Medicare
& You
The official U.S. government 
Medicare handbook 
 2
Whats new & 
important?
Medicare strives to improve access to aordable treatments to keep you healthy. 
Check out whats new this year to help you manage your health.
Saving money on your prescription drugs
If you have Medicare drug coverage (Part D) and your drug costs are high enough 
to reach the catastrophic coverage phase, you dont have to pay a copayment 
or coinsurance. Extra Helpa program that helps cover your Part D drug costs
expanded to cover more drug costs for certain people with limited resources and 
income. Go to pages 83 and 92. 
Coinsurance amounts for some Part B-covered drugs may be less if a prescription 
drugs price increased higher than the rate of ination. Go to page 40.
Lower costs for insulin and vaccines 
Your Medicare drug plan can't charge you more than $35 for a one-month supply of 
each insulin product Part D covers, and you dont have to pay a deductible for it. Go to 
page 88.
If you take insulin through a traditional pump thats covered under Medicares durable 
medical equipment benet, that insulin is covered under Medicare Part B. You wont 
pay more than $35 for a months supply and the Medicare deductible no longer 
applies. Go to pages 39 and 88.
Recommended adult vaccines are also now available at no cost to you. Go to page 50.
Changes to telehealth coverage
You can still get telehealth services at any location in the U.S., including your home, 
until the end of 2024. After that, you must be in an oce or medical facility located in 
a rural area to get most telehealth services. There are some exceptions, like for mental 
health services. Go to page 51. 
Managing and treating chronic pain 
Medicare now covers monthly services to treat chronic pain if youve been living with it 
for more than 3 months. Go to page 34. 
Better mental health care
Medicare now covers intensive outpatient program services provided by hospitals, 
community mental health centers, and other locations if you need mental health care. 
Go to pages 4647.
More times to sign up for Medicare
If you recently lost (or will soon lose) Medicaid, you may be able to sign up for 
Medicare or change your current Medicare coverage. There are other special situations 
that allow you to sign up for Medicare. Go to page 18.
COVID-19 care 
Medicare continues to cover the COVID-19 vaccine, and several tests and treatments to 
keep you and others safe. Go to page 37. 3
Contents
Whats new & important? .........................................................................................................2
Index of topics..............................................................................................................................4
What are the parts of Medicare? ...........................................................................................9
Your Medicare options .............................................................................................................10
At a glance: Original Medicare vs. Medicare Advantage ...........................................11
Get started with Medicare ......................................................................................................13
Get help finding the right coverage for you ...................................................................14
Section 1: Signing up for Medicare .....................................................................................15
Section 2: Find out what Medicare covers .....................................................................25
Section 3: Original Medicare ................................................................................................57
Section 4: Medicare Advantage Plans & other options .............................................61
Section 5: Medicare Supplement Insurance (Medigap) ...........................................75
Section 6: Medicare drug coverage (Part D) .................................................................79
Section 7: Get help paying your health & drug costs  ................................................91
Section 8: Your Medicare rights & protections  ............................................................97
Section 9: Get more information  .....................................................................................107
Section 10: Definitions  ..........................................................................................................119
Need information in an accessible format or another language?  
Go to pages 123 and 125126.
Symbol key 
Look for these symbols to help you understand your Medicare coverage.
Compare: Shows 
comparisons between  Important! Important: Highlights 
Original Medicare and  information thats important to 
Medicare Advantage Plans. review.
Cost & coverage: Gives you New! New: Highlights whats new in 
information about costs  this years Medicare & You.
and coverage for services.
Helps you nd important 
Preventive service:  information on Medicare.gov.
Gives you details about 
preventive services. 4 Index of topics
Index of topics
A C
Abdominal aortic aneurysm 30 Cardiac rehabilitation 33
Accessible Communications 123 Catastrophic coverage 81, 83
Accountable Care Organization (ACO) 29,  Cervical and vaginal cancer screenings 33
51, 74, 103, 110111, 119 Chemotherapy 34, 65
Acupuncture 30, 87 Chiropractic services 34
Advance Beneficiary Notice of   Chronic care management services 34
Non-coverage 101 Chronic pain management and treatment 
Advance care planning 3031, 35, 55 services 34
Alcohol misuse screenings & counseling 31 Claims 25, 5859, 99100, 102105, 109
Ambulance services 31, 53 Clinical research studies 27, 34, 61
Ambulatory surgical centers 3132 COBRA 1819, 89
Amyotrophic lateral sclerosis (ALS) 15 Cognitive assessment 35, 55
Appeal 28, 59, 65, 87, 97101, 108, 113 Colonoscopies 3536
Artificial limbs 49 Continuous Positive Airway Pressure (CPAP) 
Assignment 2933, 3536, 3843, 45,  devices, accessories, & therapy 36
4748, 50, 5455, 58, 5960, 65, 119 Coronavirus disease 2019 (COVID-19) 37, 
49, 50
B Cosmetic surgery 56
Cost Plan. Go to Medicare Cost Plans.
Balance exam 42
Costs (copayments, coinsurance, 
Barium enema 35
deductibles, and premiums)
Behavioral health integration services 32, 
Extra Help paying for Part D 9294
87
Medicare Advantage Plans 6465
Beneficiary and Family Centered  
Original Medicare 5859
Care-Quality Improvement 
Part A and Part B 2224, 2556
Organizations 100, 113
Part D late enrollment penalty 8385
Benefit period 27, 29, 119
Counseling to prevent tobacco use & 
Benefits coordination 22, 89, 90, 113
tobacco-caused disease 36
Bills 2324, 59, 82, 89, 99, 105
Coverage determination (Part D) 99100
Blood 26, 3233, 3536, 3839, 43, 45, 76
Covered services (Part A and Part B) 2555
Blood-based biomarker test 36
Creditable prescription drug coverage 64, 
Blue Button 59, 105, 109
79, 81, 8385, 89, 94, 119
Blue Button 2.0 59, 109
Braces (arm, leg, back, neck) 49
 Note: The bold page numbers have the most details.  Index of topics 5
D Employer group health plan coverage
Costs for Part A may be dierent 26
Defibrillators 38
Drug coverage 80, 84, 88
Dementia 35, 55, 70
How it works with Medicare 21
Demonstrations/pilot programs 74, 120, 121
Medigap Open Enrollment 77
Dental care and dentures 10, 12, 55, 56, 62, 
End-Stage Renal Disease (ESRD) 1617, 21, 
67, 75, 95
31, 42, 44, 5153, 64, 70, 74, 98
Department of Defense 113
Enroll
Department of Health & Human Services.  Medicare Advantage Plans (Part C) 6364
Go to Office for Civil Rights.
Medicare drug coverage (Part D) 8081
Department of Veterans Affairs 84, 90, 114
Extra Help (help paying Medicare drug 
Depression 32, 35, 38, 46, 55
costs) 79, 81, 83, 88, 9294, 96, 113, 120
Diabetes 34, 3839, 42, 46, 51, 70
Eyeglasses 41, 55, 75
Dialysis (kidney/renal dialysis) 16, 31, 4445, 
51, 65, 66, 98, 108
F
Disability 1519, 21, 30, 5456, 91, 96, 103, 
124 Fecal occult blood tests 3536
Drug coverage (Part D) 7990 Federal Employee Health Benefits (FEHB) 
Appeals 97101 Program 89
Coverage under Part A 2629 Federally Qualified Health Center 
Coverage under Part B 3940 services 41, 46
Join, switch, or drop 8081 Flexible sigmoidoscopies 3536
Medicare Advantage Plans 6165 Flu shot 42, 50, 54, 122
Drug plan Foot care 39, 42
Costs 8185 Formulary 81, 8586, 88, 99, 120
Enrollment 8081 Fraud 86, 103, 105106
Types of plans 79
What's covered 8588 G
Drugs (outpatient) 3940
General Enrollment Period 18, 23, 71, 80
Dual eligibles (Medicare-Medicaid 
Glaucoma screening 42
plans) 70, 9495
Durable medical equipment 9, 26, 29, 39, 
H
40, 44
Health Insurance Marketplace 18, 19, 20
E
Health Maintenance Organization (HMO) 
Plan 61, 64, 66
EKG/ECG 41, 52
Health risk assessment 55
Electronic handbook 14, 63
Health Savings Accounts (HSAs) 20
Electronic Health Records 111
Hearing aids 42, 56, 75
Electronic Medicare Summary Notices 
Hepatitis B shot 4243, 50
(eMSN) 59, 109
Hepatitis C screening 43
Electronic prescribing 112
HIV screenings 43
Emergency department services 41
Home health care/services 9, 2526, 29, 44, 
100, 108
Home infusion therapy services & 
supplies 40, 44
 Note: The bold page numbers have the most details.   6 Index of topics
Hospice care 9, 25, 2627, 61, 76, 87, 100,  M
108
Mammogram 45, 66, 70, 122
HSA. Go to Health Savings Accounts 
(HSAs). Marketplace. Go to Health Insurance 
Marketplace.
