Individual Guide to Medicare Basics | Kaiser Permanente (2023)


Get informed on the different Medicare parts, eligibility requirements, and enrollment periods that are applicable to you with this comprehensive guide to understanding Medicare basics.


>> Narrator: The National Medicare program was created in 1965 and, for many years, has given people peace of mind, knowing they’ll have access to healthcare.


Medicare is administered by the Centers for Medicare and Medicaid Services, or CMS, and provides health care coverage to people who are 65 and over and people under 65 who have certain disabilities.

There are many things to know about.

Medicare and Kaiser.

Permanente wants you to have all information you need.

In, this short video, we’ll, explain some of the basics and give you resources to learn.


First, Medicare is made up of 4 parts – Part, A, Part, B, Part, C and Part D.

Part A is hospital.


And, Part B is medical.

Insurance., Together, Part, A and Part B are known as Original Medicare.

Part C is often referred to as Medicare Advantage.

And Part D is prescriptions., Let’s start with Part A.

Part A is hospital.


It, covers:, inpatient, hospital, skilled nursing, hospice and home health.


It does not cover custodial care or long-term care.

If you’ve worked at least 10 years in a job covered by Social Security and are over 65.

You probably won’t have to pay a monthly premium for Part A.

Once you’re eligible.

You can sign up at your Social Security Office and receive a red, white and blue card to use when you get care.

Next, Part B.

Part B is the optional medical insurance that covers non-hospital things like doctor’s visits, outpatient, care, preventive, services, lab and x-ray, durable medical equipment, ambulance, services, mental health, dialysis and more.

If you qualify for Part A, you’ll also be eligible for Part B.


You will pay a monthly premium for Part B coverage and you’ll need to keep paying it for as long as you have the benefit.

And here’s, something important to remember:.

You must sign up for Part B as soon as you’re eligible, because if you don’t, you may have to pay a late enrollment penalty.

This penalty increases the Part B monthly premium by 10% for each 12-month period.

You decline.



If you delay for 3 years, your monthly premium goes up.

30%! And the amount is not a one-time penalty.

- it lasts for as long as you have the coverage.


There are a few exceptions to the penalty, such as for a person who continues to work after age, 65, it’s important to keep the timelines in mind.


Let’s move on to Part C.

Part C is often referred to as Medicare Advantage.

Part C allows you to choose a private insurance company to provide your Medicare benefits.

When, you sign up for a Medicare Advantage Plan.

You still have Original Medicare.


You receive your health care through a private insurance, company.

Medicare Advantage Plans cover all of the services Original Medicare covers, except for Hospice and clinical research studies.



You can get those exceptions covered under Original Medicare.

Medicare Advantage plans feature a network of providers.

You must use for care.

If, you choose to see a provider outside of the network, you’ll be financially responsible, except in the case of emergency or urgent care.

Once you’ve enrolled, you’ll use the Medicare Advantage plans’ member ID card.

When you get care.

But, you should still hold onto your red, white and blue Medicare card.

And finally, Part, D.

Part D provides outpatient, prescription drug coverage and can only be purchased from a private company.

You’re eligible for Part D, if you’re entitled to Part A and/or enrolled in Part B.

A Part D plan must have a list of covered drugs called a formulary.


You may only have one Part D plan at a time.

You can enroll in Part D through one of these options: a Medicare Advantage plan that includes Part D, prescription, drug coverage, a Stand-Alone Prescription Drug Plan, or with Some employers or unions.

Like Part B, Part D also has a Late Enrollment Penalty.


The penalty for Part D is 1 percent of the monthly premium.

For every month you defer your enrollment.


The penalty doesn’t apply to those who are eligible for Low-Income Subsidy, also called “Extra Help.” To apply for Extra Help and get assistance in paying for your prescription, drug premiums and costs, contact, Social Security or your state Medicaid office, or call 1-800-Medicare for more information.

Now that we’ve covered Medicare Part A, Part, B, Part, C and Part D, let’s talk some more about enrollment.

First – How to enroll in Original, Medicare or Part A and Part B: The initial enrollment period for Original Medicare begins 3 months before your 65th birthday and ends 3 months after the month.

You turn 65 – ., a total of 7 months If.

You miss your initial enrollment period.

You can sign up during the general enrollment period between January 1st and March 31st, each year.


