Medicare, A Simple Explanation

Social Security and Medicare are both programs that are household names, but do you know the true difference? Both programs help safeguard millions of Americans as well as improve the quality of life for their family and friends. While Social Security offers retirement, disability, and survivors benefits, Medicare provides health insurance.

Medicare is our country’s health insurance program for people age 65 or older and younger people receiving Social Security disability benefits. The program helps with the cost of health care, but it doesn’t cover all medical expenses or the cost of most long-term care.

When you first enroll in Medicare and during certain times of the year, you can choose how you get your Medicare coverage. There are 2 main ways to get Medicare:

Original Medicare

Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). If you want drug coverage, you can join a separate Part D plan. To help pay your out-of-pocket costs in Original Medicare (like your deductible and 20% coinsurance), you can also shop for and buy supplemental coverage. Examples include coverage from a Medicare Supplement Insurance (Medigap) policy, or from a former employer or union.

Medicare Advantage (also known as Part C)

Medicare Advantage is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.  Part C plans may have lower out-of-pocket costs than Original Medicare.  They also may offer extra benefits that Original Medicare doesn’t cover — like vision, hearing, dental, and more.

If you can’t afford to pay your Medicare premiums and other medical costs, you may be able to get help from your state. States offer programs for people eligible for or entitled to Medicare who have low income. Some programs may pay for Medicare premiums and some pay Medicare deductibles and coinsurance. To qualify, you must have limited income and resources.

You can learn more about Medicare, including how to apply for Medicare and get a replacement Medicare card on our website.

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118 thoughts on “Medicare, A Simple Explanation

      • Part C is not provided by the government – it is provided by private insurance companies and the monthly premiums vary – depending on your location and the prescription drug plan you choose. Not all plans are offered in all states. Choose a plan that covers your prescriptions. Not all plans cover the same prescriptions. You can request a copy of the ‘formulary’ which is the list of drugs covered by the particular insurance company. Don’t choose a plan based only on the cost of the premium.

        • If you have Part A and Part B you don’t need Part C. You either choose traditional Medicare (Part B) where you can go to any doctor you want, or you choose Part C, which is a private ch company plan that has network doctors you have to use in order for it to pay for your medical services. Part D is the stand alone drug plan for people who don’t have prescription coverage. I have traditional Medicare with a great Part D drug plan through the A AARP with no deductible.

          • good, comprehensive answer above.

            for those on limited income, look into HUMANA PPO…it’s a combination of medicare & supplement as ONE plan!

            monthly cost goes up to $51/month next year.

            it has tiers 1, 2, & 3; majority of my prescription meds for 3 months are FREE.

            as person stated above, check it all out.

            i’m even thinking of making an appt. with SHIP rep to explain programs for 1st time.

            best wishes to everyone thinking of which to chose or which to switch to!!

            betty gordon, iowa

          • You don’t need Medicare part C?
            If I want to change to Advantage part C they asked me to pay late fee enrollment.
            If it is not mandatory
            why to be charge late fee?

    • Survivor – gets benefits based on another family member’s work history
      Retired – gets benefits based on worker’s own work history – reduced benefits begin at age 62, full benefits at Full Retirement Age (now 66 or later, depending on date of birth – look it up)
      Disabled – gets benefits before retirement age based on symptoms of a disabling medical condition that is expected to last more than one year

    • Hi, Lesly. For your security, we do not have access to private information in this venue. We ask that members in our Blog community work with our offices with specific questions. You can call us at 1-800-772-1213, Monday through Friday, between 7:00 a.m. and 7:00 p.m., for assistance. Generally, you will have a shorter wait if you call later in the day. You can also contact your local Social Security office. We hope this helps.

    • call medicare promptly!! glad you discovered that.

      it should show BOTH A & B !! it’s important that it does.

      best wishes on getting this straightened out NOW!

      betty gordon, iowa

    • You may have other insurance that covers the same things Part B covers so that you were not required to take (and pay for) Part B.

    • Hi, Lawrence. For your security, we do not have access to private information in this venue. We ask that members in our Blog community work with our offices with specific questions. You can call us at 1-800-772-1213, Monday through Friday, between 7:00 a.m. and 7:00 p.m., for assistance. Generally, you will have a shorter wait if you call later in the day. You can also contact your local Social Security office. We hope this helps.

  1. Are you talking the A;B;C coverage within Medicare or are you talking of a supplement?

    If so are you allowed to direct me to the best additional insurance provider

  2. I have a coverage that became secondary to medicare part A from my job in NY City, also prescriptions and eye care from the union. The medical have a high deductible and never cover the 20% in full. Is there anything I can do without upsetting that secondary insurance, or the union prescription, eye and dental coverage which is like nothing anyway?