I Medicaid 10, 11, 18, 19, 21, 26, 29, 34, 53, 
5559, 65, 70, 74, 88, 9196, 103, 120
Immunosuppressive drug coverage 5253,  Medical identity theft 105
64, 92 Medical nutrition therapy 38, 46, 51
Income Related Monthly Adjustment  Medical Savings Account (MSA) Plan 20, 61, 
Amount (IRMAA) 2324, 82 6465, 67, 79, 121
Indian Health Service 84, 90, 119 Medicare
Initial Enrollment Period 17, 18, 20, 23, 71,  Part A (Hospital Insurance) 2529
80, 83, 84 Part B (Medical Insurance) 2956
Inpatient hospital care 2728 Part C (Medicare Advantage Plans) 6174
Institution 28, 70, 93 Part D (Medicare drug coverage) 7990
Insulin 39, 88
Medicare account 14, 24, 59, 91, 105, 107, 
109, 111, 112
J
Medicare Administrative Contractor 99, 103
Medicare Advantage Open Enrollment 
Join
Period 13, 7172, 80
Medicare drug plan 7980
Medicare Advantage Plan 121
Medicare health plan 6364
How they work with other coverage 64
Plan types 6670
K
Medicare Beneficiary Ombudsman 106
Medicare card 15, 2425, 37, 61, 107, 109, 
Kidney disease education 45
113114
Kidney (renal) dialysis. Go to dialysis.
Medicare Cost Plans 55, 72, 79, 82, 121
Kidney transplant 16, 45, 46, 53, 61, 64, 98
Medicare drug plan 7980
Medicare-Medicaid Plans 9495
L
Medicare Savings Programs (MSPs) 9192
Laboratory tests 37, 44, 45, 52 Medicare Summary Notice (MSN) 59, 91, 
Late enrollment penalty. Go to Penalty. 99, 101, 103, 105, 109
Lifetime reserve days 27, 120 Medicare Supplement Insurance 
Long-term care 28, 5556, 75 (Medigap) 1012, 26, 29, 5658, 64, 73, 
Lost Medicare card. Go to Replacement  7578, 89, 98, 121
Medicare card. Medication Therapy Management 
Lung cancer screenings 45 program 88
Lymphedema compression treatment  Medigap. Go to Medicare Supplement 
items 45 Insurance.
Mental health care 4647
MSN. Go to Medicare Summary Notice.
 Note: The bold page numbers have the most details.  Index of topics 7
N Pharmaceutical Assistance Programs 95
Physical therapy services 48
Notices 28, 59, 6263, 69, 81, 86, 91, 97, 
Physician assistant 39, 41, 46, 48, 53
99101, 103105, 109, 111, 124
Pilot/demonstration programs 74, 95, 120, 
Annual Notice of Change 63, 69, 81
121
Medicare Outpatient Observation Notice 
Pneumococcal shots 48, 50, 54
(also called MOON) 28
Preventive services 9, 14, 2933, 3539, 
Medicare Summary Notice (MSN) 59, 91, 
4143, 4550, 5455, 90, 108109, 122
99, 101, 103, 105, 109
Primary care doctor 31, 33, 43, 47, 50, 57, 
Nondiscrimination Notice 124
6670, 111, 122
Notice of Privacy Practices 103104
Principal care management services 49
Nurse practitioner 39, 41, 44, 46, 48, 53
Privacy notice 103104
Nursing home 26, 56, 70, 7475, 93, 95, 108, 
Private Fee-for-Service (PFFS) Plan 61, 64, 
110
69, 121
Nutrition therapy services. Go to Medical 
Program of All-inclusive Care for the Elderly 
nutrition therapy.
(PACE) 74, 95, 121
Prostate cancer screenings (PSA test) 49
O
Prosthetic/orthotic items 49
Puerto Rico 15, 16, 53, 92, 93, 96
Observation 28
Pulmonary rehabilitation programs 49
Occupational therapy services 44, 47
Office for Civil Rights 104, 124
Q
Office of Personnel Management 24, 89, 114
Open Enrollment 13, 7172, 7778, 80, 84
Quality of care 108, 110113
Opioid use disorder treatment 27, 40, 47, 
54, 8687
R
OPM. Go to Office of Personnel 
Management. Railroad Retirement Board (RRB) 1516, 20, 
Opt-out (doctors) 56, 60 2324, 59, 82, 114
Original Medicare 5760 Referral
Orthotic items 49 Denition 122
Outpatient hospital services 48 Medicare Advantage Plans 11, 62, 6670
Oxygen 40 Original Medicare 11, 57, 63
Part B-covered services 3054
P Religious non-medical health care 
institution 28
PACE. Go to Program of All-inclusive Care 
Replacement Medicare card 107, 113
for the Elderly.
Respite care 27
Payment options (premium) 2324
Retiree health insurance (coverage) 18, 19, 
Pelvic exam 33
2122, 26, 29, 5758, 64, 88, 90
Penalty (late enrollment)
RRB. Go to Railroad Retirement Board.
Part A (Hospital Insurance) 17, 18, 22
Rural emergency hospital 31
Part B (Medical Insurance) 1516, 17, 18, 23
Rural Health Clinic 46, 49
Part D (Medicare drug coverage) 64, 79, 
81, 82, 8385, 89, 93, 94
 Note: The bold page numbers have the most details.   8 Index of topics
S Supplemental insurance (Medigap)
Drug coverage 89
Screenings. Go to Preventive services.
Open Enrollment 77
Senior Medicare Patrol Program 105
Original Medicare 57
Service area 11, 63, 74, 79, 81, 122
Supplemental Security Income (SSI) 93, 96
Sexually transmitted infection screenings 
Supplies (medical) 27, 28, 36, 3940, 44, 
and counseling 50
48, 49, 51, 58, 59, 75, 88, 90, 120
SHIP. Go to State Health Insurance 
Surgical dressing services 51
Assistance Program.
Shots (vaccines) 9, 14, 37, 4243, 48, 50, 
T
54, 108, 122
Sigmoidoscopy 3536 Tax forms 2223
Skilled nursing facility (SNF) care 9, 25, 28,  Telehealth 41, 49, 51, 111
65, 74, 76, 100, 101, 111, 122 Tests (Non-laboratory) 52
SNF. Go to Skilled nursing facility (SNF)  Tiers (drug formulary) 8183, 85, 99100
care.
Transitional care management services 52
SNP. Go to Special Needs Plan.
Transplant services 16, 33, 45, 46, 5253, 
Social Security 64, 98
Change address on MSN 59
Travel 12, 53, 7576
Extra Help paying Part D costs 92
TRICARE 19, 21, 53, 84, 90, 113, 119
Other helpful contacts 113
Part A and Part B premiums 2224 U
Part D premium 82
Sign up for Part A and Part B 1519 Union
Costs for Part A may be dierent 26
Supplemental Security Income (SSI) 
benets 93, 96 Drug coverage 7980, 84, 88, 94
Medicare Advantage Plan 64
SPAP. Go to State Pharmacy Assistance 
Program. Signing up for Part B 19
Special Enrollment Period Urgently needed care 12, 53, 60
Part A and Part B 1718, 23
Part C (Medicare Advantage plans) 7173 V
Part D (Medicare drug plans) 80, 89, 93
VA. Go to Veterans' benefits.
Special Needs Plan (SNP) 61, 70
Vaccines. Go to Shots.
Speech-language pathology 39, 41, 44, 50
Veterans' benefits (VA) 84, 90, 114
SSI. Go to Supplemental Security Income.
Vision (eye care) 41, 55
State Health Insurance Assistance Program 
(SHIP) 14, 16, 56, 60, 73, 77, 78, 80, 83, 89, 
W
94, 95, 100, 105, 108, 110, 115118
State Medical Assistance (Medicaid) 
Walkers 9, 28, 40, 44
office 19, 56, 57, 70, 92, 9596, 123
Welcome to Medicare preventive visit 41, 
State Pharmaceutical Assistance 
54
Programs 95
Wellness visit 9, 14, 3031, 35, 5455, 108
Substance use disorder treatments 40, 47, 
Wheelchairs 9, 40, 44
51, 54, 55, 8687
X
X-ray 28, 48, 52
 Note: The bold page numbers have the most details.  9
What are the parts of 
Medicare?
Part A (Hospital Insurance) 
Helps cover:
  Inpatient care in hospitals
  Skilled nursing facility care
  Hospice care
  Home health care
Go to pages 2529. 
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) 
Go to pages 2955. 
Part D (Drug coverage) 
Helps cover the cost of prescription drugs (including many 
recommended shots or vaccines).
Plans that oer Medicare drug coverage (Part D) are run by 
private insurance companies that follow rules set by Medicare.