Your coverage starts the first day of the month after you sign up.


You decide to continue working after 65, but lose your employer or union coverage.

You can sign up during a Special Enrollment Period, which is anytime outside of the General Enrollment or Initial Enrollment Periods.

Next, enrolling in Part C (Medicare, Advantage, plans) and Part D (the Medicare, prescription, benefit).

To be eligible for Part C and Part D.

You must:, reside in the approved service area and have Part A and Part B.

Another way to be eligible is if you have an employer or union health plan or have coverage through a company that offers Medicare Advantage Plans, you may be able to join one of their Medicare Advantage Plans.

It’s, also important to know when to enroll.

Since most plans have a limited enrollment, period.

The, Initial, Enrollment Period for a Medicare Advantage Plan with Part D is the same as Original Medicare: 3 months before you turn 65, your birthday month and the 3 months after you turn 65 – totaling 7 months to enroll.

If, you miss your Initial Enrollment Period, you’ll have another chance to enroll.

During the Annual Enrollment Period between October 15 and December 7.

During, this time, you can enroll, drop or change your Medicare Advantage and/or Part, D, plan.

There are also Special.

Enrollment Periods that allow people to change plans or enroll outside regular enrollment periods, due to: loss of employer or union group coverage, qualification for Low Income Status also referred to as Extra Help, or relocation – you have moved or are moving.

Another way to sign up outside of the regular enrollment periods is if you enroll in a Medicare health plan that has received a 5-star Quality Rating.

Each year, the Centers for Medicare and Medicaid Services, monitor and evaluate Medicare Health, Plans, and rate the plans between 1 and 5 stars.

The ratings are based on major categories that include: preventive care, chronic care, prescription, drug services, customer service, and member satisfaction.


They give you an easy, unbiased way to evaluate the quality of different plans.

For, 5-star, Medicare, Health, Plans and Prescription drug plans.

There is a 5-star special enrollment period that runs from December, 8th to November 30th of the following year.

One, more thing: If you’d like to make changes to Part D or Part C, each year from January 1st through March 31st.

You can switch to another Medicare Advantage, Plan or disenroll from your current plan and return to Original Medicare.


This time, you may also purchase a stand-alone Part D prescription, drug plan.

Thank you for taking the time to learn a little more about the Medicare basics.

To, get more information about Social, Security, state assistance and Medicare, including Medicare Star, Quality Ratings.

Please refer to these resources, or find them in our enrollment.


We also invite you to visit our website:, where you can learn more about the benefits and services we offer, and even enroll online.

Thanks for watching and Be Well! (music).


What is the best source to learn about Medicare? ›

People with Medicare, family members, and caregivers should visit, the Official U.S. Government Site for People with Medicare, for the latest information on Medicare enrollment, benefits, and other helpful tools.

How do you qualify to get $144 back from Medicare? ›

To qualify for the giveback, you must:
  1. Be enrolled in Medicare Parts A and B.
  2. Pay your own premiums (if a state or local program is covering your premiums, you're not eligible).
  3. Live in a service area of a plan that offers a Part B giveback.

Who is the best person to talk to about Medicare? ›

Call 1-800-MEDICARE (1-800-633-4227) to talk with a customer support representative about your Medicare questions and concerns—or visit the website to start a live chat. TTY users should call 1-877-486-2048. The Medicare Support Hotline is available 24/7, except for some federal holidays.

What is the basic understanding of Medicare? ›

Medicare is federal health insurance for anyone age 65 and older, and some people under 65 with certain disabilities or conditions. Medicaid is a joint federal and state program that provides health coverage for some people with limited income and resources.

How do I get answers to Medicare questions? ›

Do you have questions about your Medicare coverage? 1-800-MEDICARE (1-800-633-4227) can help. TTY users should call 1-877-486-2048.

How do I get a Medicare manual? ›

To get a paper handbook, call us at 1-800-MEDICARE (1-800-633-4227).

Will my Medicare premiums go down if my income goes down? ›

Does my income affect my monthly premiums for Medicare? It can. If you are what Social Security considers a “higher-income beneficiary,” you pay more for Medicare Part B, the health-insurance portion of Medicare. (Most enrollees don't pay for Medicare Part A, which covers hospitalization.)

