What Original Medicare‡ (Parts A & B) Covers
Original Medicare‡ is a federal health insurance program designed for people aged 65 or older and younger people with certain health conditions. It includes Parts A and B, which help pay for hospital, medical, and other healthcare costs.
Here's a side-by-side view of what each part covers:
Medicare Part A |
Medicare Part B |
|---|---|
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Hospital stays
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Doctor visits
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Inpatient lab tests
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Outpatient lab tests
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Inpatient services and surgeries
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Outpatient services and surgeries
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Skilled nursing facility care
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Preventive health appointments
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Hospice
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Certain medical equipment you use at home
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Home healthcare, only after qualifying inpatient stay
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Home healthcare, only if deemed "homebound"
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What's Not Covered By Original Medicare?‡
Original Medicare‡ doesn't cover everything. So, depending on your healthcare needs, you may want additional coverage. Original Medicare‡ does not include benefits like these:
- Most prescription drugs
- Long-term hospital care
- Most dental care including dentures
- Eye exams
- Routine physical exams
Overview Of Original Medicare‡ Costs**
Original Medicare‡ |
Part A |
Part B |
|---|---|---|
|
Premium
|
$0 MONTHLY PREMIUM
(This applies only if you or your spouse had Social Security payroll deductions for at least 10 years.)
Your cost will be prorated if you haven’t made Social Security contributions.
|
$174.70 Each Month
(Could be higher depending on your income.)
Most people pay this with automatic deductions from Social Security.
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Deductible
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$1,632 Per inpatient 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.
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$240 PER YEAR
|
|
Copays And Coinsurance
|
Hospital Stays
$0 Days 1-60 Hospitalized
$408/Day Days 61-90 Hospitalized
$816/Day Lifetime Reserve Days
Skilled Nursing $0 Days 1-20
$204/Day Days 21-100
|
You Pay 20% Of Medicare-Approved Amount*
Medicare Pays 80% Remaining Amount |
*Some doctors may not accept the Medicare-approved amount for Original Medicare‡ Part B (medical) costs, and can charge as much as 15% (only 5% in New York state) over what Medicare will pay, and will bill you the difference. You are responsible for paying these excess charges.
**Costs listed are based on 2024 rates.
Source: https://www.medicare.gov/basics/costs/medicare-costs
Other Plan Types
More Coverage For Your Needs
Original Medicare‡ might not be enough to meet your healthcare needs. If you take prescription medications regularly or want dental, vision, and hearing benefits, you should consider other plan options. Also, if you're managing a serious or ongoing health condition, out-of-pocket costs can add up. Extra coverage can help support your health and budget. Let us walk you through different plan types.
Smart Tip: At least 74% of people who have Original Medicare‡ opt for additional coverage.1
Medicare Supplement Plans (Medigap)
You can add a Medicare Supplement plan to help pay for out-of-pocket costs like deductibles, copays, and coinsurance. For example, if you purchase a Medicare Supplement G plan, it will cover almost all your out-of-pocket costs, except for your Part B $240 annual deductible.
Medigap Plan G Covers |
You Pay |
|---|---|
|
Out-of-pocket costs like deductibles, copays, and coinsurance
|
$240 Annual Deductible
|
|
Any doctor or hospital in the U.S. that takes Medicare patients
No referrals for specialists |
$137 - $266 Monthly Premium Range2
Doesn't include coverage for prescription drugs (Part D), dental, vision, or hearing
|
With these plans, you can go to any doctor or hospital in the U.S. that takes Medicare patients – with no referral needed. This is a good choice if you travel or live in different places throughout the year.
You'll have to pay a monthly premium but it can help protect you from unexpected costs. Once you are enrolled, you must continue to pay your Original Medicare ‡ Part A and Part B monthly premiums. For most people, Part A is $0. Medicare Supplement plans don't include coverage for prescription drugs (Part D), dental, and vision. You may want to purchase plans for those benefits for an additional premium.
Smart Tip: If you miss your Medigap Open Enrollment Period, you may be denied coverage due to pre-existing conditions.
The best time to enroll in a Medicare Supplement plan is during the Medigap Open Enrollment Period. It is the six-month period beginning on the first day of the month you’re at least 65, and also enrolled in Medicare Part B.