Go to pages 7990.  10
Your Medicare options
When you rst sign up for Medicare, and during certain times of the year, you can 
choose how you get your Medicare coverage. There are 2 main ways to get Medicare:
Original Medicare Medicare Advantage  
  Original Medicare includes Medicare  (also known as Part C)
Part A (Hospital Insurance) and 
  Medicare Advantage is a 
Part B (Medical Insurance).
Medicare-approved plan from a 
  You can join a separate Medicare  private company that oers an 
drug plan to get Medicare drug  alternative to Original Medicare for 
coverage (Part D). your health and drug coverage. These 
  You can use any doctor or hospital  bundled plans include Part A, 
that takes Medicare, anywhere in  Part B, and usually Part D.
the U.S.   In many cases, you can only use 
  To help pay your out-of-pocket costs  doctors who are in the plans network.
in Original Medicare (like your 20%   In many cases, you may need to get
coinsurance), you can also shop for  approval from your plan before it 
and buy supplemental coverage. covers certain drugs or services.
  Plans may have lower or higher 
out-of-pocket costs than Original 
 Part A Medicare. You may also have an 
additional premium.
 Part B   Plans may oer some extra benets 
that Original Medicare doesnt cover
like certain vision, hearing, and dental 
services.
You can add:
  Part D
 Part A
You can also add:
 Part B
  Supplemental  
  coverage
Most plans include:
This includes Medicare 
Supplement Insurance   Part D
(Medigap). Go to Section 5 
(starting on page 75) to learn 
more about Medigap. Or, you   Some extra benets
can use coverage from a current 
or former employer or union, or  Some plans also include:
Medicaid.
  Lower out-of-pocket  
  costs
Go to Section 3 (starting on 
page 57) to learn more about 
Go to Section 4 (starting on 
Original Medicare.
page 61) to learn more about 
Medicare Advantage. 11
AT A GLANCE  
Original Medicare vs. 
Medicare Advantage
Doctor & hospital choice
Original Medicare Medicare Advantage (Part C)
You can use any doctor or hospital that  In many cases, you can only use 
takes Medicare, anywhere in the U.S. doctors and other providers who are 
in the plans network and service area 
(for non-emergency care). Some plans 
oer non-emergency coverage out of 
network, but typically at a higher cost. 
In most cases, you dont need a referral  You may need to get a referral to use  
to use a specialist. a specialist.
Cost
Original Medicare Medicare Advantage (Part C)
For Part B-covered services, you usually  Out-of-pocket costs varyplans  
pay 20% of the Medicare-approved may have lower or higher out-of-pocket
amount after you meet your deductible.  costs for certain services.
This amount is called your coinsurance.
You pay a premium (monthly payment)  You pay the monthly Part B premium 
for Part B. If you choose to join a  and may also have to pay the plans 
Medicare drug plan, youll pay a separate  premium. Some plans may have a 
premium for your Medicare drug  $0 premium and may help pay all or 
coverage (Part D).  part of your Part B premium. Most 
plans include Medicare drug coverage 
(Part D).
Theres no yearly limit on what you  Plans have a yearly limit on what 
pay out of pocket, unless you have  you pay out of pocket for services 
supplemental coveragelike Medicare  Medicare Part A and Part B cover. Once 
Supplement Insurance (Medigap). you reach your plans limit, youll pay 
nothing for services Part A and Part B 
cover for the rest of the year.
You can choose to buy Medigap to  You cant buy Medigap. 
help pay your remaining out-of-pocket 
costs (like your 20% coinsurance). Go to 
page 77. Or, you can use coverage from 
a current or former employer or union, or 
Medicaid. 12
Coverage
Original Medicare Medicare Advantage (Part C)
Original Medicare covers most medically  Plans must cover all medically 
necessary services and supplies in  necessary services that Original 
hospitals, doctors oces, and other  Medicare covers. Plans may also oer 
health care facilities. Original Medicare  some extra benets that Original 
doesnt cover some benets like eye  Medicare doesnt coverlike certain 
exams, most dental care, and routine  vision, hearing, and dental services. 
exams. Go to page 55.
You can join a separate Medicare drug  Medicare drug coverage (Part D) is 
plan to get Medicare drug coverage  included in most plans. In most types 
(Part D). of Medicare Advantage Plans, you cant 
join a separate Medicare drug plan.
In most cases, you dont need approval  In many cases, you may need to get 
for Original Medicare to cover your  approval from your plan before it covers 
services or supplies. certain services or supplies.
Foreign travel
Original Medicare Medicare Advantage (Part C)
Original Medicare generally doesnt  Plans generally dont cover medical 
cover medical care outside the U.S.  care outside the U.S. Some plans 
You may be able to buy a Medicare  may oer a supplemental benet that 
Supplement Insurance (Medigap) policy  covers emergency and urgently needed 
that covers emergency care outside  services when traveling outside the U.S.
the U.S.
This handbook explains these topics in more detail:
  Original Medicare: Go to Section 3 (starting on page 57).
  Medicare Advantage: Go to Section 4 (starting on page 61).
  Medicare Supplement Insurance (Medigap): Go to Section 5 (starting on page 75).
  Medicare drug coverage (Part D): Go to Section 6 (starting on page 79). 13
Get started with Medicare
Its important for you to: 
  Understand your Medicare coverage options. There are 2 main ways to get 
your Medicare coverageOriginal Medicare (Part A and Part B) and Medicare 
Advantage. Go to pages 1012 to learn more.
  Find out how and when you can sign up. If you dont have Medicare Part A or 
Part B, go to Section 1 (starting on page 15). If you have other health insurance, 
go to pages 1922 to nd out how your other insurance works with Medicare.
Important! If you dont have Medicare drug coverage (Part D), go to Section 6 
(starting on page 79). There may be penalties if you dont sign up when 
youre rst eligible. 
  Mark your calendar with these important dates! These may be the only times 
you have each year to change your coverage.
January 1, 2024  New coverage begins if you made a change. If 
you kept your existing coverage and your plans 
costs or benets changed, those changes also 
start on this date.
January 1 to  If you're in a Medicare Advantage Plan, you 
March 31, 2024 can change to a dierent 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 eective 
the rst day of the month after the plan gets 
your request. Go to page 63.
October 1, 2024 Start comparing your current coverage with 
other options. You may be able to save money 
or get extra benets. Visit
Medicare.gov/plan-compare.
October 15 to  Change your Medicare health or drug coverage 
December 7, 2024 for 2024, if you decide to. You can join, switch 
or drop a Medicare Advantage Plan or Medicare 
drug plan, or switch to Original Medicare during 
this Open Enrollment Period each year.
Each year, its important to review your Medicare health and drug 
coverage to make sure it still meets your needs, and decide if you want to 
make a change. You dont need to sign up for Medicare each year, but you 
should still review your options. 14
Get help finding the right 
coverage for you
Explore your coverage options
  Find and compare health and drug plans at
Medicare.gov/plan-compare.  
  Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
  Get free, personalized health insurance counseling from your State Health 
Insurance Assistance Program (SHIP). Go to pages 115118 for the phone 
number of your local SHIP. A trusted agent or broker may also be able to help.
Get the most value out of your health care
We want to make sure you have the information you need to make the best 
decisions about your health care. Look for  throughout this handbook to learn 
about costs and coverage for services.
Learn about preventive services 
Medicare covers many preventive services at no cost to you. Ask your doctor 
or other health care provider which preventive services (like screenings, shots 
or vaccines, and yearly Wellness visits) you need. Go to pages 3055 and look 
for  to learn more about which preventive services Medicare covers. 
 
Get help paying for health care 
There are multiple programs available to help with costs. Many people with 
Medicare qualify. For more on these programs, go to pages 9196.
Review this handbook online
Help Medicare save money by switching to the electronic version of your 
handbook. Log into (or create) your secure Medicare account at Medicare.gov to 
switch to the electronic handbook. Well email you a link to a PDF version instead 
of sending a paper copy in the mail each fall.
Need information in an accessible format or another 
language?
You can get the Medicare & You handbook in an accessible format at no cost
to you. Go to page 123. To get free help in a language other than English, go to 
pages 125126. 
Have questions or comments about this handbook? 
Email us at medicareandyou@cms.hhs.gov. 15
SECTION 1  
Signing up for Medicare
Will I get Part A and Part B automatically?
If youre already getting benets from Social Security or the Railroad 
Retirement Board (RRB), youll automatically get Part A and Part B starting
the rst day of the month you turn 65. (If your birthday is on the rst day of 
the month, Part A and Part B starts the rst day of the prior month.)
If youre under 65 and have a disability, youll automatically get Part A 
and Part B after getting 24 months of disability benets, either from Social 
Security or certain disability benets from the RRB. 
If you live in Puerto Rico, you dont automatically get Part B. You must 
sign up for it. Go to page 16.
If you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrigs 
disease), youll get Part A and Part B automatically the month your Social 
Security disability benets begin. 
