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Medicare Basics

What does Medicare cover?

Depending on the plan, Original Medicare and Medicare Advantage plans cover most healthcare needs for people 65 and older.

What does Medicare not cover?

Original Medicare (Parts A and B) covers many medical needs, including preventive care, lab tests, medical equipment, hospital stays, ambulance services, and more.

Original Medicare does not cover:

  • Dental
  • Vision
  • Hearing
  • Premium prescription drugs

Medicare Part C (Medicare Advantage) plans can offer coverage for these needs.

Who qualifies for Medicare?

Generally, people age 65 or older are eligible for Medicare.

What disabilities qualify for Medicare under 65?

For certain people with disabilities under the age of 65, Medicare may be available.

  • People under 65 who have received Social Security benefits for 24 months
  • Individuals with End Stage Renal Disease
  • Individuals with Amyotoropic Lateral Sclerosis (ALS)

What dental services are covered by Medicare?

Original Medicare does not cover most dental care. Certain dental services that are part of another covered procedure may be covered in limited circumstances.

Some Medicare Advantage plans can cover routine dental care and procedures.

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Medicare Enrollment

When does Medicare start?

Medicare coverage typically begins when you turn 65 years old. Your Initial Enrollment Period lasts for 7 months, starting 3 months before you turn 65.

Periods that you can enroll in a Medicare Part C of D plan:

General Enrollment Period

The General Enrollment Period, between January 1 and March 31, allows you to sign up for Medicare if you missed your initial Medicare enrollment window or switch plans. The General Enrollment Period allows you to enroll in Medicare Parts A and B only. Coverage begins July 1 for anyone enrolling during the General Enrollment Period.

Annual Enrollment Period

The Annual Enrollment Period, between October 15 and December 7, is when you can join Medicare, switch to another plan, or drop a plan.

Open Enrollment Period

So it turns out your new or existing health plan isn’t working out for you…no problem! From January 1 through March 31 each year, you may choose a different Part C Medicare Advantage Plan or Part D prescription drug plan if your current plan is not meeting your healthcare needs. You can choose a new Medicare Advantage plan, with or without drug coverage, or disenroll from a Medicare Advantage plan and return to Original Medicare only (Parts A and B).

Special Enrollment Periods

Special Enrollment Periods allow you to join a Medicare Part C of D plan at other times of the year, under certain circumstances including:

  • When you first become eligible for Medicare.
  • If you are on both Medicare and Medicaid.
  • If your current plan is terminated.
  • If you move to a community not served by your current plan.

How do I sign up for Medicare?

Your enrollment in Medicare Part A and Medicare Part B should be automatic if you currently receive Social Security Retirement Benefits.

Those who do not receive Social Security Retirement Benefits will need to enroll. You can enroll by visiting SSA.gov, by calling Social Security at 800.772.1213, or visiting your local Social Security Office.

If you would like to enroll in a Medicare Part C plan (Medicare Advantage plan), you should contact a health insurance company directly. Find more information about the Capital Blue Cross Medicare Advantage plans here.

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Medicare Parts and Medicare Plans

What is Medicare Part A?

Medicare Part A is commonly referred to as “hospital insurance.” It helps pay for inpatient hospital stays, skilled nursing facility care, hospice care, and limited areas of home health care. Medicare Part A is minimum essential health insurance coverage and is free for most enrollees.

What is Medicare Part B?

Medicare Part B is Medicare coverage for two types of services: medically necessary services, and preventive services. Part B covers doctor’s visits, blood tests, x-rays, ambulance services, durable medical equipment, limited outpatient prescription drugs, and some mental health services.

While most people do not pay a separate premium for Medicare Part A, there is a monthly premium for Part B. The premium cost for Part B medical coverage is often deducted automatically from your social security benefits.

What is Medicare Part C?

Medicare Part C is also referred to as a “Medicare Advantage Plan.” Health insurance companies, like Capital Blue Cross, offer various levels of Medicare Part C plans.

Medicare Advantage plans are an alternative to Original Medicare. They cover everything that Original Medicare covers (Part A and Part B), plus many more services, depending on the plan you choose.

Medicare Part C plans like Capital Blue Cross Medicare are usually low- or no-cost.

What is Medicare Part D?

Medicare Part D is prescription drug coverage. This Medicare drug coverage is typically included with Medicare Advantage (Part C) plans, allowing you to get generic drugs at copays as low as $0 and discounted premium drugs.

Part D coverage is also available separately for those who have Medicare Part A and B coverage only.

What is Medicare Advantage?

Medicare Advantage refers to the Medicare Part C plan. These phrases are used interchangeably and refer to Medicare coverage offered by health insurance companies.

What is a Medicare Supplement plan?

Medicare Supplement Insurance, or a “Medigap plan,” can help to pay certain health insurance costs that Original Medicare does not cover. These costs can include copayments, coinsurance, and deductibles.

People with Medicare Advantage or Part C plans are not eligible for Medigap plans.

Learn more with Capital Blue Cross’ Medicare supplement FAQ.

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Resources

Eligibility and Enrollment

Four Parts of Medicare

Medicare FAQ

What Is Medicare

Your Options

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Updated January 1, 2025

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