What is Medicare?

Medicare is a federal health insurance program. It only covers you—not your spouse or children. It’s for people 65 or older, younger people with certain disabilities, and people of any age with end-stage renal disease or ALS, also known as Lou Gehrig’s disease. To get Medicare, you must be a U.S. citizen or a legal resident who’s lived in the country for at least five years.

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Parts of Medicare

Medicare is divided into parts. Each part pays for different health services.

Part A: Hospital Coverage

What’s covered

Inpatient care in hospitals
Skilled nursing facility care
Hospice care
Home health care

For most people, Medicare Part A is free. If you don’t qualify for free Part A coverage, you can buy it. Contact your local Social Security office to find out how. Or, use Medicare’s eligibility tool to see if you’ll need to pay for Part A coverage.

Part B: Medical Coverage

What’s covered

Inpatient and outpatient doctor visits
Emergency and urgent care visits
Medical equipment including wheelchairs and walkers
Diagnostic tests and lab services
Physical and speech therapy
Mental healthcare
Annual Wellness Visit (AWV)
Preventive care including flu shots, mammograms and screenings

There is a monthly cost for Part B coverage. The cost is set each year by Medicare and based on your yearly income. If you get Social Security, your monthly premium will come out of your Social Security check automatically.

Also, there are certain situations that let you delay enrolling in Medicare Part B to avoid having to pay the monthly premium.

Part C: Medicare Advantage

Medicare Advantage plans are available from private insurance companies. They cover all the benefits under Original Medicare (Part A and Part B). Many include prescription drug coverage (Part D) as well as additional benefits like dental, vision and hearing.

To be eligible for a Medicare Advantage plan, you must:

Be enrolled in Part A and Part B
Continue paying your Part B premium
Live in the plan’s service area (CareFirst's service area includes the 50 United States, D.C. and all U.S. territories)

No two plans are alike. Since Medicare Advantage plans are offered by private insurance companies, each plan may have different out-of-pocket costs, provider networks and other features.

Group Medicare Advantage plans are provided by your former employer or union. For more information about these plans, visit the Group Medicare Advantage page.

Part D: Prescription Drug Coverage

Part D plans cover your outpatient prescription medications, including name-brand drugs and generics.

Like Part C, Part D plans are offered by private insurance companies. They cover certain common types of drugs. However, each plan may choose which specific drugs it covers.

To be eligible for a Part D plan, you must have Part A and/or Part B. You may have to pay a Part D penalty if you don't sign up when you're first eligible or if you go 63 or more days without creditable prescription drug coverage.