Turning 65: New to Medicare

Find out what you need to know if you're new to Medicare and enrolling for the first time.

What is Original Medicare?

Original Medicare (often just called “Medicare”) is a federal program that provides health insurance for people 65 and older and other people with certain disabilities. Under Original Medicare, you can receive your services from any qualified health care provider in the US who accepts Medicare.

Original Medicare is made up of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance covering doctor visits and treatment).  

Learn more about Medicare terms and resources

 

Medicare Part A

WHAT'S COVERED?
  • Inpatient services received in hospitals
  • Some inpatient care in skilled nursing facilities
  • Hospice and some home health care services

WHAT ARE THE COSTS?
  • No monthly premiums for most people
  • Hospital admission deductible (per benefit period, which is 60 consecutive days between admissions)
  • Copays and coinsurance
  • No yearly limit on your out-of-pocket costs
Under Original Medicare, you can receive your services from any qualified health care provider in the US who accepts Medicare.

Medicare Part B

WHAT'S COVERED?
  • Doctor visits
  • Outpatient care, like preventative services
  • Some services not covered by Part A, like physical or occupational therapy
  • Some home health care services

WHAT ARE THE COSTS?
  • Monthly premiums
  • Annual deductible
  • Copays and coinsurance (often you will pay 20% of cost of covered services)
  • No yearly limit on your out-of-pocket costs

Additional Coverage Options 

There is a wide range of Medicare Advantage plans, so costs, benefits, and your choice of health care provider can vary.

Once you enroll in Original Medicare, you can choose to add plan(s) from private insurance companies to help fill some of the coverage gaps and reduce your out-of-pocket costs. These plans include Medicare Supplement plans, Prescription Drug (Medicare Part D) plans, and Medicare Advantage (Medicare Part C) plans.

A variety of plan types are offered, including HMO, HMO-POS, and PPO plans.

Medicare Advantage plans often charge lower copayments and coinsurance than Original Medicare and include caps on your yearly out-of-pocket costs. Monthly premiums for these plans are also typically lower than those charged for Medicare Supplement plans.


IMPORTANT NOTE: If you sign up for additional plans, you must continue to pay any Part A or Part B monthly premiums.
 

MEDICARE ADVANTAGE PLANS
(Medicare Part C)

With Medicare Advantage plans (also called “Medicare Part C”) you can receive coverage for your Part A inpatient hospital stays, Part B doctor visits, and Part D prescription drugs all in one plan. Medicare Advantage plans cover everything that Original Medicare covers and more.

Many include other benefits including dental, routine vision and hearing exams, fitness/wellness benefits, and over-the-counter items. It may also cover emergency services abroad.

MEDICARE PRESCRIPTION DRUG PLANS
(Medicare Part D)

Original Medicare does not offer prescription drug coverage. If you want prescription drug coverage, you either have to buy a standalone Part D plan from an insurance company contracted with Medicare, or you can enroll in a Medicare Advantage plan that also offers Part D benefits.

You pay a monthly premium, deductibles, and copayments or coinsurance with stand-alone plans and with some Medicare Advantage plans.

MEDICARE SUPPLEMENT PLANS
("Medigap" Plans)

Medicare Supplement plans (also called “Medigap” plans) help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Some also cover services Original Medicare doesn’t, like care outside the US.

Supplement plans cannot cover prescription drug costs, so you can also buy a Part D Prescription Drug plan. Monthly premiums for Supplement plans are typically higher than those charged by Medicare Advantage plans

How to Enroll in Additional Plans

If you are interested in enrolling in a Medicare Advantage or Supplement plan, here is a look at the steps you will need to take.

Step One

Enroll in Original Medicare when you become eligible. 

 

What's Covered?

The government-provided Original Medicare plan...

covers hospital
stays

 

 covers doctor and
outpatient visits

 

Step Two

Then, choose between:

Medicare Supplement Plans

Original Medicare
(Parts A and B)

Medicare
Supplement Plan

Separate Prescription
Drug Plan (Part D)

 
Medicare Advantage Plans

Medicare Advantage
Plan
(Part C)

These plans include Parts A and B, plus more.

The Part D Prescription Drug Plan is included with most plans.

Eligibility and Enrollment FAQs

The following information covers Medicare eligibility and enrollment information.

