies for Medicare?

Individuals living in the United States who are 65 and older or under 65 on Social Security Disability Benefits are eligible for Medicare coverage.

People who have paid into Medicare taxes for about 10 years receive Medicare coverage with reduced premiums. While Medicare covers people who have not paid those taxes or who have higher incomes, they may have to pay more for Medicare coverage.

Do You Automatically Get Medicare with Social Security?

Some people may be automatically enrolled into Medicare if they’re already receiving Social Security benefits, but many people are not automatically enrolled. Do not assume you will begin receiving coverage when you turn 65. You may have to apply for Medicare through the Social Security Administration.

Private Medicare Plans

In addition to the health coverage provided by the government in Medicare Parts A and B, the Centers for Medicare & Medicaid Services contracts with private insurance companies so they can offer Medicare plans as well. If you are enrolled in Medicare Parts A and B, you will continue to receive 100% of that coverage regardless of any private plan you may choose. These private plans are carefully monitored by CMS to ensure they meet quality standards. In fact, CMS rates each private Medicare plan on a 1-5 star scale based on the coverage provided and consumer experiences.

Looking for Additional Benefits?
Explore Medicare Advantage Plans Online Today

Part C – Medicare Advantage

Medicare Part C (Medicare Advantage) plans are offered as a way to bundle Original Medicare coverage. These plans sometimes offer additional benefits such as:

Image

Medicare Advantage plans may also include prescription drug coverage so you don’t have to have a stand-alone prescription plan.

Part D – Prescription Drugs

Original Medicare does not cover your prescriptions, but obtaining this coverage is strongly encouraged by a fee built into the Medicare program for any time that you don’t have prescription drug coverage.

Prescription drug plans are offered by private companies and include formularies with different costs for different tiers of medications.

Medicare Supplement

Medicare Supplement plans, sometimes also called “Medigap,” do not cover additional benefits beyond Original Medicare. Instead, these plans help cover your copays, deductibles, and coinsurance. Medicare beneficiaries are typically responsible for 20% of each service; a Supplement plan would help you pay that 20%.

Get Medicare Coverage that Fits Your Needs
Explore Medicare Advantage Plans In Your Area

How Much Does Medicare Cost?

Your specific Medicare costs will vary greatly depending on your individual circumstances, but we can help you understand what some of those costs may be.

Part A

  • Premium: Most people don’t pay a premium for Part A. If you didn’t pay Medicare taxes and wish to purchase Part A coverage, you will pay a monthly premium.
  • Deductible: You will have a yearly deductible of about $1,500 in 2022.
  • Coinsurance: You have $0 coinsurance for days 1-60 in the hospital, with increasing costs at day 61 and 91

Part B

  • Premium: You will have a set monthly Part B premium that may change every year. If you have a higher income, you may pay a higher premium.
  • Deductible: Yearly deductible of $233 in 2022. This may change every year.
  • Coinsurance: After paying your deductible, you are responsible for 20% of the Medicare-Approved Amount for doctor services, outpatient therapy, and durable medical equipment.
    • The “Medicare-Approved Amount” is an amount that Medicare has agreed to pay for a certain service. It may be less than that provider usually charges.

Part C

  • Premium: Begins at $0. You must continue paying your Part A and B premiums.
    • According to research by the Kaiser Family Foundation, about two-thirds of enrollees in Medicare Advantage plans paid no additional premiums in 2021. In that same year, the average Medicare Advantage Prescription Drug Plan premium was $21/month.
  • Deductible: Varies by plan.
  • Coinsurance: Varies by plan.

If you are also enrolled in Medicaid or have a low income, you may be eligible for help with your Medicare costs.

What if I’m Eligible for Medicare and Still Working?

Using Medicare coverage may be the right choice for some people who are working. It is very dependent on the coverage offered by your employer, your health, and the Medicare coverage available in your area. There can also be fees related to delaying Medicare coverage, although those are usually waived if you have some other form of “creditable” coverage – essentially something that is close to the standard of coverage that Medicare offers for you.

Read more in our article “Medicare and Still Working Past 65.”

Speak to a Licensed Agent Today

1-800-991-4407 / TTY 711

Mon-Thu 8am-11pm, Fri 8am-9pm, Sat 10am-6pm EST


Privacy Policy | Terms of Use | Contact Us | Content Review Process

e-TeleQuote Insurance Inc. (“e-TeleQuote”), an affiliate of Primerica, Inc., does business as easyMedicare® in all states other than California, Florida and New Mexico. e-TeleQuote is a duly licensed insurance agency appointed by Medicare Advantage HMO, PPO and PFFS plans and stand-alone prescription drug plans and insurance companies holding Medicare contracts approved by The Centers for Medicare & Medicaid Services (CMS). e-TeleQuote is not connected with or endorsed by the U.S. Government or the Federal Medicare Program. Enrollment in any plan for coverage is subject to insurance company approval. Enrollment in the plan depends on the plan’s contract renewal with Medicare. By using e-TeleQuote’s easyMedicare website, you understand and agree that in California, Florida and New Mexico, we operate as e-TeleQuote Insurance, Inc. (Your IP address and/or location coordinates may be gathered to verify your location.) Sales agents/producers may be compensated based on your enrollment in a health plan. Medicare Supplement plans are not connected with or endorsed by the U.S. Government or the Federal Medicare program. e-TeleQuote complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion. easyMedicare.com is a non-government site, powered by e-TeleQuote Insurance, Inc. e-TeleQuote provides a secure way to purchase Medicare insurance from the comfort of your home or workplace. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800–MEDICARE to get information on all of your options.

Last Updated: August 22, 2022 MULTIPLAN_ETQEZMwebsite_0722_M