How does Medicare work?
Medicare decisions happen in stages. First, you’ll sign up for Medicare. Then, you’ll choose the coverage option that best fits your health care needs and preferences. Medicare is different from private insurance — it doesn’t offer plans for couples or families. You don’t have to make the same choice as your spouse.
Two steps to set up your Medicare coverage
Sign up for Part A (Hospital Insurance) and/or Part B (Medical Insurance)
You can sign up at certain times. Check when and how to sign up.
Once you have both Part A and Part B, you can choose which way you want to get your Medicare health coverage
You can choose either Original Medicare or Medicare Advantage (Part C) for your Medicare coverage.
Working past 65
Generally, you only need to sign up for Part A and B once. If you (or your spouse) are still working when you turn 65, Medicare works a little differently and you may choose to delay getting Part B. If you don't get Part B, you'll have Part A only. Learn more about getting Medicare when you’re working past 65.
How does Original Medicare work?
Original Medicare includes two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). If you choose Original Medicare, you’ll also decide if you want drug coverage (Part D) and supplemental coverage, like a Medicare Supplement Insurance (Medigap) policy.
With original Medicare you can:
- Go to any doctor or hospital that takes Medicare, anywhere in the U.S.
- Join a separate Medicare drug plan to get Medicare drug coverage (Part D).
- Buy a Medicare Supplement Insurance (Medigap) policy to help lower your share of costs or use other supplemental coverage.
What comes next:
Decide if you want to add drug coverage (Part D) and/or a supplemental (Medigap) policy. Then compare plans in your area and choose the one that best fits your health care needs and preferences.
Original Medicare covers most medically necessary services and supplies and many preventive services, like exams, vaccines, and screenings. If you go to a doctor or other health care provider that accepts the Medicare-approved amount , your share of costs may be less. If you get a service that Medicare doesn’t cover, you pay the full cost.
Original Medicare covers most, but not all of the costs for approved health care services and supplies. After you meet your deductible , you pay your share of costs for services and supplies as you get them. There’s no limit on what you’ll pay out-of-pocket in a year unless you have supplemental coverage (like Medigap, Medicaid , or employer, retiree, or union coverage). Get details on cost saving programs.
How does Medicare Advantage work?
Medicare Advantage Plans (Part C) bundle your Part A, Part B, and usually Part D coverage into one plan. Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.
With Medicare Advantage, you:
- Need to use doctors who are in the plan’s network and service area (for non-emergency and non-urgent care).
- May pay a monthly premium for the plan, in addition to the monthly Part B premium. Some plans have a $0 monthly premium or may help pay all or part of your monthly Part B premium.
- Don’t need to join a separate Medicare drug plan because most plans include Part D.
- Can’t buy Medigap because it only works with Original Medicare.
What comes next:
Compare plans in your area and choose the one that best fits your health care needs.
Medicare Advantage Plans are offered by Medicare-approved private companies that follow rules set by Medicare. Each plan can have different rules for how you get services, like needing referrals to see a specialist. Costs for monthly premiums and services you get vary depending on which plan you join.
Plans must cover all emergency and urgent care, and almost all medically necessary services Original Medicare covers. You may need to get approval ( prior authorization ) from your plan before it covers certain services or supplies. Some plans tailor their benefit packages to offer additional benefits to treat specific conditions.
Each year during Open Enrollment (October 15 – December 7), you can choose which way you get your Medicare health and drug coverage.
How does Medicare work with my other insurance?
When you have Medicare and other health insurance (like from your job), one will pay first (called a “primary payer”) and the other second (called a “secondary payer”).
If you have other insurance, who pays first depends on different factors, like if you’re still working, the type of insurance you have, and if you have a special situation, like End-Stage Renal Disease (ESRD) .
Who can get Medicare?
You must be either a U.S. citizen or U.S. national, a lawful permanent resident (green card holder), a Cuban-Haitian entrant, or lawfully living in the U.S. as a Compact of Free Association (COFA) migrant to get Part A and Part B benefits or join a Medicare health or drug plan.
What do you want to do next?
Check when & how to sign up
Get answers for your situation
Estimate my eligibility
Get estimate of when you can first sign up
Compare benefits side-by-side
Compare Original Medicare and Medicare Advantage