New To Medicare? Start Your Journey Here

Whether you’re retiring soon or turning 65, we want you to feel confident in your move to Medicare. Learn what you need to get started, including the parts of Medicare, costs, and when to enroll.

 

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What Is Medicare?

 

Medicare is a federal health insurance program designed for people aged 65 or older and younger people with certain health conditions. It helps pay for hospital, medical, and other healthcare costs.

Understanding Parts A And B (Original Medicare)

 

Put simply, Medicare Part A is your hospital insurance and Medicare Part B is your medical insurance. Together, they’re known as Original Medicare.

 

Once you’re eligible for Medicare, signing up for Medicare Parts A and B is your first step. Most people apply through the Social Security Administration during their seven-month Initial Enrollment Period, which includes the three months before the month of their 65th birthday through the three months after their 65th birthday.

 

If you’re still working and have healthcare coverage via your employer, you may want to delay your Part B enrollment.
 

Read Our Eligibility And Enrollment Article 
 

Read Our Article About Enrollment When Turning 65 

Original Medicare Coverage And Costs*

 

Medicare Parts A and B cover much of the healthcare you’ll need, but not everything. Here’s a quick summary:

   

 

Part A – Hospital Insurance

 

 

Part B – Medical Insurance

 


What it covers


Inpatient care including:

 

Hospital stays

 

Skilled nursing facility care

 

Hospice

 

Some at-home care
 


Outpatient care including:

 

Physician visits

 

Lab tests

 

Surgeries

 

Preventive health appointments

 

Outpatient services

 

Durable medical equipment
 


Premium (monthly plan fee)

 

$0

Per Month

For most people**
 

 

$174.70

PER MONTH

For most people
 


Deductibles (amount paid out of pocket before Medicare starts to pay)

 

$1,632

Per inpatient hospital benefit period

Starts when you’re admitted for inpatient care and ends 60 days after your release from a hospital or a skilled nursing facility.
 

 

$240

PER year


Copays/coinsurance (out of pocket costs per day or visit to a hospital or doctor)


Inpatient hospital stays per day:


$0 
for days 0-60 after deductible


$408
per days 61-90


$816
 per days 91-150
  

After day 150 you pay all costs.
 


You generally pay:


20%
Medicare-approved amount for the Medicare-covered services you use, with no annual out-of-pocket maximum.


80%
Remaining amount paid by Medicare
 

Source: https://www.medicare.gov/basics/costs/medicare-costs 


*Costs listed are based on 2024 rates

**Your Part A monthly premium will be $0 if you or your spouse had Social Security payroll deductions for at least 10 years.

Want More Coverage? You Have Options


Most people need additional coverage over Original Medicare. They typically select a Medicare Supplement or Medicare Advantage plan, which help pay for more costs and may include extra benefits or programs. These plans are offered by private insurance companies, like Anthem. 


 

Medicare Supplement Plans (Medigap)


These plans work with your Original Medicare plan to help cover out-of-pocket costs like deductibles, copays, and coinsurance. One important benefit is that these plans allow you to visit any doctor or facility that accepts Medicare patients,1 even while traveling.

Medicare Supplement plans do not include prescription drug coverage, so you may want to purchase a Part D plan.


 

Prescription Drug Plans (Medicare Part D)


Original Medicare only covers prescription drug costs for hospital or inpatient care. Part D prescription drug plans help cover costs for generic and brand name prescriptions, all recommended vaccines, and medical supplies for insulin injections. Stand-alone Part D plans can be added to Original Medicare or Medicare Supplement plans for an additional premium. Part D coverage is included in most Medicare Advantage plan benefits. You may also qualify for prescription drug assistance through the federal program, Extra Help .


 

Medicare Advantage (Part C) Plans



Medicare Advantage plans are comprehensive plans with $0 or low monthly premiums. They provide all the coverage of Original Medicare plus extra benefits like prescription drug, dental, vision, and hearing coverage. They’re popular among those who want one plan for their needs.

 

If you’re eligible for Medicare and Medicaid, you could get a Dual Special Needs Plan (D-SNP) with benefits for little or no cost.

How To Choose What’s Right For You


Once you’ve signed up for Original Medicare, you can choose additional health coverage based on your needs. Compare the plans to find what’s best for you.


What’s included

Parts A And B (Original Medicare)

Medicare Supplement (Medigap)

Medicare Advantage (Part C)


Hospital and medical insurance
 

 

yes

 

 

yes

 

 

yes

 


Visit any doctor or hospital accepting Medicare patients
 

 

yes

 

 

yes1

 

 

no

 


Prescription drugs2
 

 

no

 

 

no

 

 

yes

 


Limited annual out-of-pocket costs

 

no

 

 

yes

 

 

yes

 


Dental, vision, hearing coverage

 

no

 

 

no

 

 

yes

 


Extra benefits (allowances for over-the-counter supplies, groceries, etc.)