How to reduce Medicare Part B premium? ›

If you've had a life-changing event that reduced your household income, you can ask to lower the additional amount you'll pay for Medicare Part B and Part D. Life-changing events include marriage, divorce, the death of a spouse, loss of income, and an employer settlement payment.

Who qualifies for an extra $144 added to their Social Security? ›

To qualify for a Medicare giveback benefit, you must be enrolled in Medicare Part A and B. You must be responsible for paying the Part B Premiums; you should not rely on state government or other local assistance for your Part B premiums.

Will Medicare Part B premiums increase in 2023? ›

The Centers for Medicare & Medicaid Services (CMS) has announced that the standard monthly Part B premium will be $164.90 in 2023, a decrease of $5.20 from $170.10 in 2022.

Who is the largest Medicare Advantage provider? ›

UnitedHealthcare is the largest provider of Medicare Advantage plans and offers plans in nearly nine out of every 10 U.S. counties. UnitedHealthcare also partners with AARP, insuring the Medicare products that carry the AARP name.

What are the 3 requirements for Medicare? ›

Be age 65 or older; Be a U.S. resident; AND. Be either a U.S. citizen, OR. Be an alien who has been lawfully admitted for permanent residence and has been residing in the United States for 5 continuous years prior to the month of filing an application for Medicare.

Is Medicare going up in 2023? ›

For 2023, the Part A deductible will be $1,600 per stay, an increase of $44 from 2022. For those people who have not worked long enough to qualify for premium-free Part A, the monthly premium will also rise. The full Part A premium will be $506 a month in 2023, a $7 increase.

Is it necessary to have a Medicare supplement? ›

Medicare supplement plans are optional but could save you big $$$ on doctor bills. Your cost-sharing under Part B is similar. You are responsible for paying your Part B deductible, which is $226 in 2023. Then Part B Medicare only pay 80% of approved services.

Is the Medicare exam hard? ›

Many returning Medicare agents say AHIP is easy — once you get the hang of it. Nobody's perfect, especially when learning something new! If you get more questions incorrect than you thought you would, or if you fail your first time taking the final AHIP exam, don't fret.

Can Social Security help me with Medicare questions? ›

We provide general information about the Medicare program and can help you get a replacement Medicare card. Notify us timely of address changes, name changes, and deaths. Social Security enrolls you in Original Medicare (Part A and Part B).

What are good questions to ask about Medicare? ›

Use this guide to consider your options when preparing to enroll in Medicare or after you have already enrolled.
  • What are the basics? ...
  • What are your coverage options? ...
  • Should you enroll in Part D? ...
  • Are you eligible for programs that help lower Medicare costs? ...
  • What resources exist to help you navigate Medicare?

What is the out-of-pocket limit for Medicare in 2023? ›

Medicare Advantage (Part C): In 2023, the out-of-pocket maximum for Part C plans is $8,300 for approved services, but individual plans can set lower limits if they wish.

What is the out-of-pocket limit for Medicare Part D in 2023? ›

The Medicare Part D true (or total) out-of-pocket (TrOOP) threshold will bump up to $7,400 in 2023, a $350 increase from the previous year. The true (or total) out-of-pocket (TrOOP) threshold marks the point at which Medicare Part D Catastrophic Coverage begins.

What is the annual deductible for Medicare in 2023? ›

In 2023, the Medicare Part A deductible is $1,600 per benefit period and the Part B annual deductible is $226. The Centers for Medicare & Medicaid Services (CMS) releases new premiums, deductibles and coinsurance amounts for Part A, Part B and the Medicare Part D income-related monthly adjustment amounts every fall.

At what age is Social Security not taxable? ›

Social Security benefits may or may not be taxed after 62, depending in large part on other income earned. Those only receiving Social Security benefits do not have to pay federal income taxes.

What income is too high for Medicare? ›

You can sign up for Medicare no matter how much money you make. You'll pay more for Medicare if you're an individual who earns more than $97,000 or part of a couple who earns more than $194,000. You can usually pay less for Medicare if you earn less than $30,000.

