Medicare Basics

Medicare is complex. We can make it easier. We’ll show you how it works, one part at a time.
And we’ll help you understand your options so you make choices that are right for you.

Need Help? Call 1-888-285-2323 (TTY: 1-800-688-2534), 8 am - 5 pm, Monday - Friday.

Medicare has four parts. You get Part A and Part B from the federal government. You purchase Part C and Part D from health care companies like UCare that are Medicare approved.

Part A and Part B: Original Medicare

Together, Part A and Part B are called Original Medicare. Part A covers you when you stay in a hospital or nursing facility. Part B covers other medical care, like doctor visits and medical supplies.

Original Medicare does not limit how much you may have to pay out of your own pocket each year.

Hospital icon

Part A:
Hospital coverage

What it covers

  • Inpatient hospital care
  • Inpatient care in a skilled nursing facility
  • Home health care
  • Hospice care

What you pay

  • Deductible
  • Copays
  • Coinsurance

see what these terms mean

Stethoscope icon

Part B:
Medical coverage

What it covers

  • Doctor visits
  • Outpatient surgery
  • Ambulance service
  • Medical equipment and supplies (like oxygen or blood sugar test strips)

What you pay

  • Monthly Part B premiums
  • Deductible
  • Coinsurance

see what these terms mean

Gaps in Original Medicare

Original Medicare provides important coverage, but it won’t cover all the health care you might need. You’ll pay the full cost for services like these:

  • Dental cleanings, checkups, crowns and fillings
  • Routine eye exams and eyewear
  • Routine hearing exams and hearing aids
  • Routine physical exam
  • Prescription drugs you take at home
  • Care you receive outside the U.S

Part C: Medicare Advantage Plans

Medicare Advantage plans are also called Part C. These are plans you buy from Medicare-approved health care companies like UCare. They include all your Part A and Part B benefits. Many also cover copays and coinsurance and include Part D prescription drug coverage.

Unlike Original Medicare, Medicare Advantage plans limit how much you’ll need to pay out of your own pocket for medical care each year.

Hospital, stethoscope and medication icon group

Part C:
Medicare Advantage Plans

What it covers

  • Everything Original Medicare covers
  • Coverage when you travel in the U.S. or to other countries
  • May include extras like gym memberships, and routine vision, dental and hearing care
  • Prescription drugs (plans without Part D coverage are also available)

What you pay

  • Monthly Medicare Advantage plan premium
  • Part B premium
  • Deductible
  • Copays
  • Coinsurance

see what these terms mean

Part D: Prescription drug coverage

Part D covers prescription drugs you take to treat illness or injury at home. There are two ways to get Part D coverage:

  • You can choose a Medicare Advantage plan that includes Part D
  • You can buy a Part D only plan
Medication Icon

Part D:
Prescription drug coverage

What it covers

  • Drugs your doctor prescribes to treat an illness or injury at home

Note: Plans vary when it comes to what drugs they cover. Be sure to check the list of covered drugs before you enroll.

What you pay

  • Monthly premium (or your Medicare Advantage premium)
  • Deductibles
  • Copays
  • Coinsurance

see what these terms mean

Part D coverage has three stages:

  • Initial stage. You pay a deductible and coinsurance until your drug costs (what you and your plan pay) reach $4,020. Then you move into the coverage gap known as the donut hole.
  • Coverage gap. You share the cost of drug with your plan until your total out-of-pocket costs reach $6,350.
  • Catastrophic stage.  You pay a small amount for your covered drugs until the end of the year.

Want to more about the different parts of Medicare? Visit Medicare.gov.

Most people can get Original Medicare when they turn 65. If you’re already getting Social Security benefits, you’ll be enrolled automatically. If not, you’ll need to sign up to get benefits.

When to sign up for Original Medicare

If you’re eligible for Medicare when you turn 65, you can sign up during your Initial Enrollment Period. This is a 7-month period that begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65.

eligibility period

You can sign up for Original Medicare three ways:

  • Online at www.ssa.gov
  • By phone at 1-800-772-1213 or TTY 1-800-325-0778, from 7 a.m. to 7 p.m. Monday through Friday.
  • At your local Social Security Office

 

Planning to keep working? You can wait to enroll

You can sign up for Medicare even if you don’t plan to retire at age 65. Or you can wait to enroll if you have coverage through your (or your spouse’s) employer. Before you decide, It’s a good idea to talk to a licensed Medicare expert to make sure it’s the best choice for you.

Enrolling in a Part C Medicare Advantage plan

Once you’re enrolled in Original Medicare, you can choose to enroll in a Part C Medicare Advantage plan.

If you’re eligible for Medicare when you turn 65, you can sign up during your Initial Enrollment Period. This is a 7-month period that begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65.

eligibility period

To qualify, you must:

  • Have Medicare Part A and Part B
  • Live in the plan’s service area
  • Not have end-stage renal disease (ESRD)

Enrolling in a Part D plan

You can sign up for a Part D plan during your Initial Enrollment Period and your coverage will begin on the first day of the month after you apply. To qualify, you must:

  • Have Medicare Part A or Part B
  • Live in the plan’s service area

Other kinds of Medicare plans

Other Medicare plans are available to help pay for costs Original Medicare doesn’t cover. Two of the most common are:

  • Cost plans. These are only available in some Minnesota counties for 2020. Benefits vary by plan and may include Part A or Part B benefits, or both.
  • Medicare Supplement (Medigap) plans. These plans help pay for deductibles, copays and coinsurance. But they don’t cover prescription drugs, so you’d have to purchase a separate Part D plan.

Late enrollment penalties

If you don’t sign up for Part B and Part D when you first become eligible for Medicare, you may pay a penalty if you decide to sign up later. The penalty is added to your monthly premium, and you'll pay it for as long as you have Part B or Part D coverage. Some exceptions apply, see Medicare.gov (external site) for more information.

Making changes to your Medicare coverage

Once you’ve enrolled in a Medicare Advantage or Part D plan, you can make changes to your coverage during the Annual Enrollment Period that runs from October 15 to December 7 each year. You may also be able to make changes to your plan at other times of the year or under special circumstances. To learn more about Medicare enrollment periods, visit Medicare.gov.

coverage begins January 1

What’s next?

We’re ready when you are. Take the next step.

Couple smiling at each other

Learn the basics of Medicare

If you’re new to Medicare, this is a good place to start. You’ll learn about the four parts of Medicare and what they cover. You’ll also find out when to enroll.

Two men standing at a barbecue

See what to consider when choosing a plan

What’s the right plan for you? That depends on your health needs, your budget and your lifestyle. Here you’ll find tips to choose the right plan.
 

Woman riding a bike

Explore UCare Medicare plans

We offer UCare Medicare plans throughout Minnesota. You can choose the level of coverage you need and find a plan that includes extras like dental, hearing and vision benefits.

Grandfather and grandchild

Get ready to enroll in a UCare Medicare plan

Ready. Set. Enroll. Here you’ll find all the information you need to complete and submit your enrollment application.

 

Get a Medicare de-complicator guide to go

Our De-complicator Guide makes Medicare easier.
Keep it handy as you explore your options and get ready to pick a plan.

Medicare De-complicator Guide (PDF) 

Find a Medicare Meetup

We’re holding Medicare Meetups all across the state. Here’s your chance to talk with our licensed Medicare experts and learn more about UCare Medicare plans.

RSVP for a Medicare Meetup

Helpful terms to know

Premium: a monthly payment for your insurance coverage.

Co-insurance: the portion you pay for some of your services.

Deductible: the amount you have to pay toward your care before your benefits kick in.

see all terms


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September 2019