Medicare

Last Updated: October 21, 2020

Written by the Open Caregiving Team. Editorial review by Joyce O. Murphy RN, MSN.

What is Medicare?

Medicare is a government-funded health insurance program that provides healthcare for Americans 65 years of age and older. It also provides healthcare for some people who have long-term disabilities.

How does Medicare work?

Medicare has four parts: Part A, Part B, Part C, and Part D.

  • Medicare Part A and B make up Original Medicare which the federal government administers.
  • Medicare Part C (called Medicare Advantage) and Medicare part D are sold through private health insurance providers that partner with the federal government to extend coverage.

What does Medicare cover in 2020?

What does Medicare Part A cover?

Medicare Part A (Hospital Insurance) covers hospital visits and Medicare-approved care needs. These include skilled nursing facilities, hospice care, and home health care.

What does Medicare Part B cover?

Medicare Part B (Medical Insurance) covers 80% of the Medicare-approved amount for doctor visits, mental health needs, surgery at outpatient facilities, lab tests, approved medical equipment, and certain forms of preventive care. Your loved one will need to cover the remaining 20% coinsurance.

Medicare will only cover this 80% after the Part B yearly deductible has been paid. Also keep in mind that this is in addition to the Part B monthly premium.

Review the complete list of tests, items and services covered by Medicare Part B across the country.

What does Medicare Advantage Part C cover?

Medicare Part C (another name for Medicare Advantage) “bundled” plans include Part A and Part B plus they can add on benefits. These may include dental, vision, hearing care, and other benefits like prescription drugs and respite care coverage.

Medicare Advantage Plans differ based on the private insurance provider.

What does Medicare Part D cover?

Medicare Part D plans cover prescription drugs. Coverage varies widely based on the private insurance provider.

Who is eligible for Medicare in 2020?

Medicare is for US Citizens 65 or older, US Citizens under 65 with certain disabilities, and any US Citizen that suffers from End-Stage Renal Disease.

Learn more about eligibility using the Medicare Eligibility & Premium Calculator.

How much does Medicare Part A cost in 2020?

Your loved one can receive Medicare Part A without having to pay a premium (no additional cost) if they are:

  • 65 or older and paid Medicare taxes for 10 years or more.
  • 65 or older and their spouse paid Medicare taxes for 10 years or more.
  • 65 or older and receive, or are eligible to receive, retirement benefits from Social Security or the Railroad Retirement Board.
  • 65 or older and have Medicare through government employment.
  • 65 or older and their spouse has Medicare through government employment.
  • Younger than 65 years old and have received Social Security or Railroad Retirement Board disability benefits for 24 months or more.
  • Younger than 65 years old and are a kidney dialysis or kidney transplant patient.

If they do not meet any of the above conditions for premium-free Part A, they can buy Medicare Part A in 2020 for either:

  • $458 per month if they paid Medicare taxes for less than 30 quarters (less than 2.5 years).
  • $252 per month if they paid Medicare taxes for 30-39 quarters (over 2.5 years and less than 3 years and 3 months).

Learn more about how much Medicare Part A premiums may cost you in 2020 by using the Medicare Eligibility & Premium Calculator.

For more information on hospital deductible and coinsurance costs continue reading on the 2020 Medicare costs PDF.

How much does Medicare Part B cost in 2020?

Unlike Medicare Part A where most people do not pay a premium, everyone who wants Medicare Part B pays a monthly premium.

In 2020, the Medicare Part B premium starts at $144.60 per month and can be higher depending on your income level. Continue reading about how much your Medicare Part B monthly premium may cost in the 2020 Medicare Costs PDF.

Note: if you already receive Social Security benefits, your Medicare Part B monthly premium will automatically be deducted from your Social Security monthly benefit payment.

When can individuals enroll in Medicare in 2020?

Individuals can only enroll in Medicare at certain times of the year, and the cost may go up the longer they wait to sign up.

Individuals can avoid gaps in care and financial penalties by enrolling in Medicare as soon as they are eligible to do so.