    • If you have insurance through a job or union membership, Medicare is secondary to that insurance, not the other way around. Medicare will pay part of what the job/union insurance doesn’t but not all of it. Once you retire or no longer have insurance through your job, Medicare will become primary and a supplemental policy (Part G or Medigap) would cover much of the rest, or you could switch to a Part C plan like your union plan.

    • Hi, Charles. For your security, we do not have access to private information in this venue. We ask that members in our Blog community work with our offices with specific questions. You can call us at 1-800-772-1213, Monday through Friday, between 7:00 a.m. and 7:00 p.m., for assistance. Generally, you will have a shorter wait if you call later in the day. You can also contact your local Social Security office. You may also wish to contact your local Medicare SHIP (State Health Insurance Program Coordinator) to discuss your options. We hope this helps.

  3. I do not turn 65 until May 26 2020, do I subscribe to Medicare now or wait until I turn 65? I keep hearing about Open Enrollment ending in December 2019 for 2020 and want to make sure I Gary it before December if I need it.

    • Thanks for your question, Randy. If you are already getting Social Security retirement benefits, you will be enrolled in Medicare Parts A and B automatically. However, because you must pay a premium for Part B coverage, you have the option of turning it down. If you are not already getting retirement benefits, you should contact us about three months before your 65th birthday to sign up for Medicare. You can sign up for Medicare even if you do not plan to retire at age 65. To learn more about Medicare, visit here. We hope this helps.

    • Medicare ‘Open enrollment’ applies to those people already receiving Medicare benefits who want to change the plan(s) they are in.
      For new enrollies, those reaching Medicare eligibility (age 65) there is a seven-month enrollment period (3 months before you turn 65, the month you turn 65 and 3 months following the month you turn 65.). But, don’t wait for the last minute. Also, you are given the option of enrolling for only hospital coverage (PART A) or hospital (PART A) and medical (PART B) If you currently have group health insurance through your employer or union or some other source, you may want to decline Part B (MEDICAL) until that group coverage ends. Check with your insurance administrator. Some people may be automatically enrolled in Medicare if they are already receiving some form of Social Security benefits.

  4. I would like to qualify for medicare but i am living in the UK. I plan to return to the US where i am Financially responsible for my elderly parents. I started working and paying into the US system when I was 15 years old and i also represented the US in 4 olympic games including 2 silver medals. However i do not have enough social security payments to qualify for social security since my tax domicile is the UK. I am now 61 years old. What should I do ?

    • If you meet the stringent poverty requirements, and are over 65, you could apply for Supplemental Security Income, which was originally intended to supplement low monthly Social Security benefits but also stands alone as a program for impoverished disabled or elderly recipients. SSI recipients qualify for Medicaid, the medical insurance also with severe poverty requirements. If you are not that poor, then hope your UK benefits might transfer in some part to the US, just as Social Security can be paid to those living overseas.

  5. My medicare has stopped. I am not someone who came here illegally. I lost all of my documents and is having a hard time time getting them back. It is costing money I have no income coming in bearly have food. I would like to know if Social Security could begin paying me and give me a deadline to get my documents I don’t have money and this is costing quite a bit. Please help me

    • Hi, Lyris. We are sorry to hear about your situation. For your security, we do not have access to private information in this venue. We ask that members in our Blog community work with our offices with specific questions. You can call us at 1-800-772-1213, Monday through Friday, between 7:00 a.m. and 7:00 p.m., for assistance. Generally, you will have a shorter wait if you call later in the day. You can also contact your local Social Security office. We hope this helps.

  6. The only thing I do know is that we paid in to both programs. They were not meant to be handed out to just anyone. Medicare for all would ruin it for our seniors. Social security was not meant to live on but a tax we and our employers paid into to give us a little extra cash in our old age. It was not meant to be handed out to how the government feels they need to help. Thanks for asking and use our money wisely.

    • I agree with Alan. Those who have paid into Part A during their working years and who become eligible to enroll are eligible.
      The trust fund should be protected from those who want to take the money we contributed.

  7. The program is flawed I can barely get my prescriptions as well as the numerous copays for the different doctors. I was originally in the Affordable Healthcare program and then I turned 65. I preferred the Affordable Health Care is it coming back.

