Medicare Basics and Answers to Your Questions

Medicare Part A covers care you receive when you stay in a hospital (this is called “inpatient” care). It also covers care you get at skilled nursing facilities, home health care, and hospice care.

Most people get Part A from the federal government when they turn 65 if they:

• Have worked for a combined 10 years, or
• Worked 40 quarters (three-month periods) paying into Medicare. They do not need to be quarters that come one after the other.

Most people do not pay any monthly fee, or a “premium,” for Part A. You do pay part of the costs for services you get under Part A. You pay a deductible plus your share of the Medicare-approved cost for services.

Medicare Part B helps you pay for medical services. These are services like doctor visits, tests, outpatient hospital services and other like services. Part B is voluntary, which means you can choose to join it. If you choose Part B, you pay a monthly fee, or “premium,” of $174.70 in 2024 per month (subject to change for 2025). (This fee might be higher, based on your income.)

If you do not sign up for Part B when you are first able to join Medicare, you may pay a higher monthly fee if you choose to join later.

How much do I pay for care I receive under Part B?

• You must first pay a deductible, or a yearly fee for services, before your plan pays for any costs under Part B.
• After you pay your deductible, Medicare pays up to 80% of Medicare-approved charges for most covered services. You pay the remaining costs — typically 20% of the total.
• Medicare Part B covers many preventive health care services at no cost to you, like annual exams, screenings, and certain vaccines.
• Sometimes you may pay more than 20%. This can happen if your doctor does not accept “assignment”—the Medicare-approved rate for services. If a doctor does not accept assignment, you must pay your doctor what Medicare does not cover.

Medicare Part A and Part B do not cover everything. There are many services that you will need to pay for in full.

To learn more about what Medicare covers and does not cover, please call Medicare at 1-800-MEDICARE (800-633-4227). TTY users can call 1-877-486-2048 24 hours a day/seven days a week or see the “Medicare & You” handbook at Medicare.gov.

What is Medicare Part D and how do I enroll?

Medicare Part D is a prescription drug coverage plan for people who have either Medicare Part A or Part B. To sign up, all you need to do is join a plan that offers Part D.

Medicare Part D is a voluntary program. This means you don’t have to buy it when you join Medicare. Many people buy it, and some people choose not to. But if you decide to buy a Part D plan after you first sign up for Medicare, you may pay more for it each month. This is called a “late enrollment penalty.”

What drugs are covered under Medicare Part D?
All Medicare Part D plans have a list of covered drugs. This is called a “formulary.” Plan drug lists will include both generic and brand-name drugs, and will list them in levels, or “tiers,” based on cost. The lower the level or tier, the lower your cost for the drug will be.

How much will a Medicare Part D plan cost?
To join, you simply pay a monthly amount, or “premium,” to the plan you choose. Some Medicare Advantage plans include the Part D cost in their monthly plan premium, like ConnectiCare. Depending on your plan, you may also pay deductible and coinsurance costs. If you need help paying for your drugs, you may qualify for “Extra Help.”

Companies that offer Medicare Part D may cover different drugs or charge different amounts for them. So, choose a plan that offers you the best solution for your own needs.