What income level triggers higher Medicare premiums? ›

Monthly Medicare Premiums for 2023
Modified Adjusted Gross Income (MAGI)Part B monthly premium amountPrescription drug coverage monthly premium amount
Individuals with a MAGI above $153,000 up to $183,000 Married couples with a MAGI above $306,000 up to $366,000Standard premium + $263.70Your plan premium + $50.70
5 more rows

How do I avoid paying higher Medicare premiums? ›

Key Points
  1. You can reduce your Medicare premium by filing an IRMAA appeal if you are subject to IRMAA.
  2. If you have an HSA, you can use that to pay for your Part B premium, or if you qualify for Medicaid, you can get assistance paying your Part B premium.
Aug 30, 2021

How do I dodge higher Medicare premiums? ›

People can often make income adjustments before year end to dodge an IRMAA threshold, such as selling losing investments to offset capital gains. Cutting income by as little as a penny can slice almost $1,000 off an individual's annual Medicare premiums at the lowest levels, and thousands at higher levels.

What is the average Medicare Part B premium? ›

If you don't get premium-free Part A, you pay up to $506 each month. If you don't buy Part A when you're first eligible for Medicare (usually when you turn 65), you might pay a penalty. Most people pay the standard Part B monthly premium amount ($164.90 in 2023).

What is the Social Security 5 year rule? ›

You must have worked and paid Social Security taxes in five of the last 10 years. • If you also get a pension from a job where you didn't pay Social Security taxes (e.g., a civil service or teacher's pension), your Social Security benefit might be reduced.

How do I get the $16728 Social Security bonus? ›

To acquire the full amount, you need to maximize your working life and begin collecting your check until age 70. Another way to maximize your check is by asking for a raise every two or three years. Moving companies throughout your career is another way to prove your worth, and generate more money.

What changes are coming for Social Security in 2023? ›

Social Security recipients will get an 8.7% raise for 2023, compared with the 5.9% increase that beneficiaries received in 2022. Maximum earnings subject to the Social Security tax also went up, from $147,000 to $160,200.

What is the projected 2024 Medicare Part B premium? ›

They should also inform SSA that their anticipated 2024 AGI of $150,000 would put them below the high-income threshold and therefore only have it pay the regular Part B premium of $164.90 in 2024. The SSA requires tax returns and qualified life-changing event documentation for IRMAA reductions.

Is Medicare Part B going up in 2024? ›

The basic premium would increase by 2 percentage points at the beginning of each calendar year starting in 2024 until it reached 35 percent of expected costs in 2028 and then would remain at that percentage.

Is Medicare going up in 2024? ›

Also starting in 2024, the calculation of the base beneficiary premium will be adjusted, as needed, to limit increases in the base premium to no more than 6% from the prior year. (Premiums for individual Part D plan premiums and annual plan-level premium increases will continue to vary, however.)

What are the 6 things Medicare doesn't cover? ›

Some of the items and services Medicare doesn't cover include:
  • Long-Term Care. ...
  • Most dental care.
  • Eye exams (for prescription glasses)
  • Dentures.
  • Cosmetic surgery.
  • Massage therapy.
  • Routine physical exams.
  • Hearing aids and exams for fitting them.

Why do most Americans pay no premiums for Part A? ›

Part A (Hospital Insurance) costs. $0 for most people (because they or a spouse paid Medicare taxes long enough while working - generally at least 10 years).

Why are they pushing Medicare Advantage plans? ›

Many Medicare Advantage plans offer additional benefits , such as money toward dental or vision care, which isn't covered by original Medicare. About 1 in 4 people say extra benefits pushed them to choose Medicare Advantage, according to a survey by the Commonwealth Fund, a health care think tank.

Which is the cheapest health insurance for senior citizens? ›

Medicaid is the most affordable plan for seniors and retirees who have low incomes. The Medicaid public health insurance program provides free or affordable insurance for those who are eligible.

Can I drop my Medicare Advantage plan and go back to original Medicare? ›

If you joined a Medicare Advantage Plan during your Initial Enrollment Period, you can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without a drug plan) within the first 3 months you have Medicare Part A & Part B.

Can you get Medicare if you never worked? ›

Medicare Eligibility for People Who've Never Worked? Regardless of your work history, you are eligible for Medicare at age 65 (or younger in some cases) if you're a U.S. citizen.

What is the most expensive form of healthcare insurance? ›

Average health insurance premiums by tier

The average rates paid for health insurance plans generally are inversely related to the amount of coverage they provide, with platinum plans being the most expensive and catastrophic and bronze plans being the cheapest.

What happens if you don't enroll in Medicare Part A at 65? ›

Part A late enrollment penalty

If you have to buy Part A, and you don't buy it when you're first eligible for Medicare, your monthly premium may go up 10%. You'll have to pay the penalty for twice the number of years you didn't sign up.