  8. Is there a part of D or C that covers transportation to dialysis an back home again. It is costing me $18.00 each way for LYFT. That is $ 36.00 x 3, I go that many times a week which =$108.00 a week. Thats comes to
    $432.00 a month. I have tried to seek others way of transporation. But I am out of their bounty for a mile an a half. Thats a bummer. I have heard a few of the insurance company’s offering transporation, don’t know which ones.
    Can you check this out for me. I would be truly happy if you did did.
    Thanks,
    Elvira Baerman
    Email address: baermanelvira@gmail.com

  9. Would be very helpful if you could get benefits why’ll your application is being summited it’s been almost four months and I myself have been going through a lot of problems with bills and other things the bad thing is that if you don’t get approved what are you going to do that’s my appenian thank you and God bless.

  10. I have a medical policy with Kaiser at my work at present time also I am 66 years old…so my question is do i have to wait until next year to make change to Medi-care and supplemental insurance or can I do it mid year in July when we pick you insurance? Thanks for any help Lucinda

  11. I have Tricare for life, Retired military. I also am a disabled Veteran. I always use local VA for any medical services I require. Why do I have to pay for Medicare Part B, when I never use it?

    • Hi Gerald. If you have coverage under a program from the Department of Defense, your health benefits may change or end when you become eligible for Medicare. You should contact the Department of Defense or a military health benefits advisor for information before you decide whether to terminate Medicare medical insurance. For more information on how other health insurance plans work with Medicare, call the Medicare toll-free number, 1-800-MEDICARE (1-800-633-4227), and ask for Medicare and Other Health Benefits: Your Guide to Who Pays First (Publication No. CMS-02179) or visit http://www.medicare.gov/publications. You may also wish to contact your local Medicare SHIP (State Health Insurance Program Coordinator) to discuss your options. We hope this helps.

  12. I was wondering if I will ever get my full SSA since the company I was working for cut our hours back I was forced to apply for my Social security early on top of that I got injured too.

  13. How is it as of the first of the year you will no longer let us have our pain medication? I live in pain 24/7 and my pain pills take a little edge off the pain. But now they say we won’t be able to get them or if we do it will only be a few a week and have to travel 70miles a week to get the prescription. That just seem like it goes against our constitutional rights. Please rethink this new plan. I feel it will raise the crime rate out of this world. There will be more brake in, more shotting and killing. The people that used these medications for the wrong reasons will get them one way or the other.

  14. The Medicare should cover for Dental gum surgery for any tooth in bad condition to be pool it out and be replaced. Do not to be an emergency for Medicare covers. I want to be very clear is a dental surgery.

  15. I’m a federal employee retired under CSRS and you never send me my medicare card. I kept my health medical plan and when the system ask me if I have a medical health plan I filled the blanks with the medical plan that I have it wont let me continue. I need to know how can you send me my medicare card? Im 70 years old.

    • Hi Raul. For your security, we do not have access to private information in this venue. We ask that members in our Blog community work with our offices with specific questions. You can call us at 1-800-772-1213, Monday through Friday, between 7:00 a.m. and 7:00 p.m., for assistance. Generally, you will have a shorter wait if you call later in the day. You can also contact your local Social Security office. We hope this helps.

  16. Hi, I do not remember if I have Medicare A or B. I’m 66 years old and still working full time with full benefits, and would like to know if it covers ultrasounds and stress tests done at the cardiologist’s office . Thank you!

  17. This is very informative piece. Love it. Short, simple and concise. Great Job!! I hope sometime you would do a similar piece on the chart of the Part A, B, C, D and other Medicate Supplemental plans. Thank you!

  18. I WAS LAYED OF FROM A 22 YEAR JOB IN 2017 AND LOST MY WIFE AND MYSELFS GROUP MEDICAL COVERAGE. I NOW HAVE ONLY PART A AND AM A VETERAN . I AM 75 YEARS OLD AND AM ON SOCIAL SECUTITY BUT DONT KNOW HOW MUCH SINCE MY WIFE DIED. SSECURITY IS MY ONLY SOURCE OF INCOME. AM I ELIGABLE FOR PART B AND WILL THE PREMIUM FOR PART B BANKRUPT ME?

  19. Have someone contact me I have a payee Sandee Rogers, 2735 10th Street, Everett,WA 98201 425–349-6313,fax #(425)-252-0793 who is on as my payee but she may not be responsible for basically is scam or fraud of the State of Washington . I am the Head and Dictorate of the F.B.I. , SSN(*** – ** – ***) ,Passport # 500867019 please enter that number to pull up the preceding information.I would ask you to me me Federal Employer Identification Number(DCI and F.B.I.) and EIN(amtrack,NFL,JPMorgan,Bank of America) and contact me at cell#206-854-5368 home which my name is on the title and license ( Adult Family Home) 1021 Bell Street, Edmonds,WA 98020 but living as a patient home (425)-835-0562
    The whole sum of it is that I cannot move successfully and survive without my FEIN and EIN and remain on Medicaid and my Medicare has been wiped out and I can’t access my real Medicare Card and confirmation I was ever on it .
    I am the Leader and President of the Bergdorf Society and this has been a sickening cycle of people that refuse to reissue numbers, documents and do what they should honesty when the information is in the databases . I will have to indict people Federally and throw away the key … honesty …take this very seriously!

