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Understanding Medicare

Your complete Medicare 101 introduction

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.

On this page, you can find information about:

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.

Most people don’t pay a monthly premium for Medicare Part A. However, most people do pay a monthly premium for Medicare Part B. And when you need care, you’re also responsible for any deductibles, copays or coinsurance.

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.

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:

  • Your choice of plans will depend on where you live – different plans are offered in different counties.
  • Each plan has its own premium, deductible, copay and out-of-pocket maximum amounts. It’s a good idea to compare plans to make sure you choose one that meets your needs.
  • Once you enroll in a private Medicare plan, you don’t need to renew it each year, but you’ll 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:

  • 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 eligibility

To be eligible for Medicare (either Original Medicare or most private Medicare plans), 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

When you can enroll in Medicare

Starting when you turn 65, you’ll have an opportunity to enroll in 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 or Part D (unless you have health insurance through your or your spouse’s employer).

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

Your Initial Enrollment Period is your opportunity to enroll in Original Medicare (Parts A and B) or a private Medicare plan.

Your IEP is a seven-month window around your 65th birthday:

  • The three months before the month you turn 65
  • The month of your birthday
  • The three months after the month you turn 65

For example, if your birthday falls on June 10, your IEP would start on March 1 and end on September 30. For coverage to start the month you turn 65, you must sign up in the three months before the month of your birthday.

If you don’t enroll in Original Medicare Part B during your IEP, you may have a late-enrollment penalty if you enroll later. The late-enrollment penalty takes the form of higher premiums and lasts for as long as you have Part B.

If you don’t sign up for Medicare Part A and/or Part B when you’re eligible, you can apply for Medicare for the first time using the General Enrollment Period from January 1 through March 31 every year. You can also sign up for a private Medicare plan at this time.

This enrollment period is usually only available to people who didn’t sign up during their Initial Enrollment Period and who aren’t eligible for a Special Enrollment Period (see below). Coverage would begin the month after you sign up. You may have to pay a higher premium for Part A and/or Part B due to late enrollment.

A Special Enrollment Period lets you enroll in Original Medicare or a private Medicare plan outside of your IEP and the GEP due to certain circumstances, such as losing your employer coverage after the age of 65.

If you qualify for an SEP, you have a certain amount of time to enroll. The length of time is determined by the type of SEP you are qualified for, but it’s generally between two and three months.

If you or your spouse work past the age of 65, you may not need Medicare until your employer health coverage ends. Every situation is unique, and it’s important to weigh your options to ensure you’re getting the coverage you need.

For example, you might consider:

  • Combining an employer health plan and Medicare – It’s possible to have both Medicare and an employer health plan after age 65. One type of plan does not replace the other. Instead, they can work together to ensure your health care needs and expenses are covered.
  • Delaying Medicare Parts A and B – Depending on the size of your employer(s), you may be able to delay both Medicare Parts A and B without penalty as long as you or your spouse have employer health coverage. When you do enroll in Medicare, it must be within eight months of losing your health coverage or your last day of work, whichever comes first (see SEPs above).
  • Enrolling only in Part A – Most people don’t pay a monthly premium for Medicare Part A, so you could enroll while you or your spouse is still working. However, if you have a health savings account (HSA), be aware that once you enroll in any part of Medicare, you can no longer make contributions to it.

How to enroll in 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 in Original Medicare if you're not receiving Social Security benefits when you become eligible for Medicare.There are three ways you can enroll yourself in Original Medicare:

  1. Enroll online through the Social Security Administration
  2. Call the Social Security Administration at 800-772-1213 (TTY 800-325-0778), 8 a.m. to 7 p.m., Monday - Friday
  3. Enroll in person at your local Social Security office

For private Medicare plans, you can enroll at the same time as your automatic enrollment or self-enrollment in Original Medicare. If you first enrolled in Original Medicare but later want to enroll in a private Medicare plan, you can do so during the Annual Enrollment Period (AEP).

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.

If yes: If you have a strong relationship with your current care team, you’ll want to make sure you choose a plan that includes them in its network. Also, make sure needed specialty care is covered by your plan and confirm whether you need a referral to see a specialist.

In addition, the more times you visit your doctor(s), the more coverage you may need. If you see your care team multiple times a year, it’s worth looking for plans with lower deductibles and lower out-of-pocket maximums.

If no: You can be more flexible in the plans you choose.

If yes: Consider a Medicare plan that includes prescription drug coverage (Medicare Part D), like a Medicare Advantage plan. When you find a plan you like, look through the plan’s drug list (formulary) to see how your medicines are covered and look through the plan’s pharmacy network to see if your favorite pharmacies are available.

If no: Even if you don’t use prescription drugs right now, you may still want to consider Medicare Part D to avoid a late-enrollment penalty later.

If yes: A plan with low out-of-pocket maximums might be better for you.

People who exceed their out-of-pocket maximums or deductibles tend to get care regularly. Though your monthly premiums may be higher in a plan with low out-of-pocket maximums, your copays and coinsurance amounts may be lower when you visit the doctor.

If no: If you stay well under your deductible or out-of-pocket maximum each year, a plan with higher out-of-pocket maximums could be a good fit.

People in this situation usually don’t get care very often. Your copays and coinsurance amounts may be higher when you visit the doctor, but your monthly premiums will typically be lower.

If yes: You might be okay having separate plans for medical and prescription drug coverage. These plans usually come with separate member ID cards, additional paperwork and different service teams.

If no: You could find having all your Medicare benefits in one plan, like a HealthPartners UnityPoint Health Medicare Advantage plan, to be more convenient and less stressful.

HealthPartners and UnityPoint Health have combined their insurance and care expertise so you can get the most out of Medicare. You can make sure we have a Medicare Advantage plan in your county by selecting the

You’ll find a list of counties here.

Available in select counties

Plans available in these counties:

  • Benton
  • Black Hawk
  • Boone
  • Bremer
  • Buchanan
  • Butler
  • Cedar
  • Cherokee
  • Clarke
  • Clayton
  • Clinton
  • Dallas
  • Delaware
  • Fayette
  • Greene
  • Grundy
  • Guthrie
  • Hamilton
  • Hardin
  • Humboldt
  • Ida
  • Iowa
  • Jackson
  • Jasper
  • Johnson
  • Jones
  • Linn
  • Madison
  • Mahaska
  • Marion
  • Marshall
  • Muscatine
  • Plymouth
  • Polk
  • Poweshiek
  • Scott
  • Sioux
  • Story
  • Tama
  • Warren
  • Washington
  • Webster
  • Woodbury
  • Wright
Available in select counties

Plans available in these counties:

  • Fulton
  • Henry
  • Jo Daviess
  • Peoria
  • Rock Island
  • Stark
  • Tazewell
  • Woodford

Legal information

Last updated October 2022
H3416_002805 Accepted