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Medicare Basics

Basic Coverage

When you turn 65, have a qualifying disability, end-stage renal disease (ESRD) or amyotrophic lateral sclerosis
(ALS), you’re eligible for Part A and Part B — that’s Original Medicare.

Part A (Hospital Insurance) Coverage

Most people don’t pay a Part A premium because they paid Medicare taxes while working.
  • Inpatient care in a hospital
  • Limited stays in a skilled nursing facility
  • Some home health care
  • Hospice care

Part B (Medical Insurance) Coverage

Part B is optional and has a monthly premium. There is a penalty if you don’t enroll when you’re first eligible. In most cases, you can delay enrollment in Part B without penalty if you are actively at work and enrolled in an employer group health plan.
  • Doctor’s services
  • Outpatient care
  • Durable medical equipment
  • Some preventive services
  • Some prescription drugs

Out of Pocket Costs

Original Medicare doesn’t cover everything. If you need certain services that Medicare does not cover, you will
have to pay out–of-pocket unless you have other insurance to help cover the costs. Even if Medicare covers a
service or item, you’ll have to pay deductibles, coinsurance, and copayments.

Out-of-Pocket Costs you’ll pay with Parts A and B

  • Deductibles and copays for hospital stays
  • Part B annual deductible
  • Deductibles and 20% of the Medicare-approved amount for most care you get from doctors or other health care providers, outpatient therapy, Medicare Part B drugs and durable medical equipment

Out-Of-Pocket Costs you’ll pay outside of Parts A and B

  • Routine dental care
  • Routine vision care and eyewear
  • Routine hearing exam and hearing aids
  • Over-the-Counter (OTC) items such as vitamins or cold/allergy medicines

When Do I Become Eligible for Medicare?

You can sign up during these 7 months. If you plan to work past age 65, these times can differ for you:

3 Months

Before your birthday

65th Birthday

During your birthday month

3 Months

After your birthday

When Do I Become Eligible for Medicare?

You can sign up during these 7 months. If you plan to work past age 65, these times can differ for you:

3 Months

Before your birthday

65th Birthday

During your birthday month

3 Months

After your birthday

Get AMAC’s Free 2023 Medicare Guide

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Scott M.
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I want to thank Bethany for helping me. She was kind and explained things where I could understand them. Made the process easy for me. Easiest thing I have done for my retirement.”
I just got off the phone with your agent Ashley MacDonald. She was VERY patient with me .I'm turning 65 and needed help understanding all the different Medicare plans. She was very professional, knowledgeable, and friendly.
“ Marcus, thank you so much for taking the time to explain everything to me and making this process so easy for seniors! I appreciate AMAC and everything that they do for us seniors.! ”
Josephine, N.Y.
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Nancy B.

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