There are specific times when you can sign up for plans, or make changes to coverage you already have. Each year you'll have a chance to review your coverage and change plans.

WHEN YOU FIRST GET MEDICARE (INITIAL ENROLLMENT PERIOD)

Most people are first eligible to enroll in Original Medicare when they turn 65. Your seven-month-long “Initial Enrollment Period” begins three months before the month you turn 65 and ends three months after. You must be a US citizen or legal resident who has lived in the US for at least five years in a row.


DURING CERTAIN TIMES EACH YEAR (ANNUAL ENROLLMENT PERIODS)

Annual Enrollment Period for Medicare Advantage and Medicare prescription drug coverage: Every year Medicare offers an “Annual Enrollment Period,” from October 15th to December 7th, when you can add, drop, or switch your enrollment for the following plan year.

Medicare Advantage Open Enrollment Period: Medicare offers a “Medicare Advantage Open Enrollment Period” from January 1st to March 31st each year. During this period, if you’re already in a Medicare Advantage plan, you can switch to another Medicare Advantage plan. You can also disenroll from your Medicare Advantage plan and return to Original Medicare and join a Medicare Prescription Drug plan (if you choose to do so).


SPECIAL CIRCUMSTANCES (SPECIAL ENROLLMENT PERIODS)

Medicare also offers “Special Enrollment Periods” when you can make enrollment changes if certain circumstances change (for example, if you lose employer coverage, move to a new service area, or would like to switch to a plan that has earned a 5-Star quality rating from Medicare.)

When you become eligible, begin the enrollment process with the Social Security Administration:

  • If you start collecting Social Security benefits before you turn 65, Social Security should enroll you in Original Medicare (Parts A and B) automatically. They will mail your Medicare card to you three months before your 65th birthday.
  • If you don’t receive your Social Security card or you haven’t enrolled in Social Security, visit or call your local Social Security office or go to the SocialSecurity.gov website.

There are several state and federal programs that provide assistance with Medicare costs for Part A, Part B, and Part D. Eligibility varies by state and is determined by income and assets.

You can contact the Social Security Administration online, call 1-800-772-1213 (TTY/TDD: 1-800-325-0778), or visit your local Social Security office to see if you are eligible.

Medicare and Employment

More people than ever before are deciding to delay their Medicare enrollment and continue to work. While working past 65 can help you put away additional savings for retirement, you could inadvertently be penalized for not enrolling in Medicare at the proper time. Before you make this important decision, you should know what the impact could be.

We’ve put together the following information to help you better understand your option.

IF YOU ARE COVERED ON YOUR EMPLOYER'S HEALTH PLAN

Speak with your benefits administrator to see how your employer’s plan works with Medicare. You may be required to enroll in Original Medicare Parts A and B when you turn 65. Many people only enroll in Part A (hospital coverage with no premium) and delay enrollment in Part B until they lose employer coverage. Contact your Social Security office to make sure your enrollment decisions are followed.

Keep records of any prescription drug coverage you receive from your employer after you turn 65. You may need proof of this when you eventually enroll in Medicare to avoid penalties.


WHEN YOU FIRST GET MEDICARE (INITIAL ENROLLMENT PERIOD)

Most people are first eligible to enroll in Original Medicare when they turn 65. Your seven-month-long “Initial Enrollment Period” begins three months before the month you turn 65 and ends three months after. You must be a US citizen or legal resident who has lived in the US for at least five years in a row.


IF YOU ARE ON AN INDIVIDUAL HEALTH PLAN

You could save money if you switch to a Medicare plan with additional coverage.

You can enroll in Original Medicare and additional coverage within two months after your employer coverage ends. Consider applying to enroll in Original Medicare and additional coverage as soon as you are eligible so your coverage is effective at the beginning of your birthday month.
Contact Social Security to sign up for Original Medicare and pay your Part B monthly premium directly. Once you start receiving your Social Security benefits, the Part B premium will be automatically deducted from your monthly Social Security payment.

A Medicare Advantage plan could save you money.

Are you currently enrolled in Original Medicare or an employer-based health plan?

Consider Medicare Advantage—you could save more with lower copays/coinsurance plans, plus lower premiums than most Medicare supplement plans. And, many cover Part D prescription drugs!