  20. Hi, some people say that even if I picked a medicare advantage plan, I still have to pay a monthly fee and that if I continue to work, after 65 and then retire later….that this fee goes up as I wait to retire later…even if I applied for medicare? Could you explain that?

    • Hi Gilda. Thank you for your question. If you are still working and you are covered under a group health plan based on your employment, you may not need Medicare Part B, nor will you be penalized, until you stop working or your employer terminates your health care coverage. You should speak to your employer or to the health insurance plan to see what is best for you. You can read more about whether you need Medicare Part B on our internet page, and our publication titled “Medicare.” We hope this helps.

  21. Medicaid Prices for All!! Medicare you may be b(k)illed letters are the primary reason for medical hyperinflation since the 1970s. Medicaid needs sell middle class and rich people premiums and charge insurance companies and uninsured patients reasonable Medicaid prices.

    Sanders, Tony J. Digestion. Hospitals & Asylums HA-30-10-19, 551 pp. http://www.title24uscode.org/digestion.pdf

    Humans require 0.7 to 3.7 liters of distilled or filtered water for drinking and cooking daily per person. The adult bladder holds about 400 mL of urine and the kidneys produce 1 liter of urine a day, from 4-6 liters of blood. Each 24 hours about 100-200 grams of stool is evacuated. Sedentary calorie requirements in the United States for children 2-3 years is 1,000 calories, children 4-8 years 1200-1400 calories. Girls 9-13 1600 calories. Boys 9-13 1800 calories. Girls 14-18 years 1800 calories. Boys 14-18 years 2200 calories. Females 19-30 years 2000 calories. Males 19-30 2400 calories. Females 31-50 years 1800 calories. Males 31-50 2200 calories. Females 51+ years 1600 calories. Males 51+ years 2000 calories.

    Good nutrition is the foundation of health and well-being for all. Everyone needs four basic nutrients – water carbohydrates, proteins and fats – as well as vitamins, minerals and other micronutrients. The human body is two-thirds water. Fatty acids are used by the body as a source of energy and are provided for in our diet by animal fat and vegetable oils that when metabolized supply 9 cal/g. Proteins, are complex chains of amino acids, supplied chiefly by animal proteins –meat, milk, cheese and eggs – and plants such as rice and legumes and nuts, that when metabolized yield 5 cal/g. Carbohydrates are complex compounds made up of sugars that when metabolized yield 4 cal/g. Protein and calorie requirements vary, with pregnant and lactating women, children, teenagers and young adults and strenuous exercise requiring larger amounts.

    Pregnant and lactating women in emergency settings should be provided with an extra liter of water and fortified blended food commodities, in addition to the basic general ration, that are designed to provide 10–12% (up to 15%) of energy from protein and 20–25% of energy from fat. The fortified blended food should be fortified to meet two thirds of the daily requirements for all micronutrients. Teenagers and young adults also require extra food. Cheese sandwiches. Beyond infancy a child requires about 10 percent of caloric intake in protein. Protein deficiency, especially during the first year of life, has been associate with decreased brain development and lowered IQ. The amount of protein in a mother’s breast milk is 5 percent of calories.

    According to the World Health Organization (WHO) the human minimum protein requirement is 5 percent of total calories, according to the US Recommended Dietary Allowance (RDA) for adults 10 percent of total calories. For optimum protein intake WHO recommends 10-15 percent of calories. Total fat intake should be less than 30 percent of total energy intake, Saturated fatty acid intake should be less than 10 percent of total energy intake. Trans-fatty acid intake should be less than 1 percent of total energy intake. At least 1 percent of calories should come from fat. Therefore, 55-75 to 94 percent of calories in the diet should come from carbohydrates.

    Calcium + vitamin D + phosphorus = Apatite. Bones and teeth contain 99 percent of all the body’s calcium and phosphorus, that is where the body gets it. For osteoporosis therapeutic and preventive measures should emphasize adequate intake of calcium (1500 mg/day), vitamin D (400-800 IU/day) and 1,000-1,250 mg/day of phosphorus.

