Medicare & You

1 Medicare & You2021 The official government Medicare handbook What s new?Coronavirus disease 2019 (COVID-19) Medicare is committed to getting you the information you need on COVID-19. For the most up-to-date information on coverage and benefits, visit or call 1-800- Medicare (1-800-633-4227). TTY users can call out-of-pocket costs for insulinIf you join a Medicare drug plan that participates in the Part D Senior Savings Model, you could save hundreds of dollars each year in out-of-pocket costs for insulin. See page Advantage & End-Stage Renal Disease (ESRD)If you have ESRD, you can join a Medicare Advantage Plan during Open Enrollment (October 15 December 7, 2020). Your plan coverage will start January 1, 2021. See page for back painMedicare now covers up to 12 acupuncture visits in 90 days for chronic low back pain.

2 See page & other virtual services telehealth benefits allow you to get medical or health services that generally occur in-person (like office visits and consultations) from a doctor or other health care provider who s located elsewhere using real-time interactive audio and video technology (s ee page 48). Medicare also covers certain virtual services , like E-visits (see page 39) and virtual check-ins (see page 50).Get help with your Medicare coverage choices Visit to shop for and compare health and drug plans that meet your needs. You can also enter your drugs to get more accurate costs for plans in your area. Compare health care providers & servicesVisit to find and compare doctors, hospitals, nursing homes, and other health care services near you. You can now get contact information, quality ratings, and other information in a centralized place.

3 This year it s more important than ever to get a flu shot to protect your health and your family s. See page !3 ContentsGet started ..4 What are the parts of Medicare ? ..5 Your Medicare options ..6 Original Medicare vs. Medicare Advantage ..7 8 Get the most out of Medicare ..9 Index of topics ..10 Section 1: Signing up for Medicare ..15 Section 2: Find out if Medicare covers your test, item, or service ..25 Section 3: Original Medicare ..53 Section 4: Medicare Advantage Plans & other options ..57 Section 5: Medicare Supplement Insurance (Medigap) ..71 Section 6: Medicare drug coverage (Part D) ..75 Section 7: Get help paying your health & drug costs ..87 Section 8: Know your rights & protect yourself from fraud ..93 Section 9: Get more information ..105 Section 10: Definitions ..1174 Get startedIf you re new to Medicare : Learn about your Medicare coverage options.

4 There are 2 main ways to get your Medicare coverage Original Medicare (Part A and Part B) and Medicare Advantage. See the next few pages to learn more. Find out how and when you can sign up. If you don t have Medicare Part A or Part B, see Section 1, starting on page 15. If you don t have Medicare drug coverage (Part D), see Section 6, starting on page 75. There may be penalties if you don t sign up when you re first eligible. If you have other health insurance, see pages 21 22 to find out how your other insurance works with you already have Medicare : Review your Medicare health and drug coverage and make changes if it no longer meets your needs, or if you could lower your out-of-pocket costs. You don t need to sign up for Medicare each year, but you should still review your options. Mark your calendar with these important dates!

5 This may be the only chance you have each year to change your 1, 2020 Start comparing your current coverage with other options. You may be able to save money or get extra benefits. Visit 15 to December 7, 2020 Change your Medicare health or drug coverage for 2021, if you decide to. This includes changing to Original Medicare , or joining or changing a Medicare Advantage 1, 2021 New coverage begins if you made a change. If you kept your existing coverage and your plan s costs or benefits changed, those changes also start on this 1 to March 31, 2021If you re in a Medicare Advantage Plan, you can change to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time. Any changes you make will be effective the first of the month after the plan gets your request.

6 See page 59. See pages 5 9 for an overview of your Medicare options. 5 What are the parts of Medicare ?Part A (Hospital Insurance) Helps cover: Inpatient care in hospitals Skilled nursing facility care Hospice care Home health careSee pages 25 29. Part B (Medical Insurance)Helps cover: services from doctors and other health care providers Outpatient care Home health care Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment) Many preventive services (like screenings, shots or vaccines, and yearly Wellness visits) See pages 29 51. Part D (Drug coverage) Helps cover the cost of prescription drugs (including many recommended shots or vaccines).Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by pages 75 86. 6 Your Medicare optionsWhen you first enroll in Medicare and during certain times of the year, you can choose how you get your Medicare coverage.

7 There are 2 main ways to get Medicare :Original Medicare Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). If you want drug coverage, you can join a separate Medicare drug plan (Part D). To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also shop for and buy supplemental coverage. Can use any doctor or hospital that takes Medicare , anywhere in the Advantage(also known as Part C) Medicare Advantage is an all in one alternative to Original Medicare . These bundled plans include Part A, Part B, and usually Part D. Plans may have lower out-of-pocket costs than Original Medicare . In many cases, you ll need to use doctors who are in the plan s network. Most plans offer extra benefits that Original Medicare doesn t cover like vision, hearing, dental, and more.

8 Part A Part BYou can add: Part DYou can also add: Supplemental coverageThis includes Medicare Supplement Insurance (Medigap). Or, you can use coverage from a former employer or union, or Medicaid. Part A Part BMost plans include: Part D Extra benefitsSome plans also include: Lower out-of-pocket costsSee Section 3 (starting on page 53) to learn more about Original Section 4 (starting on page 57) to learn more about Medicare A GLANCE Original Medicare vs. Medicare AdvantageDoctor & hospital choiceOriginal MedicareMedicare AdvantageYou can go to any doctor or hospital that takes Medicare , anywhere in the many cases, you ll need to use doctors and other providers who are in the plan s network and service area for the lowest costs. Some plans won t cover services from providers outside the plan s network and service area.

9 In most cases, you don t need a referral to see a may need to get a referral to see a MedicareMedicare AdvantageFor Part B-covered services , you usually pay 20% of the Medicare -approved amount after you meet your deductible. This is called your coinsurance. Out-of-pocket costs vary plans may have lower out-of-pocket costs for certain pay a premium (monthly payment) for Part B. If you choose to join a Medicare drug plan (Part D), you ll pay that premium separately. You may pay the plan s premium in addition to the monthly Part B premium. (Most plans include drug coverage (Part D).) Plans may have a $0 premium or may help pay all or part of your Part B premiums. There s no yearly limit on what you pay out of pocket, unless you have supplemental coverage like Medicare Supplement Insurance (Medigap).Plans have a yearly limit on what you pay out of pocket for services Medicare Part A and Part B covers.

10 Once you reach your plan s limit, you ll pay nothing for services Part A and Part B covers for the rest of the can get Medigap to help pay your remaining out-of-pocket costs (like your 20% coinsurance). Or, you can use coverage from a former employer or union, or can t buy and don t need Medigap. 8 CoverageOriginal MedicareMedicare AdvantageOriginal Medicare covers most medically necessary services and supplies in hospitals, doctors offices, and other health care settings. Original Medicare doesn t cover some benefits like eye exams, most dental care, and routine exams (see page 51).Plans must cover all of the medically necessary services that Original Medicare covers. Most plans offer extra benefits that Original Medicare doesn t cover like some vision, hearing, dental, routine exams, and more. Plans can now cover more of these benefits (see page 57).