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What is Medicare and What are Parts A, B, C and D?

Medicare is the federal health insurance program for:

• people 65 or older
• people under 65 and receiving Social Security Disability Insurance for a certain amount of time
• people under 65 with End-Stage Renal Disease.

When you first enroll in Medicare, you can enroll in either “Original Medicare” or a Medicare Advantage Plan, also known as Part C.

Original Medicare

“Original Medicare” includes Part A and Part B. If you want prescription coverage, you can enroll in a separate Part D plan.

• Medicare Part A (hospital insurance)
  Part A covers hospital care, care in a skilled nursing facility, hospice care, and some home health care. 
• Medicare Part B (medical insurance)
  Part B covers certain doctors’ services, outpatient care, medical supplies (like wheelchairs and walkers), and preventive services.
• Medicare Part D (prescription drug coverage)
  Part D offers prescription coverage. It consists of prescription drug insurance plans offered by private companies approved by Medicare. 

Medicare Advantage Plans / Part C

A Medicare Advantage Plan, also known as Part C, is private insurance contracted with Medicare. It should cover all the same benefits as Original Medicare. Many plans also include the prescription coverage, so you do not need to enroll in a separate Part D plan. Some plans may also cover additional benefits that are not covered by “Original Medicare” such as vision, hearing and dental.

Even if you enroll in a Part C plan, you still likely have to pay your Part B premium.

Differences

It is important to be aware of the differences between Original Medicare and Part C plans. Part C plans may have different:

• networks of providers
• coverage rules
• premiums (in addition to the Part B premium)
• cost-sharing for coverage services.

Before you enroll in a Part C plan, you need carefully consider the costs and the network of providers. Things to consider:  

• Some Part C plans do cover services that are not covered by Original Medicare, such as dental and vision and coverage abroad.
• Do your current providers accept your desired Part C plan? Part C plans have networks of providers. You need to understand the network.
• The plan may also require you to get referral to see a specialist and get prior authorizations.
• A Part C plan won’t necessarily be cheaper than Original Medicare. You need to compare the costs of the premiums, deductibles and copayments while considering your health care needs.

Here are some ways to learn more:

• Call SHIP (the State Health Insurance Assistance Program) at 1-800-642-5119 to discuss your options.
• Use the Medicare Plan Finder.

Who is eligible for Medicare?

Medicare eligibility for people age 65 and older

In most cases, you will become eligible for Medicare when you turn 65.

• If you are 65 years old and collect or qualify to collect Social Security or Railroad Retirement benefits, you are eligible for Medicare.
• If you are 65 years old but do not qualify to collect Social Security our Railroad Retirement yet, you qualify for Medicare if:
  • You are a current US resident and are either
    • a U.S. citizen, or
    • a permanent U.S. resident who has lived in the U.S. for 5 continuous years

Medicare eligibility for people younger than 65

If you are younger than 65, you can be eligible for Medicare if:

• you are disabled and have been receiving Social Security Disability Insurance (SSDI) for more than 24 months, or
• you have Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease) and are receiving SSDI, or
• you have been diagnosed with End-Stage Renal Disease (ESRD), and
  • you are getting dialysis treatments or have had a kidney transplant, AND
  • you are eligible to receive SSDI (Social Security Disability Insurance), or
  • you are eligible to receive Railroad Retirement benefits, or
  • you have enough “work credits” to be considered to be “fully” insured by Social Security

Learn how to sign up for Medicare.

Learn more

Learn more by selecting "Start Over." Then choose Health and "I need help with Medicare." You can also read more about Medicare by visiting the Medicare section of our website.