If you automatically get Medicare, youll get your red, white, and blue 
Medicare card in the mail 3 months before your 65th birthday or 25th 
month of disability benets, and you dont need to pay a premium for 
Part A (sometimes called premium-free Part A). Most people choose 
to keep Part B. If you dont want Part B, let us know before the coverage 
start date on your Medicare card. If you do nothing, youll keep Part B and 
pay Part B premiums through your Social Security or RRB benets. If you 
have other coverage and need help deciding if you should keep Part B, go to 
page 19. If you choose not to keep Part B but decide you want it later, you 
may have a delay in getting Medicare Part B coverage because you can 
only sign up at certain times. You may also have to pay a late enrollment 
penalty for as long as you have Part B. Go to page 23. 
Will I have to sign up for Part A and/or Part B?
If youre close to 65, but NOT getting Social Security or RRB benets, 
youll need to sign up for Medicare. Visit SSA.gov/medicare to apply for Part 
A and Part B. You can also contact Social Security 3 months before you turn 
65 to set up an appointment. If you worked for a railroad, contact the RRB. 
In most cases, if you dont sign up for Part B when youre rst eligible, you 
may have a delay in getting Medicare Part B coverage in the future because 
you can only sign up at certain times. You may also have to pay a late 
enrollment penalty for as long as you have Part B. Go to page 23.
 Note: Go to pages 119122 for definitions of blue words.  16 SECTION 1: Signing up for Medicare
If you have End-Stage Renal Disease (ESRD) and want Medicare, 
youll need to sign up for it. Contact Social Security to nd out when 
and how to sign up for Part A and Part B. For more information, visit 
Medicare.gov/publications to review the booklet, Medicare Coverage of 
Kidney Dialysis & Kidney Transplant Services.
Important! If you live in Puerto Rico and get benets from Social Security 
or the RRB, youll automatically get Part A the rst day of the 
month you turn 65 or after you get disability benets for 24 
months. However, if you want Part B, youll need to sign up 
for it by completing an Application for Enrollment in Part B 
Form (CMS-40B). To get this form in English and Spanish, visit:  
Medicare.gov/basics/forms-publications-mailings/forms/enrollment. 
If you dont sign up for Part B when youre rst eligible, you may have a 
delay in getting Part B coverage in the future because you can only sign 
up at certain times. You may also have to pay a late enrollment penalty 
for as long as you have Part B. Go to page 23.
Where can I get more information? 
Call Social Security at 1-800-772-1213 for more information about your 
Medicare eligibility and to sign up for Part A and/or Part B. TTY users can 
call 1-800-325-0778. If you worked for a railroad or get RRB benets, call 
the RRB at 1-877-772-5772. TTY users can call 1-312-751-4701. 
You can also get free, personalized health insurance counseling from your 
State Health Insurance Assistance Program (SHIP). Go to pages 115118 for
the phone number of your local SHIP. 
After youve signed up for Medicare Part A and/or Part B, its time 
to look at your coverage options. People get Medicare coverage in 
dierent ways. To get the most out of your coverage, review all of 
your options and decide what best meets your needs. Go to pages 
1113 for more details. 
If I didnt get Part A and Part B automatically, when 
can I sign up?
If you didnt automatically get premium-free Part A (for example, because 
youre still working and not yet getting Social Security or Railroad 
Retirement Board (RRB) benets), you can sign up for it any time after 
youre rst eligible for Medicare. Go to page 22 for more information. 
In this example, your Part A coverage will go back (retroactively) 6 months 
from when you sign up for Part A or apply for Social Security or RRB 
benets, but no earlier than the rst month youre eligible for Medicare. 
Depending on how you become eligible for Part A, the retroactive period 
may be dierent.
You can only sign up for Part B during the enrollment periods listed on the 
next page. SECTION 1: Signing up for Medicare 17
Important! Remember, in most cases, if you dont sign up for Part A (if you have 
to buy it) and Part B when youre rst eligible, your enrollment may 
be delayed and you may have to pay a late enrollment penalty. Go to 
pages 2223.
What are the Part A and Part B enrollment periods?
You can only sign up for Part B (and/or Part A if you have to buy it) during
these enrollment periods.
Initial Enrollment Period 
Generally, you can rst sign up for Part A and/or Part B during the 7-month 
period that begins 3 months before the month you turn 65 and ends 3 months 
after the month you turn 65. If your birthday is on the rst of the month, 
your 7-month period starts 4 months before the month you turn 65 and ends 
2 months after the month you turn 65. 
Example: If you turn 65 on June 2, your 7-month period would begin in March 
and end in September. If you turn 65 on June 1, your 7-month period would 
begin in February and end in August.
If you sign up for Part A and/or Part B during the rst 3 months of your Initial 
Enrollment Period, in most cases, your coverage begins the rst day of your 
birthday month. However, if your birthday is on the rst day of the month, your 
coverage starts the rst day of the prior month. 
If you sign up the month you turn 65 or during the last 3 months of your Initial 
Enrollment Period, your coverage starts the rst day of the month after you 
sign up.
Special Enrollment Period
After your Initial Enrollment Period is over, you may have a chance to sign up 
for Medicare during a Special Enrollment Period. For example, if you didnt
sign up for Part B (or Part A if you have to buy it) when you were rst eligible 
because you have group health plan coverage based on current employment
(your own, a spouses, or a family members if you have a disability), you can 
sign up for Part A and/or Part B:
  Any time youre still covered by the group health plan 
  During the 8-month period that begins the month after the employment 
ends or the coverage ends, whichever happens rst 
Your coverage starts the rst day of the month after you sign up. Usually, you 
wont have to pay a late enrollment penalty if you sign up during a Special 
Enrollment Period. This period doesnt apply if youre eligible for Medicare 
based on End-Stage Renal Disease (ESRD), or youre still in your Initial 
Enrollment Period.
To sign up for Part A and/or B, contact Social Security at 
1-800-772-1213. TTY users should call 1-800-325-0778. 18 SECTION 1: Signing up for Medicare
Important! COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage, 
retiree health plans, VA coverage, and individual health insurance 
coverage (like coverage through the Health Insurance Marketplace) 
arent considered coverage based on current employment and don't 
count as employer coverage for a Special Enrollment Period. There 
may be reasons why you should take Part B instead of, or in addition 
to, COBRA coverage. You have 8 months after your coverage based 
on current employment ends to sign up for Part B without a penalty, 
whether or not you choose COBRA. However, if you have COBRA and 
youre eligible for Medicare, COBRA may only pay a small portion of your 
medical costs. You generally arent eligible for a Special Enrollment Period 
to sign up for Medicare when that COBRA coverage ends. Go to page 89 
for more information about COBRA coverage. To avoid paying a penalty, 
make sure you sign up for Medicare when youre rst eligible. If you have 
retiree coverage, it may not pay for your health services if you dont have 
both Part A and Part B.
Exceptional situations for a Special Enrollment Period 
There are other circumstances where you may be able to sign up for 
Medicare during a Special Enrollment Period. You may be eligible if you 
miss an enrollment period because of certain exceptional circumstances, 
like being impacted by a natural disaster or an emergency, incarceration, 
employer or health plan error, losing Medicaid coverage, or other 
circumstances outside of your control that Medicare determines 
to be exceptional. For more information, visit Medicare.gov or call 
1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
Important! If you recently lost Medicaid and you now qualify for Medicare, but didnt 
sign up for Medicare when you rst became eligible, you may be able to 
sign up for Part A and Part B without paying a late enrollment penalty. 
If you already have Medicare but lost Medicaid, you also have coverage 
options. For more information, check out the "Losing Medicaid?" fact 
sheet at go.Medicare.gov/losingmedicaid. 
General Enrollment Period 
If you have to pay for Part A but dont sign up for it and/or dont sign up 
for Part B (for which you must pay premiums) during your Initial Enrollment 
Period, and you dont qualify for a Special Enrollment Period, you can sign 
up during the General Enrollment Period from January 1March 31 each 
year. You may have to pay a higher Part A and/or Part B premium for late 
enrollment. Go to pages 2223. 
When you sign up during the General Enrollment Period, your coverage 
starts the rst day of the month after you sign up. 
Not sure if you qualify for an enrollment period? Visit Medicare.gov, or call 
1-800-MEDICARE.  SECTION 1: Signing up for Medicare 19
I have other health coverage. Should I get Part B?
This information can help you decide if you should get Part B based on the 
type of health coverage you may have. 
Employer or union coverage
If you or your spouse (or family member if you have a disability) are still 
working and you have health coverage through that employer or union, go 
to page 21 to nd out how your coverage works with Medicare. You can also 
contact the employer or union benets administrator for information. This 
includes federal or state employment and active-duty military service. It 
might be to your advantage to delay Part B enrollment while you still have 
health coverage based on your or your spouses current employment. 
