Medicare Made Easy: Beginner’s Medicare Overview
Last Updated : 08/30/20196 min read
If you’re new to Medicare and not sure what to start, this Medicare overview was written for you. From how it all works to how to enroll, our Medicare overview breaks down the basics to help you get started.
Medicare made easy
Medicare is a government health-care program for older Americans. Some people under 65 may qualify for Medicare because of disability or certain health conditions.
No Medicare overview would be complete without explaining the different “parts” of Medicare:
- Part A is hospital coverage and generally includes services you’d get in a hospital, skilled nursing facility, or hospice setting. Browse our Medicare overview of Part A.
- Part B is medical coverage and may include outpatient services like preventive services, doctor visits, and durable medical equipment. Find our Medicare overview of Part B.
- Part C refers to the Medicare Advantage program. Medicare Advantage plans cover Part A and Part B services through Medicare-approved private insurance companies. Here’s our Medicare overview of Part C.
- Part D is prescription drug coverage, available through Medicare-approved private insurance companies. You don’t get it automatically. Here’s a helpful Medicare overview of Part D.
Medicare overview: your coverage choices
When you’re first eligible for Medicare, you usually get Part A and Part B (see below for more on enrollment). But once you have Medicare, there are actually two main ways you can get your coverage. As our Medicare overview will show, how you get your Part A and Part B benefits also affects the other types of coverage you can get.
- You can stay with Original Medicare.
If you go this route, you can enroll in a stand-alone Medicare Part D prescription drug plan for help with medication costs. You might also be able to buy a Medicare Supplement plan if you’d like help with certain out-of-pocket costs in Original Medicare. Take a look at this Medicare Supplement overview.
- You can enroll in Medicare Advantage, in most cases.
Medicare Advantage plans must include at least the same level of coverage as Medicare Part A and Part B.
Most Medicare Advantage plans include prescription drug coverage. Many also offer other extra benefits that Original Medicare doesn’t cover, such as routine vision or dental, wellness programs, and hearing. Here’s an overview of additional benefits that Medicare Advantage may cover.
Please note that Medicare Supplement insurance doesn’t work with Medicare Advantage plans. When you’re deciding what type of coverage to get, don’t plan on having both Medicare Advantage and Medicare Supplement coverage at the same time.
Medicare overview: what Medicare coverage is right for me?
This Medicare overview may be a good starting point in your research, but only you can decide the type of coverage that may fit your situation. Here’s a summary of some things to consider:
Medicare overview of Original Medicare (Part A and Part B)
- Doesn’t have provider networks.
- Doesn’t require you to get a referral to see a specialist.
- Doesn’t cover everything, such as most prescription drugs you take at home, or routine vision or dental care. You can enroll in a separate Medicare Part D prescription drug plan.
- Doesn’t have a yearly out-of-pocket limit.
- May come with certain costs, like premiums, deductibles, and coinsurance/copayments.
Medicare overview of Medicare Advantage
- May have a provider network, depending on the plan type.
- May require a referral to see a specialist, depending on the plan type.
- May come with extra benefits.
- Often includes prescription drug benefits.
- Has a yearly out-of-pocket limit, which varies by plan.
- Requires you to enroll in Medicare Part A and Part B, and live within the plan’s service area.
As you can see from this Medicare overview, your preferences and needs may affect your choice of coverage. For example, you might prefer Original Medicare’s lack of provider networks if you travel often within the U.S. Or, if you like the convenience of having your Medicare benefits in one plan, Medicare Advantage might be an option.
Here’s a helpful Medicare overview comparing Original Medicare and Medicare Advantage.
Medicare overview: how to enroll
Our Medicare overview can’t emphasize this enough: it may be important to enroll as soon as you’re eligible. For most people, this is their Initial Enrollment Period, the seven-month window when they’re first eligible for Medicare. If you wait to enroll, you might have to pay higher premiums later because of late enrollment penalties.
What you need to do to sign up for Medicare depends on your situation. Many people are automatically enrolled in Part A and Part B. But some people need to sign up for Part A and/or Part B. Here’s a Medicare overview of a couple different enrollment periods for Medicare.
You can sign up for Medicare through Social Security online, by phone, or in person. Or, if you worked for a railroad, you can contact the Railroad Retirement Board.
Medicare overview: after you have Medicare
After you’re signed up for Medicare, your coverage isn’t set in stone. There are set times of the year when you can usually make changes, and it’s sometimes a good idea to take advantage of them.
You may want to review your Medicare coverage every year. If you have a Medicare Advantage plan or a stand-alone Medicare Part D prescription drug plan, they’ll send you a notice every fall. It’s called the Annual Notice of Change, and it tells you about any changes that might affect your coverage. You may want to check if your plan still covers your prescriptions, for example, or if your cost-sharing has gone up.
One of the most important time periods can be the Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage (October 15 to December 7 of every year). This is your chance to do a yearly coverage checkup. And, if you’re not happy, you can usually switch plans, disenroll from your current plan, and more.
Outside of set enrollment periods, you might be limited to making changes only in special situations.
Medicare overview: finding Medicare plans
We hope this Medicare overview has given you a good starting point for understanding your options.
If you’re ready to explore Medicare plan options, you can get started right now. Just enter your zip code into the plan finder tool on this page. If you like, you can enter your prescription drugs and even doctors to find plan options that may cover your medications and providers.
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