 

no

 

 

no

 

 

yes

 


$0 or low monthly premiums

 

no

 

 

no

 

 

yes

 


Includes network of providers and pharmacies

 

no

 

 

no1

 

 

yes

 

Learn Medicare Basics

 

Medicare doesn’t have to feel overwhelming. Boost your knowledge and confidence with our free guide, or read our articles.

 

Frequently Asked Questions For People Who Are New To Medicare

Medicare is a federal government health insurance program, designed to provide health insurance for Americans and legal U.S. residents over the age of 65. It also covers individuals under the age of 65 with certain qualifying disabilities or medical conditions.

 

Medicare includes four parts: A, B, C, and D. Here’s a quick explanation of each.

 

Original Medicare, including Part A (hospital/inpatient insurance) and Part B (medical/doctor/outpatient insurance), is administered by the federal government through the Social Security Administration (SSA) and the Centers for Medicare and Medicaid Services (CMS).

 

Medicare Part C, commonly known as Medicare Advantage, is only available from private insurance companies, like Anthem. Medicare Advantage plans, a.k.a. “all-in-one" plans, cover Original Medicare Parts A and B, and much more. They typically include Part D prescription drug coverage, as well as dental, vision, hearing, and more.

 

Medicare Part D covers the costs of prescription drugs. These plans are also only available from private insurance companies and can be purchased as stand-alone coverage or as part of a Medicare Advantage plan.

To be eligible for Medicare, you must be a U.S. citizen or legal permanent resident. Legal permanent residents must live in the U.S. for at least five continuous years prior to the month they apply for Medicare. You must also meet at least one of the following requirements:

  • Age 65 or older
  • Younger than 65 with a qualifying disability
  • Any age with a diagnosis of end-stage renal disease (ESRD) or Lou Gehrig’s Disease (ALS)

In general, most people enroll during their Initial Enrollment Period, which is a seven-month window around your 65th birthday:

  • Three months before the month you turn 65
  • The month you turn 65
  • Three months after the month you turn 65

If you are eligible to enroll due to a disability, your seven-month Initial Enrollment Period includes the month you receive your 25th disability check, the three months before, and three months after.

Many people confuse the terms Medicare and Medicaid. While they’re both government-run health insurance programs, they generally help two different groups of people:

  • Medicare is a federal program and provides health coverage to those older than 65 and to some younger individuals with certain disabilities, at any income level.
  • Medicaid provides health coverage for people with low incomes.  Medicaid programs are administered at the state level and are often assisted by funds from the federal government.

If you are eligible for both Medicare and Medicaid, you may qualify for a Dual Special Needs Plan that offers extra benefits at little to no extra cost.

Here are a few things to consider if you’re still working past 65.

  • You don’t have to enroll in Medicare when you turn 65 if you work for a company with 20 or more employees. Make sure you have adequate coverage through your employer if you are delaying enrollment.
  • If you work for a company with fewer than 20 employees or have an individual or family plan, you should enroll in Medicare at age 65 or you might face penalties.
  • You can enroll in all or part of Medicare even if you’re still working. A Medicare plan could offer valuable benefits at no cost to you.
  • You can no longer contribute to a Health Savings Account (HSA) if you enroll in any part of Medicare while you’re still working. If you delay Medicare enrollment until after you turn 65, you should stop contributing to your HSA at least six months before you enroll in Medicare.
  • You may be eligible for a Special Enrollment Period if you decide to wait to enroll in Medicare once your employer coverage ends.
  • You should always check with your employer’s health plan benefits administrator before enrolling in Medicare or changing your coverage.

Ready To Shop?

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Have questions? Talk to a licensed agent:

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Original Medicare: Part A (Hospital Insurance) and Part B (Medical Insurance).
 

1Medicare Select Plans are the exception. For non-emergency services covered by Medicare, you must use a hospital in our Select hospital network to receive full benefits.
 

2If the plan type does not include prescription drugs, you can add a standalone Part D plan for an additional premium.
 

Anthem Blue Cross and Blue Shield is a Medicare Advantage plan with a Medicare contract. Anthem Blue Cross and Blue Shield is a D-SNP plan with a Medicare contract and a contract with the state Medicaid program. Enrollment in Anthem Blue Cross and Blue Shield depends on contract renewal.


For Medicare Supplement only: Not connected with or endorsed by the U.S. government or the federal Medicare program.