Coverage based on current employment doesnt include: 
  COBRA (or similar continuation coverage after employment ends) 
  Retiree coverage 
  VA coverage 
  Individual health insurance coverage (like through the Health Insurance 
Marketplace) 
TRICARE
If you have TRICARE (health care program for active-duty and retired service 
members and their families), you generally must sign up for Part A and 
Part B when youre rst eligible to keep your TRICARE coverage. However, 
if youre an active-duty service member or an active-duty family member, 
you dont have to sign up for Part B to keep your TRICARE coverage. For 
more information, contact your TRICARE contractor. Go to page 90. 
If you have CHAMPVA coverage, you must sign up for Part A and Part B 
to keep it. Call 1-800-733-8387 for more information about CHAMPVA.
 
Medicaid
If you have Medicaid and dont have Part B, Medicaid may help you sign 
up for it. Medicare will pay rst, and Medicaid will pay second. Medicaid 
may be able to help pay your Medicare out-of-pocket costs (like premiums, 
deductibles, coinsurance, and copayments). 
Call your State Medical Assistance (Medicaid) oce for more 
information and to nd out if you qualify. Visit Medicaid.gov/about-us/
beneficiary-resources/index.html#statemenu, or call 1-800-MEDICARE 
(1-800-633-4227) to get the phone number for your states Medicaid oce. 
TTY users can call 1-877-486-2048. 20 SECTION 1: Signing up for Medicare
Health Insurance Marketplace
Even if you have Marketplace coverage (or other individual health coverage 
that isnt based on current employment), you should generally sign up for 
Medicare when youre rst eligible to avoid the risk of a delay in Medicare 
coverage and the possibility of a Medicare late enrollment penalty. 
Here are some important points to consider if you have Marketplace coverage: 
  You need to end your Marketplace coverage in a timely manner when you 
become eligible for Medicare to avoid an overlap in coverage. 
  Once youre considered eligible for premium-free Part A, or already have 
Part A with a premium, you wont qualify for help from the Marketplace to 
pay your Marketplace plan premiums or other medical costs. If you continue 
to get help paying for your Marketplace plan premiums after that point, you 
may have to pay back some or all of the help you got when you le your 
federal income taxes. 
Visit HealthCare.gov to connect to the Marketplace in your state and learn 
more. To nd out how to end your Marketplace plan or Marketplace savings 
when your Medicare coverage begins, visit HealthCare.gov/medicare/
changing-from-marketplace-to-medicare. You can also call the Marketplace 
Call Center at 1-800-318-2596. TTY users can call 1-855-889-4325.
Health Savings Account (HSA)
You arent eligible to make contributions to an HSA after you have Medicare. 
To avoid a tax penalty, you should make your last HSA contribution the month 
before your Part A coverage begins. Premium-free Part A coverage will go 
back (retroactively) 6 months from when you sign up for Part A or apply for 
benets from Social Security or the Railroad Retirement Board (RRB), but no 
earlier than the rst month youre eligible for Medicare. Depending on how you 
become eligible for Part A, the retroactive period may be dierent. Review the 
chart below to help decide when its best to stop your HSA contributions. 
If you sign up for During your Initial You can avoid a tax penalty
Medicare: Enrollment Period by making your last HSA 
contribution the month
2 months after your 
before you turn 65.
Initial Enrollment 
Period ends
If you wait to sign up  Less than 6 months  You can avoid a tax 
for Medicare: after you turn 65 penalty by stopping HSA 
contributions the month 
before you turn 65.
6 or more months  You can avoid a tax 
after you turn 65 penalty by stopping HSA 
contributions 6 months 
before the month you apply 
for Medicare.
Note: A Medicare Medical Savings Account (MSA) Plan is similar to an HSA. 
Go to page 67. SECTION 1: Signing up for Medicare 21
How does my other insurance work with Medicare?
When you have other insurance (like group health plan, retiree health, or Medicaid 
coverage) and Medicare, there are rules for whether Medicare or your other 
coverage pays rst. 
If you have retiree health coverage (like  Medicare pays rst. 
insurance from your or your spouses former 
employment)... 
If youre 65 or older, have group health plan  Your group health plan 
coverage based on your or your spouses  pays rst. 
current employment, and the employer has 
20 or more employees... 
If youre 65 or older, have group health plan  Medicare pays rst. 
coverage based on your or your spouses 
current employment, and the employer has 
fewer than 20 employees... 
If youre under 65 and have a disability, have  Your group health plan 
group health plan coverage based on your or a  pays rst. 
family members current employment, and the 
employer has 100 or more employees... 
If youre under 65 and have a disability, have  Medicare pays rst. 
group health plan coverage based on your or a 
family members current employment, and the 
employer has fewer than 100 employees... 
If you have group health plan coverage based  Your group health plan 
on your or a family members employment or  pays rst for the rst 
former employment, and youre eligible for  30 months after you 
Medicare because of End-Stage Renal Disease  become eligible for 
(ESRD)... Medicare. Medicare pays 
rst after this 30-month 
period. 
If you have TRICARE... Medicare pays rst, unless 
youre on active duty, 
or get items or services 
from a military hospital 
or clinic, or other federal 
health care provider.
If you have Medicaid... Medicare pays rst.
Important! If youre still working and have employer coverage through work, contact your 
employer to nd out how your employers coverage works with Medicare. 22 SECTION 1: Signing up for Medicare
Here are some important facts to remember about how other insurance works 
with Medicare-covered services: 
  The insurance that pays rst (primary payer) pays up to the limits of its 
coverage. 
  The insurance that pays second (secondary payer) only pays if there are costs 
the primary payer didnt cover. 
  The secondary payer (which may be Medicare) might not pay all of the 
uncovered costs. 
  If your group health plan or retiree health coverage is the secondary payer, 
youll likely need to sign up for Part B before your insurance will pay. 
Visit Medicare.gov/publications to review the booklet, Medicare and Other Health 
Benets: Your Guide to Who Pays First. You can also call 1-800-MEDICARE 
(1-800-633-4227) for more information. TTY users can call 1-877-486-2048.
Important! If you have other insurance or changes to your insurance, you need to let 
Medicare know by calling Medicares Benets Coordination & Recovery Center 
at 1-855-798-2627. TTY users can call 1-855-797-2627. 
If you have Part A, you may get a Health Coverage form (IRS Form 1095-B) 
from Medicare. This form veries that you had health coverage in the past year. 
Keep the form for your records. Not everyone will get this form. If you dont get 
Form 1095-B, dont worry. You dont need it to le your taxes.
Do I have to pay for Part A?
You usually dont pay a monthly premium for Part A coverage if you or your 
spouse paid Medicare taxes while working for a certain amount of time. This is 
sometimes called premium-free Part A. If you arent eligible for premium-free 
Part A, you may be able to buy it. For more information on how to pay your 
Part A premium, go to page 24.
If you buy Part A, youll pay a premium of either $278 or up to $505 each 
month in 2024 depending on how long you or your spouse worked and paid 
Medicare taxes. If you need help paying your Part A premium, go to pages 9192. 
If you have questions about paying for Part A, visit Medicare.gov or call 
1-800-MEDICARE.
In most cases, if you choose to buy Part A, you must also have Part B and pay 
monthly premiums for both. If you choose NOT to buy Part A, you can still buy 
Part B if youre eligible.
Whats the Part A late enrollment penalty? 
If you arent eligible for premium-free Part A, and you dont buy it when youre 
rst eligible, your monthly premium may go up 10%. Youll have to pay the higher 
premium for twice the number of years you could have had Part A but didnt 
sign up. For example, if you were eligible for Part A for 2 years but didnt sign up, 
youll have to pay a 10% higher premium for 4 years. SECTION 1: Signing up for Medicare 23
How much does Part B coverage cost?
The standard Part B premium amount in 2024 is $174.70. Most people pay the 
standard Part B premium amount every month.
If your modied adjusted gross income is above a certain amount (in 2024: 
$103,000 if you le individually or $206,000 if youre married and le jointly), 
you may pay an Income Related Monthly Adjustment Amount (IRMAA). 
IRMAA is an extra charge added to your premium.
To determine if youll pay the IRMAA, Medicare uses the modied adjusted 
gross income reported on your IRS tax return from 2 years ago. Visit 
Medicare.gov to learn more about IRMAA.
Note: You may also pay an extra amount for your Medicare drug coverage 
(Part D) premium if your modied adjusted gross income is above a certain 
amount. Go to page 82.
If you have to pay an extra amount and you disagree (for example, your 
income is lower due to a life event), visit SSA.gov or call Social Security at 
1-800-772-1213. TTY users can call 1-800-325-0778.
Whats the Part B late enrollment penalty? 
Important! If you dont sign up for Part B when youre rst eligible, you may have 
to pay a late enrollment penalty for as long as you have Part B. Your 
monthly Part B premium may go up 10% for each full 12 months in the 
period that you couldve had Part B, but didnt sign up. If youre allowed to 
sign up for Part B during a Special Enrollment Period, you usually dont pay 
a late enrollment penalty. Go to pages 1718. 
