Coverage

What You Should Know about Medicare Coverage

Christian Worstell

by Christian Worstell | Published February 18, 2021 | Reviewed by John Krahnert

Original Medicare, which includes Medicare Part A and Medicare Part B, provides a number of benefits.

Learn more about your coverage options below.

Medicare Part A and Part B Benefits

Original Medicare is the federal health care program that provides health care insurance for people age 65 or older and younger people with certain disabilities or with end-stage renal disease.

Original Medicare consists of two parts: Medicare Part A and Medicare Part B.

Medicare Part A covers:

  • Hospital care
  • Home health services
  • Nursing home care
  • Skilled nursing family care
  • Hospice care

Medicare Part B covers:

  • Services (doctor's visits, surgeries, lab tests) and supplies needed to diagnose or treat an illness or condition that meet accepted standards of medical practice
  • Services to prevent or detect an illness or a condition at an early stage

Note: Although Original Medicare provides comprehensive health care coverage, it does leave some out-of-pocket expenses to beneficiaries including:

  • Deductibles
  • Copayments
  • Coinsurance
  • First three pints of blood
  • Excess charges

Medicare Supplement Insurance

Medigap, also called Medicare Supplement Insurance, helps cover some of the out-of-pocket costs that are associated with Original Medicare.

There are 10 standardized Medigap plans that are sold in most states by private insurers licensed to do so. Availability and cost can vary by state.

All Medigap plans must offer coverage for your:

  • Medicare Part A coinsurance for hospital care
  • Medicare Part A coinsurance or copayment for hospice care
  • Medicare Part B coinsurance or copayment
  • First three pints of blood

You can then select a Medigap plan with the benefits that meets your needs, if you desire.

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Medicare Supplement Benefits

Part A coinsurance and hospital coverage

Part B coinsurance or copayment

Part A hospice care coinsurance or copayment

First 3 pints of blood

Skilled nursing facility coinsurance

Part A deductible

Part B deductible

Part B excess charges

Foreign travel emergency

A B C* D F1* G1 K2 L3 M N4
50% 75%
50% 75%
50% 75%
50% 75%
50% 75% 50%
80% 80% 80% 80% 80% 80%

* Plan F and Plan C are not available to Medicare beneficiaries who became eligible for Medicare on or after January 1, 2020. If you became eligible for Medicare before 2020, you may still be able to enroll in Plan F or Plan C as long as they are available in your area.

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1 Plans F and G offer high-deductible plans that each have an annual deductible of $2,370 in 2021. Once the annual deductible is met, the plan pays 100% of covered services for the rest of the year. The high-deductible Plan F is not available to new beneficiaries who became eligible for Medicare on or after January 1, 2020.

2 Plan K has an out-of-pocket yearly limit of $6,220 in 2021. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.

3 Plan L has an out-of-pocket yearly limit of $3,110 in 2021. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.

4 Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to $50 copayment for emergency room visits that don’t result in an inpatient admission.

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Insurance companies authorized to sell Medigap policies aren’t required to offer every option, but every insurer that sells them must offer Medigap Plan A and either Plan C or Plan F.

Call 1-888-642-0148 today to chat with a licensed insurance agent about the right Medigap plan option for your unique health care needs.

Medicare enrollment form

Enrolling in Medicare

If you're already receiving Social Security or railroad retirement benefits when you turn 65, you'll be automatically enrolled in Part A and Part B. If you are younger than 65, you'll be automatically enrolled after you 24th month of disability benefits.

If you're still working, the best time to enroll in Medicare is during your Medicare Initial Enrollment Period. Your Medicare Initial Enrollment Period goes into effect three months before you turn 65. You have a seven-month period to sign up.

If you don’t sign up during your Initial Enrollment Period, you can enroll during the General Enrollment Period, which runs from January 1 to March 31 each year. If you enroll during general enrollment, coverage doesn't begin until July 1.

If you’ve turned 65 and are already receiving Social Security benefits, or have applied for them, the Social Security Administration will notify you that you're automatically being enrolled. Otherwise, you can enroll by:

Call 1-800-995-4219 to chat with a licensed agent, or read through our guide, What Does Original Medicare Cover? to learn more.

Resource Center

Medicare Preventive Benefits

As a Medicare beneficiary, you may be eligible for a range of preventive health services. Medicare Part B (Medical Insurance) provides coverage for the following. Read more

Does Medicare Cover Mental Health?

Medicare covers qualified outpatient and inpatient mental health care services. Medicare Supplement (Medigap) plans can help cover your out-of-pocket mental health costs. Read more
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