Here are the three opportunities to enroll in Medicare:

  • When someone is about to turn 65 years old: Their first opportunity to enroll in Medicare is in the 3 months before the month they turn 65 and the 3 months after the month they turn 65 (they have a 7-month period to enroll in Medicare the year they turn 65).
    • They may need to pay a penalty in the form of higher premiums if they miss their first opportunity to enroll.
  • General Enrollment:
    • If they miss their first 7 month enrollment period the year they turn 65, they can enroll any year after that between January 1st and March 31st, which is considered General Enrollment.
  • Special Enrollment Periods (SEP):
    • If they missed their first opportunity to enroll in Medicare and they are part of an employer group health plan, or they are covered by a spouse that is part of an employer group health plan, they may be eligible for a special enrollment period.
      • See below for more details on special enrollment periods for individuals that deferred Medicare enrollment due to alternative employer coverage.
    • They may also be eligible for a special enrollment period if their employment ends or if their employer group health plan insurance ends.

Continue reading about who is eligible for special enrollment periods and more information on the penalties individuals may face for late enrollment on the Medicare website.

How to enroll in Medicare

Individuals turning 65 or older and who are not already receiving social security benefits can enroll in Medicare Part A and Part B on the Social Security Administration website. This takes 10 minutes or less to complete, and is also offered en Español aqui.

Individuals can also apply over the phone by calling the Social Security Administration at 800-772-1213.

Once your loved one has filled out the enrollment application, Social Security will review their application and reach out with questions or to request further information.

Before enrolling, understand that signing up for Medicare when an individual already has employer/group based health insurance can create issues and penalties. Individuals should speak with their company benefits department to learn how signing up for Medicare will affect their current plan.

Do you need to enroll in Medicare if you are receiving Social Security?

If your loved one is receiving Social Security benefits, they will automatically enroll in Medicare Part A and Part B, three months before they turn 65.

They should receive a welcome packet in the mail. If they do not receive a Medicare welcome packet, they should reach out to Social Security.

People with Amyotrophic Lateral Sclerosis (ALS) will automatically be enrolled in Medicare Part A and Part B the same month they first receive Social Security benefits.

How long does it take for Medicare coverage to start?

The start date of someone’s Medicare coverage depends on when they enroll and their eligibility status.

The cases below are for people who enrolled during their initial enrollment period:

  • If they enroll in Part A and Part B during the 3 month period before they turn 65 their coverage will begin on the first day of the month they turn 65.
    • So if they turn 65 on May 15th, 2020 and enroll in the 3 months prior to May, their Medicare coverage will begin on May 1st 2020.
    • The only exception to this is if their birthday is on the first day of the month, in which case their coverage will start on the first day of the prior month.
  • If they enroll in Part A and Part B in their birthday month or the 3-month period following their 65th birthday month Medicare Part A coverage will retroactively begin on the first day of the month they turn 65.
  • Their Medicare Part B coverage will be delayed based on the below schedule:
    • If they enrolled in the month they turned 65 → Part B coverage will start 1 month after they enrolled.
    • If they enrolled in the month after they turned 65 → Part B coverage will start 2 months after they enrolled.
    • If they enrolled 2 months after the month they turned 65 → Part B coverage will start 3 months after they enrolled.
    • If they enrolled 3 months after the month they turned 65 → Part B coverage will start 3 months after they enrolled.

The cases below are for people who enrolled after their initial enrollment period:

  • If they enrolled in Medicare Part A in the 6 months following their 65th birthday month:
    • Their Medicare Part A coverage will retroactively start on the first day of the month of their 65th birthday.
      • So if they turn 65 on May 15th 2020 and you sign up for Medicare Part A on August 5th, their coverage will retroactively start on May 1st.
    • Individuals cannot enroll in Medicare Part B outside of their initial enrollment period or the General Enrollment Period unless they qualify for a Special Enrollment Period.
  • If they enroll in Medicare Part A more than 6 months following their 65th Birthday month:
    • Their Medicare Part A coverage will retroactively go back 6 months from when they enrolled.
      • So if they turn 65 on May 15th 2020 and signed up for Medicare Part A on December 5th, their coverage will retroactively start on June 1st.
  • If they enroll in either Medicare Part A or B during the General Enrollment Period – their Medicare coverage will begin on July 1st of the same year they enrolled.
  • If they enroll in either Medicare Part A or B during a Special Enrollment Period (SEP) – their coverage will begin the first day of the month following enrollment.