Example: Mr. Smiths Initial Enrollment Period ended December 2020. He 
waited until March 2023 (during the General Enrollment Period) to sign 
up for Part B. His Part B premium penalty is 20%, and hell have to pay 
this penalty in addition to his standard Part B premium for as long as he 
has Part B. (Even though Mr. Smith didnt have Part B for 27 months, this 
included only 2 full 12-month periods.)
Cost & coverage: To learn how to get help with Medicare costs, go to 
Section 7 (starting on page 91).
How can I pay my Part B premium? 
If you get Social Security or Railroad Retirement Board (RRB) benets, 
your Part B premium will be deducted from your monthly benet payment. 
Note: If you get a bill from the RRB, mail your premium payments to:
RRB Medicare Premium Payments 
PO Box 979024 
St. Louis, MO 63197-9000
If you have questions about bills you get from the RRB, call 1-877-772-5772. 
TTY users can call 1-312-751-4701. 24 SECTION 1: Signing up for Medicare
If youre a federal retiree with an annuity from the Oce of Personnel 
Management and you aren't entitled to Social Security or RRB benets, 
you can ask to have your Part B premiums deducted from your annuity. Call 
1-800-MEDICARE (1-800-633-4227) to make your request. TTY users can 
call 1-877-486-2048.
If you dont get these benet payments, youll get a bill for your Part B 
premium. Typically, Part B premiums are billed quarterly (every 3 months). 
If you also pay for Part A or Part D IRMAA, or use Medicare Easy Pay to pay 
your premiums, youll get a monthly bill (go to pages 22 and 82). There are 4 
ways to pay your premium bill: 
1. Pay online by credit card, debit card, savings or checking account. To do 
this, log into (or create) your secure Medicare account at Medicare.gov. 
Paying online is a faster and more secure way to make your payment 
without sending your personal information in the mail. Youll get a 
confirmation number when you make your payment. 
2. Pay directly from your savings or checking account through your banks 
online bill payment services. Ask your bank if it allows customers to pay 
bills onlinenot all banks offer this service and some may charge a fee. 
Your bank will need this information:
  Your Medicare number: Its important that you use the exact number 
on your red, white, and blue Medicare card, but without the dashes.
  Payee name: CMS Medicare Insurance
  Payee address: 
Medicare Premium Collection Center 
PO Box 790355 
St. Louis, MO 63179-0355
3. Sign up for Medicare Easy Pay. This is a free service that automatically 
deducts your premium payments from your savings or checking 
account each month. Visit Medicare.gov/medicare-easy-pay, or call 
1-800-MEDICARE to find out how to sign up.
4. Mail your payment to Medicare. You can pay by check, money order, 
credit card, or debit card. Write your Medicare number on your payment, 
and fill out your payment coupon. Mail your payment and coupon to:
Medicare Premium Collection Center
PO Box 790355
St. Louis, MO 63179-0355
If you have questions about your premiums, call 1-800-MEDICARE or visit 
Medicare.gov. 
If you need to change your address on your bill, call Social Security at 
1-800-772-1213. TTY users can call 1-800-325-0778. 
You may be able to get help from your state to pay your Part A and Part B 
premiums through a Medicare Savings Program. Go to pages 9192. 25
SECTION 2  
Find out what Medicare 
covers
What services does Medicare cover? 
In this section, youll nd information about the items, tests, and services 
that Original Medicare (Part A and Part B) covers in hospitals, doctors 
oces, and other health care facilities. You may be eligible for the 
Medicare-covered services in this section if you have both Part A and 
Part B.
If you have Original Medicare, youll use your red, white, and blue Medicare 
card to get your Medicare-covered services. Your Medicare card shows 
whether you have Part A (listed as HOSPITAL), Part B (listed as MEDICAL), or 
both, and the date your coverage begins. 
Important! If you join a Medicare Advantage Plan or other Medicare health plan, 
in most cases, youll use your plans card to get your Medicare-covered 
services.
Note: If youre not lawfully present in the U.S., Medicare wont pay for your 
Part A and Part B claims, and you cant join a Medicare Advantage Plan or a 
Medicare drug plan.
What does Part A cover? 
Part A (Hospital Insurance) helps cover: 
  Inpatient care in a hospital 
  Skilled nursing facility care
  Hospice care 
  Home health care 
Pages 2629 list common services Part A covers and general descriptions. 
For more information on Part A-covered services, visit 
Medicare.gov/coverage.
Cost & coverage: Find out whats covered using your mobile device. 
To get Medicare coverage information, download Medicares free 
Whats covered mobile app on your smartphone or tablet. Whats 
covered is available in the App Store and on Google Play. 
 Note: Go to pages 119122 for definitions of blue words.  26 SECTION 2: Find out what Medicare covers
What do I pay for Part A-covered services? 
Copayments, coinsurance, or deductibles may apply for each service listed 
on the following pages. 
If youre in a Medicare Advantage Plan or have other insurance (like 
Medigap, Medicaid, employer, retiree, or union coverage), your 
copayments, coinsurance, or deductibles may be dierent. For more 
information about costs, contact your plan or visit 
Medicare.gov/plan-compare.
You can also call 1-800-MEDICARE (1-800-633-4227). TTY users can call 
1-877-486-2048.
Part A-covered services
Blood 
If the hospital gets blood from a blood bank at no charge, you wont have 
to pay for it or replace it. If the hospital has to buy blood for you, you 
must either pay the hospital costs for the rst 3 units of blood you get in a 
calendar year, or you or someone else can donate the blood. 
Home health services 
Part A and/or Part B covers home health benets. Go to page 44. 
Hospice care 
To qualify for hospice care, a hospice doctor and your doctor (if you have one) 
must certify that youre terminally ill, meaning you have a life expectancy of 
6 months or less. When you agree to hospice care, youre agreeing to comfort 
care (palliative care) instead of care to cure your terminal illness. You also must 
sign a statement choosing hospice care instead of other Medicare-covered 
treatments for your terminal illness and related conditions. 
Coverage includes: 
  All items and services needed for pain relief and symptom management 
  Medical, nursing, and social services 
  Drugs for pain and symptom management
  Durable medical equipment for pain relief and symptom management
  Aide and homemaker services 
  Other covered services you need to manage your pain and other 
symptoms, as well as spiritual and grief counseling for you and your family 
Medicare-certied hospice care is usually given in your home or other 
facility where you live, like a nursing home. Original Medicare will still pay for 
covered benets for any health problems that arent part of your terminal 
illness and related conditions, but hospice should cover most of your care.
Medicare wont pay room and board for your care in a facility, unless the 
hospice medical team decides you need short-term inpatient care to manage 
pain and other symptoms. This care must be in a Medicare-approved facility, 
like a hospice facility, hospital, or skilled nursing facility that contracts with 
the hospice.  SECTION 2: Find out what Medicare covers 27
Medicare also covers inpatient respite care, which is care you get in a Medicare-
approved facility so that your usual caregiver (family member or friend) can 
rest. You can stay up to 5 days each time you get respite care. 
After 6 months, you can continue to get hospice care as long as the hospice 
medical director or hospice doctor recerties (at a face-to-face meeting) that 
youre still terminally ill. 
You pay:
  Nothing for hospice care. 
  A copayment of up to $5 per prescription for outpatient drugs for pain and 
symptom management. 
  Five percent of the Medicare-approved amount for inpatient respite care. 
Original Medicare will be billed for your hospice care, even if youre in a 
Medicare Advantage Plan. When you get hospice care, your Medicare 
Advantage Plan can still cover services that arent part of your terminal 
illness or any conditions related to your terminal illness. For more on hospice 
care and to nd Medicare-approved providers, contact your plan or visit 
Medicare.gov/care-compare.
Inpatient hospital care
Medicare covers semi-private rooms, meals, general nursing, drugs (including
methadone to treat an opioid use disorder), and other hospital services and 
supplies as part of your inpatient treatment. This includes care you get in
acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, 
long-term care hospitals, psychiatric care in inpatient psychiatric facilities,
and inpatient care for a qualifying clinical research study. This doesnt include 
private-duty nursing, a television or phone in your room (if theres a separate
charge for these items), personal care items (razors or slipper socks), or a private 
room, unless medically necessary.
If you also have Part B, it generally covers 80% of the Medicare-approved 
amount for doctors services you get while youre in a hospital. 
In each benefit period, you pay:
  Days 160 (of each benet period): $0 after you meet your Part A deductible.
  Days 6190 (of each benet period): A $408 coinsurance amount each day.
  After day 90 (of each benet period): An $816 coinsurance amount each day 
while using your 60 lifetime reserve days.
After you use all of your lifetime reserve days, you pay all costs.
