Understanding Medicare

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Learn the basics of health insurance, Medicare eligibility, and coverage options.

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Explore the parts of Medicare, coverage options, costs, low-income programs, and key differences from Medicaid.

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Learn how factors like age, disability status, and specific medical conditions affect Medicare eligibility.

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Understand when Medicare pays first or second and whether your drug coverage is creditable for delaying Part D enrollment.

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Understand how Medicare interacts with job-based insurance, whether you're turning 65 or eligible due to disability. Learn when to enroll in Medicare and how Medicare enrollment affects Health Savings Accounts (HSAs).

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Understand how retiree insurance coordinates with Medicare and Part D to make the best enrollment choices.

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Learn how COBRA works, who is eligible, how it coordinates with Medicare, and when coverage can be extended or ends.

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Understand how Federal Employee Health Benefits coordinate with Medicare, Part B enrollment, and drug coverage options.

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Learn how TRICARE for Life coordinates with Medicare and Part D to make the best coverage decisions.

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Explore how VA benefits, Part B, Part D, and CHAMPVA work with Medicare to help you make informed coverage decisions.

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Learn how Medicare coordinates with workers’ compensation for job-related injury coverage.

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Understand how Qualified Health Plans (QHPs) and Small Business Health Options Program (SHOP) plans coordinate with Medicare and impact enrollment decisions.

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Explore programs that help lower Medicare and prescription drug costs for those with limited incomes. Learn about Medicaid, Medicare Savings Programs, Extra Help, and options for reduced-cost care.

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Medicare Savings Programs can help cover Medicare costs, including premiums and out-of-pocket expenses. Learn about eligibility, benefits, application processes, and state-specific rules.

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Explore how Medicaid works alongside Medicare to help cover health care costs, long-term care, and prescription drugs for those with limited income. Learn about eligibility, state-specific programs, and how to apply.

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Discover how the Extra Help program can lower your Medicare Part D costs and provide special enrollment opportunities. Learn about eligibility, how to apply, and ways to maintain your benefits.

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Explore how SPAPs can help lower your prescription drug costs. Learn about eligibility, benefits, and how these programs work alongside Medicare Part D to cover premiums, deductibles, and copays.

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Discover how EPIC, New York’s pharmaceutical assistance program, helps residents 65+ reduce Medicare Part D costs, covering premiums, copays, and more. Learn how it works with Extra Help and Medicare Savings Programs to provide additional savings.

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Get an overview of Medicare coverage, from hospital stays and doctor visits to prescription drugs and telehealth services. Learn what’s covered, what’s not, and how Medicare benefits apply when traveling or during public health emergencies.

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Understand how Medicare covers inpatient hospital stays and discharge planning, including costs, benefit periods, and lifetime reserve days.

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Medicare covers many outpatient services, but provider choices and billing practices can affect your costs. Learn about which providers to see to get care at the lowest cost and what to do if your provider will not file a claim.

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Medicare’s home health benefit provides essential services for those needing skilled care at home. Learn about eligibility requirements, covered services, the homebound rule, how coverage differs under Part A and Part B, and the process for starting care with a certified home health agency.

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Medicare Part B covers medically necessary DME for home use. Learn about eligibility, supplier requirements, costs, and what’s covered or excluded, such as repairs, replacements, and power wheelchairs.

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Medicare Part B covers a range of outpatient rehabilitation services. Learn about eligibility, covered settings, costs, and options for more intensive rehabilitation care.

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Medicare Part A covers SNF care after a hospital stay if certain conditions are met. Learn about coverage limits, costs, eligibility requirements, and what happens if you need care beyond Medicare’s 100-day limit.

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Medicare covers a range of preventive services to help detect and manage health conditions early. Learn about eligibility, coverage details, and costs for screenings, vaccines, wellness visits, and counseling services designed to keep you healthy.

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Medicare covers a range of mental health and addiction recovery services. Learn about eligibility, costs, and where to access care to support your mental health needs.

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Medicare covers outpatient hospital services, but costs and coverage depend on the type of care you receive. Learn about observation status, emergency room visits, and other outpatient services.

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Medicare covers various ambulance services, including emergency and certain non-emergency transport. Learn about coverage details, costs, and requirements for both routine and emergency ambulance transportation.

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Medicare’s hospice benefit provides end-of-life care focused on comfort, covering services like skilled nursing and prescriptions. Learn about eligibility, coverage details, and what happens if you need to stop or continue hospice care.

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Medicare covers limited vision and dental care. Learn what Medicare does cover, like cataract surgery and dental services related to other medical conditions. Explore alternative options for coverage, including Medicare Advantage supplemental benefits.

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Medicare offers limited coverage for long-term care. Learn about alternatives like Medicaid, long-term care insurance, and other resources for nursing homes, home care, respite care, and home modifications.

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An appeal is a request for Medicare or your plan to review its coverage decision. Learn how to file appeals and get coverage for denied services.

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If Original Medicare does not cover your care, you can appeal. An appeal is when you ask Medicare to make a new decision about whether it will pay for your service, item, or other care.

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If your Medicare Advantage Plan does not to cover your care, you can appeal. An appeal is when you ask your plan to make a new decision about whether it will pay for your service, item, or other care.

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If your Part D plan does not cover your drug, you can appeal. An appeal is when you ask your plan to make a new decision about whether it will cover your drug.

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Do you pay a higher Medicare premium because of a late enrollment penalty or higher income? Learn whether you have any options for lowering your premium.

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Learn about Medicare Advantage HMO benefits, costs, and provider restrictions. Understand how these plans compare to Original Medicare to determine the best coverage option for your needs.

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Explore Medicare Advantage PPO coverage for in-network and out-of-network care, costs, and provider flexibility. Compare PPOs, HMOs, and Original Medicare to find the best fit for your health care needs.

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Explore Medicare Advantage PFFS plan benefits, provider access, and costs. Compare PFFS plans with HMOs and Original Medicare to determine the best coverage option for your needs.

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Learn about Medicare SNP eligibility, costs, coverage, and enrollment requirements. Understand what happens if you lose eligibility and what questions to ask to determine if a SNP is the right choice for your health care needs.

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Discover how MSA plans differ from other Medicare Advantage options, including their costs, coverage, and deductible requirements. Learn what qualifies as a medical expense to determine if an MSA plan is a cost-effective choice for your health care needs.

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Learn how to recognize and report fraud and rules insurance plans or agents must follow when selling plans.

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Explore what Medicare’s prescription drug benefit does and does not cover, and how to fill gaps in Part D coverage.

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Learn about Medicare Part D enrollment periods so you can enroll on time, pick a drug plan that meets your needs, and avoid gaps in coverage or late enrollment penalties.

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Learn about Part D costs like premiums and copays, and see what you may pay for drugs during Part D coverage phases.

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