For further information on coverage start dates and schedules, visit Medicare’s When will my coverage start?

Where is Medicare accepted in 2020?

Medicare offers online tools for finding doctors, hospitals, and other providers that accept Medicare near your loved one. See below for the different search options:

Will Medicare pay for a family caregiver?

Medicare does not pay family caregivers for their time however there are State Medicaid programs that may pay a family caregiver.

Will Medicare pay for assisted living?

Medicare will not cover residential care in a non-medical facility.

Will Medicare pay for home care?

Medicare Part A and B will cover at-home skilled care by a Medicare-certified home health care agency if:

  • It is prescribed by a doctor and delivered part-time (not daily).
  • It is short term for recovery or rehab purposes (once the patient is stable Medicare will stop covering care).
  • The patient is unable to leave home without the help of another person or wheelchair.

If your loved one is approved for Medicare covered home health care, Medicare will pay for 100% of the home health care services. It will pay for 80% of the Medicare-approved amount for durable medical equipment (DME) for the first 20 days.

Learn more about Medicare covered home health care on our Home Health Care page.

Will Medicare pay for hospice care?

Medicare Part A will cover all of hospice care if:

  • A patient’s doctor and hospice doctor certify that a patient is terminally ill and is expected to live for 6 months or less.
  • A patient legally agrees to stop treatment to cure their illness, opting for palliative care to provide comfort.
  • The hospice care is delivered by a Medicare-approved hospice provider.

Continue reading about Medicare covered hospice on our Hospice page.

What does Medicare Part A and Part B not cover in 2020?

Medicare Part A and B will not cover all medical treatments, services and tests. Review Medicare’s comprehensive list of treatments not covered by Medicare.

Search if your Medicare coverage includes a certain service using the Medicare Coverage Search tool. Make sure to type it in exactly as it is spelled (for example “Cosmetic surgery”). If you do not get a result the first time, try using different wording.

Which Medicare plan is the best fit?

Medicare can help you compare plans and figure out what is best for your loved one using the Medicare compare tool /En Español aqui.

What is a Medicare PACE Plan?

PACE stands for Programs of All-inclusive Care for the Elderly. These are state-by-state plans that help aging people 55 years or older get care outside of nursing homes in their community.

PACE plans are an alternative if Medicare does not cover your home care.

To be eligible for a PACE plan, your loved one must:

  • Be 55 years or older
  • Have Medicare or Medicaid (or both)
  • Require state certified nursing-home-level care

Learn more about what PACE covers and who is eligible on Medicare’s PACE page.

For more information on joining a PACE program, visit your state’s PACE site.

What is a Medicare Savings Program (MSPs)?

Does Medicare cover pre-existing conditions?

Yes, Medicare covers all pre-existing conditions by federal law. There are no circumstances under Medicare Parts A, B, or D where pre-existing conditions will affect coverage for eligible Medicare recipients.

Do Medicare supplement plans (Medigap) cover pre-existing conditions?

Medicare supplement plans will cover pre-existing conditions if the Medicare recipient enrolls in the plan during their one-time Medicare supplement open enrollment window or in a guaranteed issue situation. If they apply after the one-time window and have a pre-existing condition, they may face a waiting period or get declined for coverage.

Do Medicare Advantage plans cover pre-existing conditions?

Medicare Advantage plans cover all pre-existing conditions other than End Stage Renal Disease (ESRD). Medicare Advantage recipients will still have to cover their co-pays and coinsurance for any services related to their pre-existing health conditions.

Is there a maximum out-of-pocket cost for Medicare in 2020?