    Exclusive breastfeeding – defined as the practice of only giving an infant breast milk for the first 6 months of life – has the single largest potential impact on child mortality of any preventive intervention. Together with appropriate complementary feeding, breastfeeding has the potential to reduce mortality among children under 5 years of age by 19%. Exclusive breastfeeding reduces the risk of gastrointestinal infection and of all-cause mortality, and protects infants from respiratory infections. Exclusive breastfeeding also has a protective effect against obesity later in life. Key recommendations are to improve maternity protection through the workplace (e.g. 6 months of mandatory paid maternity leave and polices to encourage women to breastfeed in the workplace), to empower women to exclusively breastfeed. The United States currently does not pay for 12 weeks of maternity leave, but protects the mother from wrongful termination of employment. A woman is entitled to 14 weeks paid leave Maternity Protection pursuant to ILO Convention No. 183 (2000). Six months is 24 weeks. There is now credible medical evidence that a woman should exclusively breastfeed for the first six months. WHO has specifically explained that this justifies 6 months mandatory paid leave. Therefore the unemployment compensation programs needs to estimate the costs of 24 weeks paid maternity protection based on the 6-months of exclusive breastfeeding ruling to update Maternity Protection ILO Convention No. 183 (2000) in WHO Essential Nutrition Actions: Mainstreaming Nutrition Through the Life-Course (2019).

    • If you have insurance through a job or union membership, Medicare is secondary to that insurance, not the other way around. Medicare will pay part of what the job/union insurance doesn’t but not all of it. Once you retire or no longer have insurance through your job, Medicare will become primary and a supplemental policy (Part G or Medigap) would cover much of the rest, or you could switch to a Part C plan like your union plan.

  22. I could almost live on what I pay for Medicare and insurance (BCBS) if house and car were paid for. Just wonder what my BCBS coverage would be without Medicare. Life goes on and you can’t live with it and can’t live without it in today’s world.

  23. my husband and I are 70 and 72 yrs old we want to know can we get part D the our benefits that we already have, we have a and b now, but really can’t afford this coverage thru other ins companies.

    thank you
    virginia hubler

  24. I need My MEDICARE PART A Card , and I am NOTIFYING YOU THAT I HAVE A (MEDICARE) worker’s compensation set aside MEDICARE account!!!
    I need coordination of BENEFITS,

    Nathan J Lee, I need my Medicare Part A Card Also

    • Hi, Jeffery. We are sorry to hear that. First, realize that you may not need a replacement card. You will rarely need to show it. Knowing the Social Security number is what is important. To see if you’re eligible to apply for a replacement Social Security card online or to learn more on the process and what documents you will need to get a card please visit our Social Security Number and Card page. We hope this helps.

  25. I have a huge issue. I am on Medicare part a, b and d, but they are over charging for everything because they base irma and magi from 2 years ago and I don’t earn anywhere near that. As a result I am less likely to use any of it unless it’s last resort emergency. For awhile I can afford it, but not long term. I have daily expenses too. I paid 1300 for a quarter only to receive yet another bill for 243. If I needed meds, I wouldn’t be able to do that either because the deductible is too high so I am paying for part d even though I don’t need it to avoid a fine. I feel you need to work on the glitches and stop over charging.

  26. I didn’t know that Part C medicare plans have the potential to be lower in out of pocket costs than original Medicare plans. My mother is looking to enroll in Medicare so that she can be protected for a lower cost because she is retired and doesn’t have much monthly income. I will be sure to keep this in mind as we look for an agent to help us get the most cost-effective coverage for her. https://financialgrade.com/medicare-general-agency-in-la-mesa-ca/

  27. .Writing with style and getting good compliments on the article is quite hard, to be honest.
    But you’ve done it so calmly and with so cool feeling and you’ve nailed the job.
    his article is possessed with style and I am giving a good compliment. Best!
    Thank you for the information about health care l.

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  31. It is interesting that you can bundle part a, b and d together in Medicare Advantage. My mom is turning 65 next year and we’ve been discussing what she should plan for. We may consider consulting someone that does supplemental plans for advice. https://www.senior-advisors.com/

  32. Thank you for your help in explaining that medicare helps to cover expenses like drug coverage with a Part D plan. However, it sounds like there is a good amount of gap in the insurance which could leave my mother paying a lot of money. My mother is getting up there in age and I am worried about how she would pay for any large medical bills. I wonder if she should look at supplement insurance plans to see if any of those would help her. https://medicaresupplementinsuranceexchangeus.com/

  33. Hi, I’ll be 65 on March 4, 2020 and I have insurance with the company I work for. Do I have to register for medicare Part A only? If I have to sign up, what do I need to do? I do not see anything on medicare site to sign for Part A, only.
    Thank you!

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