Medicare FAQs

Medicare vs. Medicaid: What’s the difference?

Medicare and Medicaid are both types of federal (government-funded) health insurance plans. However, they serve different groups and have different eligibility requirements:

Medicare: 

• Available to people age 65 or older and those receiving Social Security Disability Insurance (SSDI, or Disability) for 24 consecutive months for chronic medical conditions, such as permanent kidney failure or Lou Gehrig’s disease (ALS)
• Has four parts:
  • Part A (Hospital Insurance)
  • Part B (Medical Insurance, also known as Original Medicare)
  • Part C (Medicare Advantage Plans)
  • Part D (Prescription Drug Coverage)

Learn more about the parts of Medicare and what they cover.

Medicaid:

• Helps individuals and families with limited income, including children, pregnant people, older adults and people with disabilities (income requirements vary by state)
• Does not have an age requirement
• May include extra services that Medicare doesn’t always cover, such as nursing home care, dental, hearing or vision 

Can I have Medicare and Medicaid?

Yes. Some people are “dually eligible” for both Medicare and Medicaid. Medicare (and any other health plans you may have) pays covered expenses first. Medicaid pays any remaining balance.

When do I enroll in Medicare?

Automatic Enrollment

You are automatically enrolled in Medicare Parts A and B if you:

• Are receiving Social Security or Railroad Retirement benefits at age 65 or older
• Are under age 65 and receive disability benefits for 24 consecutive months
• Have ALS. You are automatically enrolled the month your disability benefits begin.

Manual Enrollment

If you're not receiving benefits, you must apply for Medicare by contacting either:

• Social Security Office
• Railroad Retirement Board (if you worked for the railroad)

Initial Enrollment Period (IEP)

You can enroll during the IEP. This seven-month window:

• Starts three months before the month you turn 65
• Includes the month of your 65th birthday
• Ends three months after that month.

Coverage begins either:

• On the first day of your birth month
• The month before your birth month, if your birthday is on the 1st of the month

Late Enrollment in Medicare

If you miss the seven-month Initial Enrollment Period, you must wait until the General Enrollment Period:

• Enroll from January 1 to March 31
• Coverage begins July 1

Penalties for Late Enrollment:

Part B Premium increases by 10% for each 12-month period you delay enrollment.

• This increase is permanent.
• If you don’t have enough work credits to qualify for free Part A, you can buy it.
• The Part A premium also increases by 10%, regardless of how late you enroll.

What services does Medicare cover?

What services does Medicare cover? 

Part A 

Helps cover:

• Inpatient hospitalization
• Skilled nursing facility care
• Home health care
• Hospice care 

Part A is subject to deductibles and coinsurance per benefit period.

Part B 

Helps cover:

• Medical expenses
• Clinical laboratory services, including blood work   
• Home health care outpatient hospital treatment
• Ambulatory surgical services (outpatient surgeries)
• Preventive benefits
• Durable medical equipment
• Emergency or non-emergency ambulance transport

Part B has a monthly premium and an annual deductible. After meeting the annual deductible, Medicare provides 80% coverage. You pay 20% of all Medicare-covered services based on the Medicare Fee Schedule.

Part C (Medicare Advantage) and Part D

• Part C: Combines the services of Parts A, B and D, as well as additional benefits not covered by Medicare, into a single plan that you get through a private insurance company
• Part D: Covers prescription drugs, usually as an add-on to Medicare Part A and Medicare Part B.

Does Medicare cover all types of doctor visits?

No, Medicare doesn’t cover all types of doctor visits. It’s important to know what is covered under your plan. Types of visits include: 

• “Welcome to Medicare” preventive visit: Medicare covers one preventive care visit within the first year of enrollment.
• Annual wellness visit: Medicare covers one preventive care visit each year after you have had Medicare for longer than 12 months.
• Problem-based visit: Medicare covers “sick visits” to address new or worsening symptoms or help you manage an existing health condition.
• Annual physical: Medicare does not cover a yearly physical exam, though some Medicare Advantage plans do. 

Medicare does not cover:

• Care received outside of the U.S., except in Canada and Mexico
• Custodial care (help with day-to-day living)
• Eyeglasses
• Hearing exams and hearing aids
• Most dental care
• Most immunizations
• Private nurses

Medicare annual wellness visits vs. annual physical: What’s the difference? 

An annual wellness visit, covered by Medicare, focuses on preventive care, identifying health risks and helping you plan for long-term wellness. An annual physical, not covered by Medicare, is a complete physical workup that often includes lab testing and other services. It focuses on identifying health problems.