  • Original Medicare (Part A and Part B): has no maximum out-of-pocket costs in 2020. That means the person enrolled is responsible for paying 20% of medical bills, including co-payments, deductibles and coinsurance.
    • Here’s an example: If your loved one has an accident or needs costly treatment for an illness, they’ll need to pay the 20% co-payment not covered by Original Medicare.
    • This can add up to tens of thousands of dollars a year.
  • Medicare Advantage Plans: Medicare Advantage Plans have a maximum out-of-pocket cost known as MOOP. Each year CMS sets the MOOP for Medicare Advantage plans. For 2020 the maximum out-of-pocket cost for Medicare Advantage Plans is $6,700 although some plans set a lower limit.
    • Some Medicare Advantage Plans set another limit for out-of-network providers. This second limit is higher than the first limit, and is the combination of in-network and out-of-network providers.
    • Most Medicare Advantage Plans only apply MOOP to Medicare Part A and B. There are some that extend the maximum out-of-pocket to supplemental coverage like vision or dental.
    • All cost-sharing associated with Medicare Part A and Part B counts towards your maximum out-of-pocket costs. These include co-payments, deductibles, and coinsurance. Medicare Part D cost-sharing does not contribute to your MOOP.

What is a Medicare Supplemental Insurance Plan (Medigap)?

Medicare Supplemental Insurance Plans are called Medigap plans. They help to pay the remaining healthcare costs not covered by Original Medicare. These include the deductibles, co-payments, and co-insurance that are part of Medicare Part A and Part B.

Medigap plans are helpful for people who are willing to pay a higher premium. This helps to reduce their potential Medicare Parts A and B out-of-pocket costs.

What is the difference between Medigap and Medicare Advantage?

  • Medigap plans help pay for benefits covered in Medicare Part A and Part B.
  • Medicare Advantage plans add to your Medicare benefits by covering dental, vision, and hearing care.

In 2020, Medigap plans do not cover:

  • Long-term care
  • Vision, hearing, or dental care
  • Prescription drug coverage (unless you purchased Medigap before 2006)
  • Private nursing services

You are not allowed to purchase a Medigap plan if you’ve got a Medicare Advantage plan. You can get a Medigap plan if you switch back to Original Medicare.

How do you get a Medigap plan?

Medigap plans are sold by Medicare approved private insurers. Coverage varies based on the provider.

  • In order to purchase a Medigap plan, you must already have Medicare Part A and Part B.
  • Once you purchase a Medigap plan, you pay a monthly premium for your Medigap policy, plus your monthly premium for Medicare Part B.
  • After you buy a Medigap policy, the private insurance can’t cancel your policy as long as you pay the monthly premium.

Each person who wants a Medigap policy must purchase their own. No Medigap policy will pay for a spouse or loved one’s Medicare costs unless they have their own policy.

What are guaranteed issue rights (Medigap Protections)?

Guaranteed issue rights, often known as “Medigap Protections,” require insurance companies to offer people Medigap policies under specific circumstances. This happens when they lose their previous health care coverage, or it changes.

Medigap Protections don’t let insurance companies deny you a Medigap Policy, or charge you more because of pre-existing conditions.

Learn more about examples in which Medigap Protections cover you or your loved one on Medicare’s guaranteed issue rights page.

How to pick the right Medigap policy

All Medigap policies are similar according to federal and state laws, offering the same basic benefits. Some Medigap policies offer more benefits; they are identified by a letter showing what they offer.

You can compare the different Medigap policies side-by-side using the chart at the bottom of Medicare’s Medigap comparison page.

If you or your loved one lives in Massachusetts, Minnesota, or Wisconsin, Medigap policies are standardized differently for these states. Click on the state in which you’re interested for more info.

How to find a Medigap policy in my state?

Find out which state insurance companies sell Medigap policies in your area by using the Medicare Policy Finder.

What is COBRA?

Cobra allows people who leave or lose their job to keep their group health plan coverage for 18 to 36 months after their employment ends. To do so they must continue to pay their insurance premium.

Can you have COBRA and Medicare at the same time?

The answer to this question is based on which form of insurance you had first, COBRA or Medicare.

  • If you have a COBRA plan in the month you become eligible for Medicare, your COBRA plan typically ends and you enroll in Medicare Part A and B.
    • In this scenario, you most likely want to enroll in Medicare Part B right when you become eligible because you will not get a special enrollment period for Part B when Cobra ends.
    • When your COBRA plan ends, you may be allowed to keep certain coverage that Medicare does not offer, like dental or vision. Contact your insurance provider to learn more.
  • If you already have Original Medicare (Part A and B) when you become eligible for COBRA, you can enroll in COBRA as a secondary insurance for anything that Medicare does not cover. (Medicare remains your primary insurance.)
    • In this scenario is it likely you want to keep Medicare as it covers most of your costs. Plus, COBRA plans are often more expensive.
    • Before you enroll in COBRA, contact your State Health Insurance Assistance Program for information about Medigap or Medicare Advantage plans. That office can help you sort out the option best for you.

