Medicare basics

What is Medicare?

Medicare is the federal health insurance program for people 65 and older, and for some younger people with certain disabilities or conditions. Here is how it works, in plain language.

Who can get Medicare?

Medicare started in 1965 and is run today by the Centers for Medicare & Medicaid Services (CMS). You may qualify if you are:

Age 65 or older
Under 65 and receiving Social Security disability benefits
Living with End-Stage Renal Disease (ESRD) or ALS

The four parts of Medicare

Parts A and B together are called Original Medicare.

Part A

Hospital insurance

Generally covers inpatient hospital care, skilled nursing facility care, hospice and some home health care. Many people do not pay a Part A premium because they or a spouse paid Medicare taxes long enough while working. Deductibles and other costs may still apply.

Part B

Medical insurance

Covers medically necessary services such as doctor visits and outpatient care. Part B typically has a monthly premium that can vary based on income, plus a deductible and coinsurance.

Part C

Medicare Advantage

Plans offered by private insurance companies approved by Medicare. They must cover the services covered by Original Medicare and may include benefits such as dental, vision, hearing or prescription drug coverage. You must be enrolled in Parts A and B to join.

Part D

Prescription coverage

Helps cover prescription medications and is offered by Medicare-approved private insurance companies. Coverage, premiums, deductibles and medication costs vary by plan, location and the drugs you take.

What Part A does not cover

Part A generally does not pay for private-duty nursing, personal care items, a TV or phone in your room, or a private room unless medically needed. You will also have a deductible for each hospital benefit period.

Medicare Supplement plans

Medicare Supplement, or Medigap, plans work alongside Original Medicare. They can help with certain out-of-pocket costs such as copayments, coinsurance and deductibles. Benefits are standardized by plan letter, but pricing can vary by insurer and other factors.

Eligibility & enrollment

Many people first become eligible around age 65. Your Initial Enrollment Period generally begins three months before the month you turn 65 and ends three months after it. Other enrollment opportunities may apply based on your situation.

Annual Enrollment Period: October 15–December 7.
Medicare Advantage Open Enrollment: January 1–March 31 for people already enrolled in Medicare Advantage.
Special Enrollment Periods: may be available after certain qualifying events.

Enrollment rules and costs can change, and plan options vary by location. We’ll help you compare the plans available here in Pennsylvania for your individual circumstances.

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