Prescription Drug Plans (Part D)
Medicare Part D standalone plans can be added to your Original Medicare‡ or Medicare Supplement plan to help cover the cost of your prescription drugs. Most Medicare Advantage plans include prescription drug Part D coverage.
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Part D Covers
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Part D Does Not Cover
|
|---|---|
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Brand name medications
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Over-the-counter medications
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Generic prescriptions
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Vitamins
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All recommended vaccines
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Fertility drugs
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Medical supplies for insulin injections
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Medications for anorexia or weight control
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Depending on your income, you may qualify for Extra Help , a federal program that helps pay for Medicare Part D costs.
Smart Tip: If you don't enroll when you're first eligible, you might be charged a Part D late enrollment penalty.
Medicare Advantage Plans (Part C)
Medicare Advantage plans provide all-in-one coverage that includes Part A, Part B, and most include prescription drugs (Part D). They typically offer $0 or low monthly premiums and benefits such as routine dental, vision, and hearing care, as well as fitness memberships.
You could also receive a spending allowance to pay for things like over-the-counter health items, groceries, and utilities, all managed with one convenient prepaid benefits card. Not all plans offer these benefits.
HMO vs. PPO Plan Types
When selecting a plan, you may have a choice between a Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). Consider these differences to help you decide which is right for you:
Medicare Advantage (Part C) |
HMO |
PPO |
|---|---|---|
|
Premium
|
Lower premiums and copays
|
Higher premiums and copays
|
|
Network
|
Requires patients to use in-network doctors and hospitals
|
Allows patients to visit out-of-network doctors and hospitals
|
|
Referrals
|
May need referrals from their primary care physician (PCP) to see a specialist
|
No referrals for specialists
|
Before you select a Medicare Advantage HMO plan, make sure your doctor is in-network. Even if you’re thinking about a PPO, you should still check to see if your doctors are in-network. It might save you money if they are.
Smart Tip: Out-of-pocket costs can vary by plan, so make sure the plan you select is a good fit for your budget.
Medicare Advantage Special Needs Plans (SNPs)
Some Medicare Advantage plans provide coverage for people with limited incomes or specific health needs. You will need to qualify for these plans.
Dual Special Needs Plans (D-SNPs) |
Chronic Special Needs Plans (C-SNPs) |
Institutional Special Needs Plans (I-SNPs) |
|---|---|---|
|
For people who qualify for both Medicare and Medicaid
|
For people living with:
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For people living in:
|
Smart Tip: Special Needs Plans offer extra support, including a care coordinator to help you develop and maintain your care plan.
Choosing And Comparing Plans
Which Plan Should You Choose?
Here's a simple checklist you can refer to with important things to consider when selecting plans.
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Consider these costs
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Are these in-network?
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What benefits do you need?
|
|---|---|---|
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Premiums
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Doctors
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Vision care
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Copays
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Specialists
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Dental care
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Deductibles
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Hospitals
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Hearing care
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Prescription drug prices
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Healthcare facilities
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Fitness programs
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Maximum out-of-pocket
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Pharmacies
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Allowances for extras like over-the-counter items, groceries, and transportation.
|
Compare Coverage By Plan
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Included
|
Original Medicare‡
|
MedSupp (Medigap)
|
Medicare Part D
|
Medicare Advantage (Part C)
|
|---|---|---|---|---|
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Hospital and medical insurance
|
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Prescription drugs
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Limited annual out-of-pocket costs
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Dental, vision, hearing coverage
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Extra benefits
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$0 or low monthly premiums
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Access any doctor or hospital in the U.S. that accepts Medicare patients
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Network of providers and pharmacies
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You can't be enrolled in both a Medicare Supplement and Medicare Advantage plan at the same time. For Prescription Drug Plans (Part D) you must be enrolled in Original Medicare‡ Part A and/or Part B, and continue to pay your Part A and/or Part B monthly premiums.
Smart Tip: Once enrolled in Medicare Advantage or MedSupp, you must continue to pay your Original Medicare‡ Part A and Part B monthly premiums. For most, Part A is $0.
Eligibility And Enrollment
Are You Eligible For Medicare?
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)
Smart Tip: You must sign up for Parts A and B before you can choose a Medicare Advantage (Part C) or MedSupp plan.
Working After 65
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. Here are a few things to consider if you’re still working:
- 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 are required to enroll in Medicare at age 65 or face penalties.
- 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’re required to 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 administrator before making any changes to your coverage.
