What you need to know about Medicare

Medicare can be complex. We consider it our job to make it as clear and simple as possible so you can make the right choice for you.

The 4 parts of Medicare and what they cover

Medicare is made up of four parts. Two of those parts are sponsored by the Federal government and two refer to plans you can get from private health insurance companies, like UCare.

Medicare Part A and Part B: Original Medicare

Medicare Part A: Hospital Insurance

Part A covers:

Up to 150 days in the hospital
Up to 100 days in a skilled nursing facility (after at least three days in the hospital)
Home health care
Hospice care

You’re responsible for: Copays, Deductibles, Coinsurance.

Medicare Part B: Medical Insurance

Part B covers:

Doctor visits (for regular screenings, vaccines, an annual wellness, and illnesses or injuries)
Outpatient surgery (when you have the surgery and go home the same day)
Ambulance (if you have an emergency and the ambulance brings you to the hospital)

You’re responsible for: Copays, Deductibles, Coinsurance, Monthly premium.

Gaps in Original Medicare

Original Medicare covers a lot, but it doesn’t pay for all the health care you may need. If you only have Part A and Part B coverage, you’ll pay the full cost for services Original Medicare doesn’t cover, including:

Routine dental care
Hearing aids
Routine eye exams and eye wear
Routine physical exams
Fitness club memberships
Prescription drugs you may take at home
Care in a skilled nursing facility without a qualifying 3-day hospital stay
Most care you receive when traveling outside the U.S.

Medigap Plans

If you choose Original Medicare, you can buy extra coverage from private insurance companies to help pay for things that Medicare Part A and Part B don’t cover. Medigap plans cover things like coinsurance and copays, deductibles, your share of extended hospital stays and hospice costs, blood transfusions, and foreign travel emergencies.

Medicare Part C: Medicare Advantage plans

Part C is also known as Medicare Advantage. These are private plans that cover everything Original Medicare does plus prescription drugs and other extras.

Medicare Advantage plans cover:

Everything original Medicare covers
Extras like vision, dental, over-the-counter items, hearing aids and fitness benefits (depending on the plan)
Part D prescription drug coverage

You’re responsible for: Monthly premiums, Copays, Deductibles, Coinsurance.

Medicare Part D: Prescription drug coverage

You can purchase Part D coverage from private health care companies to help cover the cost of your prescriptions. There are two ways to get Part D:

As part of a Medicare Advantage plan (MA-PD)
As a separate, standalone prescription drug plan (PDP)

Part D covers:

Prescription drugs you take regularly or for an illness or injury as long as they are on your plan’s drug list or formulary. Drug lists vary by plan, so it’s important to check that your prescriptions are included before you pick a plan.

You’re responsible for: Monthly premiums, Copays, Deductibles, Coinsurance.

A note on penalties

You don’t have to get a Part D plan when you enroll in Medicare. But if you don’t sign up when you first become eligible, you may pay a late enrollment penalty if you decide to sign up later. You’ll pay the penalty for as long as you have Part D coverage. To learn more about penalties related to Part D enrollment, visit the Medicare website

Phases of Part D coverage

Part D coverage is broken into a few phase. In general:

The initial phase is where you’ll pay any deductible and co-insurance specified in your plan. Once your total (what you and your plan pay) drug costs reach $4,660, you move into what’s called the coverage gap or donut hole.
During the coverage gap, you will share a larger portion of the drug costs until your total out-of-pocket costs, including what you paid in the initial phase, reaches $7,400.
Once you’ve reached $7,400 in out-of-pocket costs, you enter the catastrophic coverage, during which you get a 75% discount on drug costs.

When to enroll in Medicare

Most people are eligible for Medicare at age 65. If you’re already receiving Social Security benefits, you’ll be enrolled automatically.

If you’re not receiving Social Security benefits, you’ll need to sign up for Medicare. You have seven months to sign up for Medicare — three months before your 65th birthday, the month of your 65th birthday, and three months after your 65th birthday.

Example: Your birthday July 4

Medicare enrollment calendar: 3 months before and 3 months after 65th birthday

A note on delaying enrollment
You can wait to enroll if you plan to keep working and have coverage through your employer or your spouse’s employer.

How to enroll in Medicare

You can sign up for Medicare three ways:

Online at ssa.gov
By phone at 1-800-772-1213
In person at a Social Security Office

Learn more about the enrollment process

Getting a Medicare Advantage, Medigap plan

Once you’re enrolled in Original Medicare, you can decide to enroll in a Part C (Medicare Advantage) or Medigap plan from a private insurance company.

There are multiple timeframes where you can enroll in or change your plan choice:

Initial enrollment

This is when you first become eligible for Medicare. During that time, you can enroll in Medigap and Part D plans (if you choose Original Medicare) or a Medicare Advantage Plan for the current year.

Annual Election Period

After your initial enrollment, you can make changes to your plan choices for the following year during the Annual Election Period (AEP) from October 15 to December 7.

Medicare Advantage Open Enrollment Period (MA-OEP)

During the Medicare Advantage Open Enrollment Period (MA-OEP), Medicare Advantage members may enroll in another Medicare Advantage plan or disenroll from their Medicare Advantage plan and return to Original Medicare (limited to one change). This period runs from January 1 through March 31.

In addition to these time frames, there are special circumstances in which you can enroll or make changes. For example, if you were covered by your employer’s plan and didn’t enroll during the initial enrollment period or you moved to a new area with different plan options.

For all of the details on enrollment guidelines and requirements, visit medicare.gov.

Medicare FAQs

Over the years, we’ve heard a thing or two from Medicare shoppers. From our Medicare Meetups, phone consultations and one-on-one meetings with people just like you – we’ve compiled answers to a list of some common questions we hear.

Medicare FAQs