Part A only pays for up to 190 days of inpatient psychiatric hospital care 
provided in a freestanding psychiatric hospital during your lifetime. 
Note: Hospitals are now required to include the standard charges for all of their 
items and services (including the standard charges negotiated by Medicare 
Advantage Plans) on a public website to help you make more informed decisions 
about your care. 28 SECTION 2: Find out what Medicare covers
Am I an inpatient or outpatient? 
Whether youre an inpatient or an outpatient aects how much you pay for 
hospital services and if you qualify for Part A skilled nursing facility care. 
  Youre an inpatient when the hospital formally admits you with a doctors 
order. 
  Youre an outpatient if youre getting emergency or observation services 
(which may include an overnight stay in the hospital or services in an 
outpatient clinic), lab tests, or X-rays, without a formal inpatient admission 
(even if you spend the night in the hospital). 
Each day you have to stay, you or your caregiver should always ask the 
hospital and/or your doctor, or a hospital social worker or patient advocate, if 
youre an inpatient or outpatient.
Important! Sometimes doctors will keep you as an outpatient for observation services 
while they decide whether to admit you as an inpatient or release (discharge) 
you. If youre under observation more than 24 hours, you must get a 
Medicare Outpatient Observation Notice (also called MOON). This notice 
tells you why youre an outpatient (in a hospital or critical access hospital) 
getting observation services, and how it aects what you pay in the hospital 
and for care after you leave.
Religious non-medical health care institution (inpatient care) 
If you qualify for inpatient hospital or skilled nursing facility care in these 
facilities, Medicare will only cover inpatient, non-religious, non-medical items 
and services, like room and board, and items or services that dont need a 
doctors order or prescription (like unmedicated wound dressings or use of a 
simple walker). Medicare doesnt cover the religious portion of this type of care.
Skilled nursing facility care 
Medicare only covers skilled nursing facility care after a 3-day minimum 
medically necessary inpatient hospital stay* (not including the day you leave 
the hospital) for an illness or injury related to the hospital stay. Medicare covers 
semi-private rooms, meals, skilled nursing and therapy services, and other 
medically necessary services and supplies in a skilled nursing facility.
To qualify for skilled nursing facility care, your doctor must certify that you need 
daily skilled care (like intravenous uids/medications or physical therapy) which, 
as a practical matter, you can only get as a skilled nursing facility inpatient. 
Medicare doesnt cover non-medical long-term care. Go to page 56.
You may get skilled nursing care or therapy if its necessary to improve or 
maintain your current condition. If you disagree with your discharge, you can 
appeal. For example, if youre discharged only because you arent improving, 
but you still require skilled nursing or therapy care to keep your condition from 
getting worse, you can appeal.   SECTION 2: Find out what Medicare covers 29
In each benefit period, you pay: 
  Days 120: $0 copayment. Note: If youre in a Medicare Advantage Plan, you 
may be charged copayments during the rst 20 days.
  Days 21100: $204 copayment each day.
  Days 101 and beyond: You pay all costs.
*Note: You may not need a 3-day minimum inpatient hospital stay if your 
doctor participates in an Accountable Care Organization (ACO), or an entity 
participating in another type of Medicare initiative approved for a Skilled 
Nursing Facility 3-Day Rule Waiver. If your provider participates in an ACO 
(pages 110111), check with them to nd out what benets may be available. 
Medicare Advantage Plans may also waive the 3-day minimum. Contact your 
plan for more information. 
What does Part B cover? 
Medicare Part B (Medical Insurance) helps cover medically necessary doctors 
services, outpatient care, home health services, durable medical equipment, 
mental health services, and other medical services. Part B also covers many 
preventive services. Go to pages 3055 for a list of common Part B-covered 
services and general descriptions. Medicare may cover some services and tests 
more often than the timeframes listed if needed to diagnose or treat a condition. 
To nd out if Medicare covers a service that isnt on this list or for more on 
Part-B covered services, visit
Medicare.gov/coverage. 
Or, call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. 
What do I pay for services Part B covers? 
The list of covered services (in alphabetical order on the following pages) 
gives general information about what you pay if you have Original Medicare
and use doctors or other health care providers who accept assignment (go to 
pages 5960). Youll pay more if you use doctors or providers who dont accept
assignment. If youre in a Medicare Advantage Plan or have other insurance (like 
Medigap, Medicaid, employer, retiree, or union coverage), your copayments,
coinsurance, or deductibles may be dierent. Contact your plan for more 
information.
Under Original Medicare, if the Part B deductible applies, you must pay all 
costs (up to the Medicare-approved amount) until you meet the yearly Part B 
deductible. After you meet your deductible, Medicare will pay its share and you 
typically pay 20% of the Medicare-approved amount (if the doctor or other health 
care provider accepts assignment). Theres no yearly limit on what you pay out of 
pocket if you have Original Medicare. There may be limits on expenses you pay 
through supplemental coverage you may have, like Medigap, Medicaid, employer, 
retiree, or union coverage.
You pay nothing for most covered preventive services if you get the services from 
a doctor or other qualied health care provider who accepts assignment. However, 
for some preventive services, you may have to pay a deductible, coinsurance, or 
both. These costs may also apply if you get a preventive service in the same visit 
as a non-preventive service.  30 SECTION 2: Find out what Medicare covers
Part B-covered services
This apple   is next to the preventive services on pages 3055. 
Preventive service  
Abdominal aortic aneurysm screenings 
Medicare covers an abdominal aortic aneurysm screening ultrasound once if 
youre at risk (only with a referral from your doctor or other qualied health care 
provider). Youre considered at risk if you have a family history of abdominal 
aortic aneurysms, or youre a man 6575 and have smoked at least 100 
cigarettes in your lifetime. You pay nothing for the screening if your doctor or 
other qualied health care provider accepts assignment. 
Acupuncture
Medicare only covers acupuncture (including dry needling) for chronic low back 
pain. Medicare covers up to 12 acupuncture visits in 90 days for chronic low 
back pain dened as:
  Lasting 12 weeks or longer
  Not having an identiable cause (for example, not an identiable disease like 
cancer that has spread, or an infectious or inammatory disease) 
  Pain that isnt associated with surgery or pregnancy
Medicare covers an additional 8 sessions if you show improvement. You can 
get a maximum of 20 acupuncture treatments in a 12-month period. The Part B 
deductible and coinsurance apply. If you arent showing improvement, Medicare 
wont cover the 8 additional treatments.
Not all providers can give acupuncture, and Medicare cant pay licensed 
acupuncturists directly for their services. 
Advance care planning 
Medicare covers voluntary advance care planning as part of your yearly 
Wellness visit (go to pages 5455). This is planning for care you would 
get when you need help making decisions for yourself. As part of advance 
care planning, you may choose to complete an advance directive. This is an 
important legal document that records your wishes about medical treatment 
in the future, if you arent able to make decisions about your care. You can talk 
about an advance directive with your health care provider, and they can help 
you ll out the forms, if you prefer. 
Consider carefully who you want to speak for you and what directions you 
want to give. You have the right to carry out your plans as you choose without 
discrimination based on your age or disability. You can update your advance 
directive at any time. You pay nothing if its given as part of the yearly 
Wellness visit, and your doctor or other qualied health care provider accepts 
assignment.  SECTION 2: Find out what Medicare covers 31
Medicare may also cover this service as part of your medical treatment. 
When advance care planning isnt part of your yearly Wellness visit, the 
Part B deductible and coinsurance apply. 
Need help with your advance directive? Visit the Eldercare Locator at 
eldercare.acl.gov to nd help in your community.
Preventive service  
Alcohol misuse screenings & counseling 
Medicare covers an alcohol misuse screening for adults (including pregnant 
individuals) who use alcohol, but dont meet the medical criteria for alcohol 
dependency. If your primary care doctor or other health care provider 
determines youre misusing alcohol, you can get up to 4 brief, face-to-
face counseling sessions per year (if youre competent and alert during 
counseling). You must get counseling in a primary care setting, like a doctors 
office. You pay nothing if your primary care doctor or other health care 
provider accepts assignment. 
Ambulance services 
Medicare covers ground ambulance transportation to a hospital, critical 
access hospital, rural emergency hospital, or skilled nursing facility for 
medically necessary services when traveling in any other vehicle could 
endanger your health. Medicare may pay for emergency ambulance 
transportation in an airplane or helicopter if you need immediate and rapid 
ambulance transport that ground transportation cant provide. 
In some cases, Medicare may pay for limited, medically necessary, 
non-emergency ambulance transportation if you have a written order from 
your doctor stating that ambulance transportation is medically necessary. 
For example, someone with End-Stage Renal Disease (ESRD) may need a 
medically necessary ambulance transport to a facility that provides dialysis. 
Medicare will only cover ambulance services to the nearest appropriate 
medical facility thats able to give you the care you need. 
You pay 20% of the Medicare-approved amount. The Part B deductible 
applies. 
