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Understanding Medicare

Whether you’re new to Medicare or just want a refresher, we’re here to help you get the most out of your health care.


With Medicare, it can be difficult to know where to start. It’s complex, and you want to gather as much information as possible to feel confident in selecting the right coverage for you. We make finding out Medicare details as simple as possible.

Get to know Original Medicare

Medicare is a federal health insurance program that helps cover health care costs for those who qualify. The basic coverage you can receive directly from the U.S. government is called Original Medicare – also known as Medicare Parts A and B.

Medicare Part A

Medicare Part A covers certain hospital-related expenses you may be charged during a traditional hospital stay, through home health care or in a skilled nursing facility. These can include costs like room fees, meals and more. Part A also covers necessary medical supplies and drugs that are provided at these facilities.

Medicare Part A does not cover doctor fees, or hospital fees considered medically unnecessary, such as private duty nursing, the television or telephone in your room (if separate charges apply), or personal care items such as razors and slippers.

Medicare Part B

Medicare Part B covers medical expenses like routine doctor visits, outpatient services and some diagnostic screenings. Part B may cover some medication administered during your visit but not drugs that are prescribed for you to take after the visit.

Premiums and out-of-pocket expenses

Most people don’t pay a monthly premium for Part A. However, everyone pays a monthly premium for Part B. And when you need care, you’re also responsible for deductibles, copays and coinsurance.

Medicare eligibility

To be eligible for Medicare, you must be a United States citizen or lawfully present in the United States. You must also:

  • Be age 65 or over, OR
  • Be under age 65 with certain disabilities, OR
  • Have end-stage renal disease

How to enroll in Original Medicare

Many people are automatically enrolled in Original Medicare (Part A and Part B) once they're eligible. But not everyone is.

You'll be automatically enrolled in Original Medicare if:

  • You're receiving Social Security benefits or Railroad Retirement Board benefits when you turn 65, OR
  • You're eligible for Medicare because of a disability or medical condition

You must enroll yourself if you're not receiving Social Security benefits

There are three ways you can enroll yourself in Original Medicare:

  1. Online through the Social Security Administration
  2. Via phone to Social Security at 800-772-1213 or 800-325-0778 (TTY), Monday through Friday, from 8 a.m. to 7 p.m.
  3. In person at your local Social Security office

When you can enroll in Original Medicare

Starting when you turn 65, you’ll have an opportunity to enroll in Original Medicare. But if you wait until after your first enrollment window around your 65th birthday, you may have to pay a late-enrollment penalty for Part B.

It’s a good idea to learn about all enrollment windows so you can take action when the time is best for you.

More choices with private Medicare plans

Original Medicare covers the basics, but not much more. There are many important services that Original Medicare doesn’t include, like prescription drug coverage, hearing exams and eye care.

When you need more coverage than you get with Original Medicare, consider enrolling in a plan with additional coverage from a private insurer like HealthPartners UnityPoint Health.

Here are some things to keep in mind about private Medicare plans:

  • Each plan has its own premium, deductible, copay and out-of-pocket maximum amounts.
  • Your choice of plans will depend on where you live – different plans are offered in different counties.
  • Once you enroll in a private Medicare plan, you don’t need to renew it each year, but you may have opportunities to switch plans if your needs change.

Types of private Medicare plans

Most people who sign up for a private Medicare plan choose from these options during their initial enrollment period:

  • Medicare Advantage plans – Provide the same coverage as Original Medicare, and they often offer extra benefits like dental and Part D prescription drug coverage
  • Medicare Part D plans – Help cover the cost of your prescriptions
  • Medicare Supplement plans – Help bridge the gaps of Original Medicare

Medicare Advantage and Part D plans also have an Annual Enrollment Period (AEP), which gives you an annual opportunity to change your plan if your health care needs evolve.

Tips for comparing and choosing a plan

If you’re not sure which kind of Medicare plan will meet your needs, answering a few questions may help you compare plan details.

HealthPartners UnityPoint Health Medicare plans

HealthPartners and UnityPoint Health have combined their insurance and care expertise so you can get the most out of Medicare. Our Medicare Advantage plans combine medical and prescription drug coverage with extra perks and benefits.

Find a Medicare Advantage plan

Legal information

Last updated October 2021

H3416_001602 Accepted

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