Do I have to enroll in Medicare if I continue to have health coverage after age 65 from my own or my spouse’s employer?

The answer to this depends on if the employer has greater or fewer than 20 employees.

If the employer has 20 employees or more and you or your spouse are actively working for the employer, you have the choice to defer Medicare coverage after you turn 65 without incurring late enrollment penalties if you choose to enroll later.

  • You would want to defer Medicare only if the health insurance plan in which you’re enrolled in is Medicare-approved or comparable.
  • In this scenario, you will be entitled to a special enrollment period (SEP) of 8 months to sign up for Medicare once the employer coverage ends.
  • You cannot defer Medicare enrollment without penalty if you or your spouse’s health benefits come from a COBRA plan or former employer retirement plan. Actively working means you or your spouse currently works for the employer that is providing your primary insurance plan.
  • If you are covered by an employer plan, it rarely makes sense to enroll in Medicare Part B.
    • Enrolling in Medicare Part B in this scenario may cause you to pay multiple premiums for minimal extra coverage and you may be giving up the right to buy advantageous Medicare Supplemental Insurance (Medigap) when the employer plan ends.
    • Discuss the consequences of enrolling in Part B with your employer.

If the employer has less than 20 employees: The employer decides whether they will require you to enroll in Medicare when you turn 65. Employees or spouses of employees in this scenario should proactively ask if the employer will require Medicare enrollment when you turn 65.

  • In the case your employer requires you to enroll, Medicare will become the primary insurance provider and the employer plan will become the secondary plan.
  • Ask about the details of how Medicare and your employer plan fit together and request that the decision be delivered in writing so you have documentation of enrollment in both plans.
  • In this scenario, enrolling in Medicare Part B will not hurt your ability to buy Medicare Supplemental Insurance (Medigap) after the employment ends since Medicare is already your primary plan.

Continue reading about when to defer Medicare enrollment and how it may affect future coverage on AARP.

What is the 2020 Medicare deductible?

Every year the Centers for Medicare & Medicaid Services adjusts the Medicare premiums, deductibles, and copayment amounts based on the Social Security Act.

2020 Medicare Part A Deductible

  • The 2020 Medicare Part A hospital deductible is $1,408 ($44 more than in 2019).

2020 Medicare Part B Deductible

  • The 2020 Medicare Part B annual deductible is $198 in 2020 ($13 more than the annual deductible in 2019).

For more information on 2020 deductibles visit the CMS site.

What federal government office is in charge of Medicare and Medicaid?

The Centers for Medicare and Medicaid Services (CMS) oversee federal management of:

  • Medicare
  • Medicaid
  • The Health Insurance Exchanges

CMS pledges to put patients first.

How do I check the status of a Medicare application?

You can check the status of your loved one’s Medicare application starting 5 days after submission.

If you are having trouble accessing the Social Security Administration Website you can call them at: 1-800-772-1213 (TTY 1-800-325-0778) from 7 a.m. to 7 p.m. weekdays.

How do I complain or appeal a Medicare decision?

All current or potential Medicare beneficiaries have the right to appeal a Medicare decision or payment amount within 120 of days receiving the Medicare Summary Notice. Learn about the process for filing a Medicare Medicare Appeal on the Medicare website.

I have more questions about Medicare. Who can I talk to?

Visit Medicare’s contact page to reach out to the most appropriate contact.

What is Medicare’s phone number?

The phone number for Medicare’s Service Center is: 800-633-4227 or TTY: 877-486-2048.

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Related Topics To Learn About

Social Security Administration (SSA)

Social Security Administration (SSA) offers 3 types of social security benefits including: Retirement Benefits, Disability Insurance (SSDI), Survivors Benefits.

Medicaid

Medicaid is a federal and state jointly funded healthcare program that covers health services for certain people with low-incomes.