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Medicare · federal

Medicare (Original Medicare and Medicare Advantage)

U.S. Centers for Medicare & Medicaid Services

Medicare is the federal health insurance program. Original Medicare = Part A (hospital insurance) + Part B (medical insurance) and lets beneficiaries use any doctor or hospital that takes Medicare, anywhere in the U.S. (all 50 states, DC, Puerto Rico, U.S. Virgin Islands, Guam, Northern Mariana Islands, American Samoa). Original Medicare beneficiaries can add a separate Part D drug plan and/or buy a Medigap (Medicare Supplement) policy to help cover the 20% coinsurance and other out-of-pocket costs. Medicare Advantage (Part C) is an alternative offered by private health plans that Medicare approves; these bundled plans include Parts A and B and usually Part D, often with extra benefits (vision, hearing, dental), but typically use a network and require prior authorization for some services. They have an annual out-of-pocket maximum, so Medigap is not needed.

Who qualifies

U.S. citizens and qualifying lawful residents age 65 or older; or under 65 with qualifying disability (after 24 months of SSDI), End-Stage Renal Disease, or ALS.

What it covers

Part A: inpatient hospital, skilled nursing facility, hospice, some home health. Part B: doctor visits, outpatient care, preventive services, durable medical equipment. Part C (Medicare Advantage): bundled A+B, usually includes Part D, often adds vision/hearing/dental. Part D: prescription drug coverage.

Cost

Part A is premium-free for most enrollees with sufficient work history; Part B has a standard monthly premium plus 20% coinsurance after deductible (under Original Medicare). Medicare Advantage premiums and cost-sharing vary by plan and county. Beneficiaries on Original Medicare with high out-of-pocket exposure typically buy a Medigap policy. Low-income beneficiaries can apply for Medicare Savings Programs and Extra Help to reduce premiums and drug costs.

How to apply

Enroll through Social Security: online at ssa.gov, by phone at 1-800-772-1213, or in person at a local SSA office. Many people are auto-enrolled when they start Social Security retirement benefits. In Washington, free unbiased counseling on plan choices is available through SHIBA.

Where to get this in Washington

50 organizations deliver this program. Coverage varies, so check the area each one serves.

Apply by phone
1-800-MEDICARE (1-800-633-4227)
Apply online
www.medicare.gov/basics/get-started-with-medicare/medicare-basics/parts-of-medicare

Source www.medicare.gov/basics/get-started-with-medicare/medicare-basics/parts-of-medic