Smart Tip: If you have an individual policy, sign up for Original Medicare‡ when you turn 65 to avoid a monthly Part B late enrollment penalty.
Where Do You Enroll?
For Original Medicare‡ (Parts A & B)
Sign up for Original Medicare‡ through the Social Security Administration. Here are three ways to enroll:
Online:
Visit the official government website
By Phone:
1-800-772-1213 (TTY: 1-800-325-0778)
In-person:
Find your nearest Social Security office
For Anthem Medicare Plans
Once you've enrolled in Original Medicare,‡ you can sign up for additional coverage, including Medicare Supplement plans, Prescription Drug (Part D) plans, or Medicare Advantage (Part C) plans. We’re here to help.
Smart Tip: If you’re receiving Social Security or Railroad Retirement Board benefits four months prior to your 65th birthday, you’ll be automatically enrolled in Original Medicare‡ (Parts A and B).
When Can You Enroll?
You can sign up or change your Medicare coverage at different times, based on your situation. It's important to understand these enrollment periods, so you don't miss your opportunity to get the healthcare coverage you need.
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Enrollment Periods
|
Time Frames
|
Action You Can Take
|
|---|---|---|
|
Initial Enrollment Period (IEP)
|
7 months
Starts 3 months before your 65th birthday month and ends three months after it
|
You can enroll
|
|
Annual Enrollment Period (AEP)
|
Oct. 15 - Dec. 7
|
You can add or change plans
|
|
General Enrollment Period (GEP)
|
Jan. 1 – March 31
|
You can enroll
|
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Special Enrollment Period (SEP)
|
Based on life changes, like moving to a new area
|
You can add, drop, or change plans
|
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Plan-Specific Enrollment Periods
|
|
|
|---|---|---|
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Medicare Advantage Open Enrollment Period (OEP)
|
Jan. 1 - March 31
|
You can change or drop your Medicare Advantage plan one time only.
|
Smart Tip: Once you're enrolled in a Medicare plan, you are automatically renewed every year as long as your plan continues to be offered and you pay your premiums.
When Does Your Coverage Start?
Depending on the plan you choose and when you sign up, your benefits will begin at different times.
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|---|
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Original Medicare‡
|
|
|
|---|---|---|
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During your Initial Enrollment Period before your 65th birthday
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The first day of your 65th birthday month. If your birthday comes on the first of the month, your coverage begins the first day of the previous month.
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During your Initial Enrollment Period after you turn 65
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The first day of the next month
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Medicare Advantage and Part D
|
|
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|---|---|---|
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During Your Initial Enrollment Or Special Enrollment Period
|
Your birthday month or the first day of the next month
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During Medicare Advantage Open Enrollment Period
|
The first day of the next month
|
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During Annual Enrollment Period
|
January 1
|
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Medicare Advantage Dual Special Needs Plan (D-SNP)
|
|
|
|---|---|---|
|
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When you're first eligible
|
The first day of the next month
|
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Once a quarter
|
The first day of the next month
|
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Annual Enrollment Period
|
January 1
|
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Medicare Supplement Plans
|
|
|
|---|---|---|
|
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During your Initial Enrollment or Medigap Open Enrollment Periods
|
Your birthday month or the first day of the next month
|
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Anytime
|
The first day of the next month
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Employer To Medicare
Review these common considerations when moving from employer-provided coverage to Medicare.
Medicare And Your Health Savings Account (HSA)
If you have an HSA, stop adding to it six months before you enroll in Medicare to avoid a tax penalty. After enrolling in Medicare, you can use the money left in your HSA to pay for Medicare premiums, copays, deductibles, and coinsurance.
Medicare And Your Health Reimbursement Arrangement (HRA)
You can use an HRA to pay some medical expenses and Medicare premiums. However, be aware that your account won't be accessible once you stop working for the employer providing the HRA.
COBRA – Continuation Of Coverage
If you have COBRA, your coverage will stop when you become eligible for Medicare. Sign up during your Initial Enrollment Period to avoid any gaps in coverage.
Coverage For Military Personnel (TRICARE)
If you are an active service member, at 65, you can sign up for Medicare during the Initial Enrollment Period and keep your TRICARE coverage into retirement.
If you're considering a Medicare Advantage plan, choose one without prescription drug coverage. Your TRICARE prescription drug coverage will likely be better.