Medicare is your health insurance once you turn 65. It's a federal program that helps cover your medical costs. Like most healthcare plans, it doesn't cover everything, and costs can vary widely depending on your location and specific healthcare needs.
Medicare is a complex system with vast amounts of information and numerous options that can be difficult to navigate. Understanding the Medicare basics will help you make informed decisions about your healthcare and avoid costly mistakes.
This comprehensive Medicare guide is a different type of senior resource center. One that’s designed to help you worry less and live more.
This resource center dives into all the Medicare basics to help seniors and their families by providing clear, reliable information without the sales pressure.
Our goal is simple: to help you understand Medicare basics by providing clear, straightforward information, including how and when you qualify, how to get the best possible coverage, and what to expect in terms of costs and enrollment dates.
We've organized everything you need to know into easy-to-understand sections that you can explore at your own pace.
See how to qualify for Medicare and when you can take advantage of it.
Who gets Medicare? It’s pretty straightforward. You qualify for Medicare if you:
Most people become eligible at 65, regardless of whether they're still working or how much they earn.
Can green card holders get Medicare? Yes, green card holders who have lived in the U.S. for at least five years and meet the work requirements can qualify for Medicare, unless this has changed as of the current press time in the U.S.
When and how you can sign up, switch plans, or make changes to your existing coverage throughout the year.
Automatic Enrollment: If you're already receiving Social Security benefits when you turn 65, you'll automatically be enrolled in Parts A and B. You'll receive your Medicare card in the mail.
Manual Enrollment: If you're not receiving Social Security, you need to actively participate in Medicare enrollment through Social Security (online, by phone, or in person). Many people work with a Medicare insurance agent to help navigate their options and ensure proper enrollment.
When to Enroll: Your Initial Enrollment Period is a 7-month window: 3 months before your 65th birthday month and 3 months after. Missing this window can result in late enrollment penalties and gaps in coverage.
Still Working at 65? If you have employer health insurance, you may be able to delay Medicare enrollment without penalties. However, the rules are complex, so check with your HR department and Medicare before making this decision.
Initial Enrollment: When you first become eligible (around your 65th birthday)
Detailed explanations of the four parts of Medicare and what’s included in each, plus how to differentiate between Medicare vs Medicaid, details on Medicare Part D, and where Medigap fits in.
Learn everything you need to know about The Four Parts of Medicare.
Medigap (Medicare Supplement Insurance) is private insurance designed to fill the "gaps" in Original Medicare coverage. Here's how it fits into the Medicare system:
Medigap is NOT a fifth part of Medicare. Instead, it's private insurance that works alongside Original Medicare (Parts A and B) to cover costs that Medicare doesn't pay.
Medigap only works with Original Medicare, never with Medicare Advantage. If you have a Medicare Advantage plan, you cannot have Medigap insurance, and vice versa.
Dive into more details on what Medigap covers, Medigap plan types, Medigap enrollment rules, and more in our Guide to Medigap.
There are lots of Medicare options, but we’ll break down the two most common plan combinations out there.Area Agencies on Aging are nonprofit agencies designated by states to address the needs of all seniors at the local level.
How should you decide which Medicare plan is right for you or the senior in your life?
When deciding which option is right for you or the senior in your life, there are some important questions to consider:
Remember, you can make changes during the annual Medicare Open Enrollment Dates (October 15 - December 7), though some changes become more difficult to make as you age.
The most important thing is to enroll as soon as you're first eligible to avoid penalties and coverage gaps. When in doubt, speak with a licensed Medicare agent who can answer questions and help you compare specific plans in your area.
We’ll provide a general overview of what to expect from the four parts of Medicare coverage, with some variations depending on your location and enrollment choices.
Medicare costs vary significantly depending on your plan choices and where you live; however, we provide a general breakdown of some typical costs you can expect to encounter. It is essential to check your specific plan for exact costs by location, provider, or service.
Cost Sharing refers to the portion of healthcare expenses that beneficiaries must pay out of pocket, creating a shared financial responsibility between the individual and the Medicare program.
To learn more, check out our guide to Medicare Costs.
A few important things to be aware of as you first enter the Medicare world.
While Medicare covers a wide range of essential healthcare services, many individuals have coverage needs that extend beyond Original Medicare (Parts A and B). Here are a few common areas where you can explore added coverage through Medicare Part C:
Coverage depends on which Part C plan you enroll in. Please confirm benefit details before enrolling in a specific plan.
One of the most common questions we get: Does Medicare pay for senior living?
Unfortunately, Medicare provides little to no coverage for senior living options. It only covers short-term skilled nursing care after a hospital stay, not ongoing assisted living or memory care.
Many families are surprised to learn that some assisted living facilities accept Medicaid, which may be an option for those who qualify financially, as Medicaid can help cover long-term care costs that Medicare doesn't cover. This is one of many important distinctions between the two often-confused but very different insurance plans.
Many seniors prefer to age at home, and there are several benefits of home care that Medicare may help cover. Does insurance cover home care? Medicare covers home health services when you're homebound and need skilled nursing, physical therapy, or other skilled care services. However, Medicare doesn't cover private aide services or custodial care.
Home nursing care costs can be significant when paid privately, so it is important to understand what Medicare covers. Medicare may cover skilled home health services, but families often need to supplement these with private care for daily living assistance.
Many seniors benefit from exploring senior discounts available through Medicare Advantage plans or community programs. These can include fitness memberships, transportation services, and other wellness benefits.
For families concerned about care quality, it's essential to know that if problems arise in nursing facilities, a nursing home negligence lawyer can help protect residents' rights and ensure proper care standards are maintained and/or enforced.
Tips on where you can get started and prepare information for efficient and accurate Medicare enrollment.
Medicare can be complicated, but understanding its fundamentals is the first step.
What’s the difference, and how to remember.
It's important to understand the difference between Medicaid and Medicare. Medicare is primarily based on age or disability, while Medicaid is an income-based assistance program that can work in conjunction with Medicare for those who qualify financially.
Helpful tip: MedicAID is based on income, while MediCARE is usually based on age.
Associating the 'i' in' Aid 'with the' i' in 'Income' and the 'A' in 'Care' with the 'A' in 'Age' has been a useful reminder. 🙂
There is an abundance of information out there. Here are some other trusted resources.
Medicare decisions affect your health and finances for years to come. Here are some other helpful Medicare resources for seniors and their caretakers:
Remember: There's no perfect Medicare plan, but there is a plan that's right for your health needs, budget, and preferences. Understanding your options is the best investment you can make in your future healthcare.
This information is based on currently available Medicare data and is subject to change. Find more details on Medicare.gov or call 1-800-MEDICARE for the most current information.
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