Will Medicare be cut in 2023? ›

Physicians are facing a 2% cut in Medicare payment in 2023, and 2024 will bring at least a 1.25% cut.

How much will Social Security and Medicare increase in 2023? ›

Social Security and Supplemental Security Income (SSI) benefits for approximately 70 million Americans will increase 8.7 percent in 2023.

What is the downside to Medigap plans? ›

Because Medigap plans are sold by private insurance companies, they can charge different monthly premiums. While plans are standardized in regard to coverage and benefits, they are not standardized in regards to cost. Cost can even increase over time based on inflation, your age and other factors.

Is Medicare with a supplement more expensive than a Medicare Advantage? ›

Medicare Supplement typically has a higher monthly premium compared to Medicare Advantage. Specifically, Medicare Advantage plans could cost between $0 and $100 a month, while Supplement coverage may vary between $50 and $1,000 per month.

Does Medicare always pay 80 percent? ›

Medicare Part B pays 80% of the cost for most outpatient care and services, and you pay 20%. For 2023, the standard monthly Part B premium is $164.90.

What are the 3 main parts of Medicare? ›

What are the parts of Medicare?
  • Medicare Part A (Hospital Insurance) Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
  • Medicare Part B (Medical Insurance) ...
  • Medicare Part D (prescription drug coverage)

What is the most used Medicare plan? ›

AARP/UnitedHealthcare is the most popular Medicare Advantage provider with 28% of all enrollment. Plans are well-rated and have affordable premiums and add-on benefits, a valuable combination that could account for AARP/UHC having the largest number of Medicare Advantage enrollees.

What is the most basic Medicare plan? ›

Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). You can join a separate Medicare drug plan to get Medicare drug coverage (Part D). You can use any doctor or hospital that takes Medicare, anywhere in the U.S.

What is the most important source of funding for Medicare? ›

Funding for Medicare Comes Primarily from General Revenues, Payroll Taxes, and Premiums. Funding for Medicare, which totaled $888 billion in 2021, comes primarily from general revenues (46%), payroll tax revenues (34%), and premiums paid by beneficiaries (15%) (Figure 8).

What are the 4 things Medicare doesn't cover? ›

Some of the items and services Medicare doesn't cover include:
  • Long-Term Care. ...
  • Most dental care.
  • Eye exams (for prescription glasses)
  • Dentures.
  • Cosmetic surgery.
  • Massage therapy.
  • Routine physical exams.
  • Hearing aids and exams for fitting them.

What does ABCD mean in Medicare? ›

Part A provides inpatient/hospital coverage. Part B provides outpatient/medical coverage. Part C offers an alternate way to receive your Medicare benefits (see below for more information). Part D provides prescription drug coverage.

Which states use Medicare the most? ›

Top 10 U.S. states based on number of Medicare beneficiaries in 2021
CharacteristicNumber of Medicare beneficiaries
New York3,705,610
6 more rows
Jun 14, 2023

What is the lowest Medicare? ›

$0 for most people (because they or a spouse paid Medicare taxes long enough while working - generally at least 10 years). If you get Medicare earlier than age 65, you won't pay a Part A premium. This is sometimes called “premium-free Part A.”

How much is the cheapest Medicare plan? ›

What's the least expensive Medicare Supplement plan? Plan K is the cheapest Medigap plan, with an average cost of $77 per month for 2023. For those who are only interested in protecting themselves against major medical expenses, high-deductible Plan G costs $47 per month, on average.

How much is basic Medicare a month? ›

If you don't buy Part A when you're first eligible for Medicare (usually when you turn 65), you might pay a penalty. Most people pay the standard Part B monthly premium amount ($164.90 in 2023).

How much do most seniors pay for Medicare? ›

Although nearly everyone will get free Medicare Part A, the total cost for all components of Medicare will typically be between $165 and $370 per month. These costs are waived or reduced for those who qualify for low-income financial assistance programs.

How long will Medicare last? ›

Medicare hospital insurance benefits, aka Medicare Part A, are expected to fully pay out until 2031, a three-year improvement from the last trustee report.

How is Medicare paid for by individuals? ›

Income taxes paid on Social Security benefits. Interest earned on the trust fund investments.

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