Ambulatory surgical centers 
Medicare covers the facility service fees related to approved surgical 
procedures done in an ambulatory surgical center (outpatient facility that 
performs surgical procedures, and the patient is expected to be released 
within 24 hours). Except for certain preventive services (for which you pay 
nothing if your doctor or other health care provider accepts assignment), you 
pay 20% of the Medicare-approved amount to both the ambulatory surgical 
center and the doctor who treats you. The Part B deductible applies. You 
pay all of the facility service fees for procedures Medicare doesnt cover in 
ambulatory surgical centers.  32 SECTION 2: Find out what Medicare covers
Cost & coverage: To get cost estimates for ambulatory surgical center 
outpatient procedures, visit
Medicare.gov/procedure-price-lookup.
Bariatric surgery
Medicare covers some bariatric surgical procedures, like gastric 
bypass surgery and laparoscopic banding surgery, when you meet 
certain conditions related to morbid obesity. For cost information, visit 
Medicare.gov/coverage/bariatric-surgery.
Behavioral health integration services
If you have a behavioral health condition (like depression, anxiety, or another 
mental health condition), Medicare may pay your provider to help manage 
that condition. Some providers that manage behavioral health conditions may 
oer integrated care services, like the Psychiatric Collaborative Care Model. 
This model is a set of integrated behavioral health services, including care 
management support that may include:
  Care planning for behavioral health conditions
  Ongoing assessment of your condition
  Medication support
  Counseling
  Other treatment your provider recommends
Your health care provider will ask you to sign an agreement for you to get these 
services on a monthly basis. Your Part B deductible and coinsurance will apply 
to the monthly service fee.
Blood 
If the provider gets blood from a blood bank at no charge, you wont have to 
pay for it or replace it. However, youll pay a copayment for the blood processing 
and handling services for each unit of blood you get. The Part B deductible 
applies. If the provider has to buy blood for you, you must either pay the 
provider costs for the first 3 units of blood you get in a calendar year, or you or 
someone else can donate the blood. 
Preventive service  
Bone mass measurements 
This test helps to see if youre at risk for broken bones. Medicare covers it once 
every 24 months (more often if medically necessary) for people who have 
certain medical conditions or meet certain criteria. You pay nothing for this test 
if your doctor or other qualified health care provider accepts assignment.  SECTION 2: Find out what Medicare covers 33
Cardiac rehabilitation 
Medicare covers comprehensive programs that include exercise, education, and 
counseling if youve had at least one of these conditions: 
  A heart attack in the last 12 months 
  Coronary artery bypass surgery 
  Current stable angina pectoris (chest pain) 
  A heart valve repair or replacement 
  A coronary angioplasty (a medical procedure used to open a blocked artery) 
or coronary stenting (a procedure used to keep an artery open) 
  A heart or heart-lung transplant 
  Stable chronic heart failure 
Medicare covers regular and intensive cardiac rehabilitation programs. Medicare 
covers services in a doctors oce or hospital outpatient setting. You pay 20% 
of the Medicare-approved amount if you get the services in a doctors oce, 
and a copayment in a hospital outpatient setting. The Part B deductible applies. 
Preventive service  
Cardiovascular behavioral therapy 
Medicare covers a cardiovascular behavioral therapy visit one time each year 
with your primary care doctor or other qualified primary care practitioner 
in a primary care setting (like a doctors office) to help lower your risk for 
cardiovascular disease. During this visit, your doctor may discuss aspirin use (if 
appropriate), check your blood pressure, and give you tips on eating well. You 
pay nothing if your primary care doctor or other health care provider accepts 
assignment. 
Preventive service  
Cardiovascular disease screenings 
These screenings include blood tests for cholesterol, lipid, and triglyceride levels 
that help detect conditions that may lead to a heart attack or stroke. Medicare 
covers these screening blood tests once every 5 years. You pay nothing for the 
tests if the doctor or other qualified health care provider accepts assignment. 
Preventive service  
Cervical & vaginal cancer screenings 
Medicare covers Pap tests and pelvic exams to check for cervical and vaginal 
cancers. As part of the pelvic exam, Medicare also covers a clinical breast exam 
to check for breast cancer. Medicare covers these screening tests once every 
24 months in most cases. Medicare covers these screening tests once every 
12 months if youre at high risk for cervical or vaginal cancer, or if youre of 
child-bearing age and had an abnormal Pap test in the past 36 months. 
Medicare also covers Human Papillomavirus (HPV) tests (as part of a Pap test) 
once every 5 years if youre 3065 without HPV symptoms. 
You pay nothing for the lab Pap test, the lab HPV with the Pap test, the Pap 
test specimen collection, and pelvic and breast exams if your doctor or other
qualified health care provider accepts assignment.  34 SECTION 2: Find out what Medicare covers
Chemotherapy 
Medicare covers chemotherapy in a doctors oce, freestanding clinic, or 
hospital outpatient setting if you have cancer. You pay a copayment for 
chemotherapy in a hospital outpatient setting. 
You pay 20% of the Medicare-approved amount for chemotherapy in a 
doctors oce or freestanding clinic. The Part B deductible applies. 
For chemotherapy in an inpatient hospital setting covered under Part A, go 
to inpatient hospital care on pages 2728. 
Chiropractic services 
The only service ordered by a chiropractor that Medicare covers is 
manipulation of the spine to correct a subluxation (when the spinal joints fail 
to move properly, but the contact between the joints remains intact). You 
pay 20% of the Medicare-approved amount. The Part B deductible applies. 
Chronic care management services 
If you have 2 or more serious chronic conditions (like arthritis and diabetes) 
that you expect to last at least a year, Medicare may pay for a health care 
providers help to manage those conditions. This includes a comprehensive 
care plan that lists your health problems and goals, other providers, 
medications, community services you have and need, and other health 
information. It also explains the care you need and how it will be coordinated. 
If you agree to get this service, your provider will prepare the care plan for 
you or your caregiver, help you with medication management, provide 24/7 
access for urgent care management needs, give you support when you go 
from one health care setting to another, and help you with other chronic care 
needs. 
You pay a monthly fee, and the Part B deductible and coinsurance apply. If 
you have supplemental insurance, including Medicaid, it may help cover the 
monthly fee. 
New! Chronic pain management and treatment services
Medicare covers monthly services for people living with chronic pain 
(persistent or recurring pain lasting longer than 3 months). Services may 
include pain assessment, medication management, and care coordination 
and planning. The Part B deductible and coinsurance apply.
Clinical research studies 
Clinical research studies test how well dierent types of medical care work 
and if theyre safe, like how well a cancer drug works. Medicare covers some 
costs, like oce visits and tests in certain qualifying clinical research studies. 
You may pay 20% of the Medicare-approved amount, depending on the 
treatment you get. The Part B deductible may apply. 
Note: If youre in a Medicare Advantage Plan, Original Medicare may cover 
some costs along with your Medicare Advantage Plan. Contact your plan for 
details. SECTION 2: Find out what Medicare covers 35
Cognitive assessment & care plan services
When you visit your provider (including your yearly Wellness visit), they may 
perform a cognitive assessment to look for signs of dementia, including Alzheimers 
disease. Signs of cognitive impairment include trouble remembering, learning new 
things, concentrating, managing nances, or making decisions about your everyday 
life. Conditions like depression, anxiety, and delirium can also cause confusion, so 
its important to understand why you may be having symptoms.
Medicare covers a separate visit with a doctor or health care practitioner to do a full 
review of your cognitive function, establish or conrm a diagnosis like dementia or 
Alzheimers disease, and develop a care plan. You can bring someone with you, like 
a spouse, friend, or caregiver, to help provide information and answer questions.
During this visit, the doctor or health care practitioner may:
  Perform an exam, talk with you about your medical history, and review your 
medications.
  Identify your social supports including care that your usual caregiver can 
provide. 
  Create a care plan to help address and manage your symptoms.
  Help you develop or update your advance care plan. Go to pages 3031.
  Refer you to a specialist, if needed.
  Help you understand more about community resources, like rehabilitation 
services, adult day health programs, and support groups. 
The Part B deductible and coinsurance apply.
Preventive service  
Colorectal cancer screenings 
Medicare covers these screenings to help nd precancerous growths or nd cancer 
early, when treatment is most eective. Medicare may cover one or more of these 
screening tests: 
  Barium enema: Medicare covers this test once every 48 months if youre 45 or 
older (or every 24 months if youre high risk) when your doctor uses it instead 
of a exible sigmoidoscopy or screening colonoscopy. You pay 20% of the 
Medicare-approved amount for your doctors services. In a hospital outpatient 
setting, you also pay the hospital a copayment. The Part B deductible doesnt 
apply. 
Visit Medicare.gov/coverage/barium-enemas for more information.
  Screening Colonoscopies: Medicare covers this screening test once every 
120 months (or every 24 months if youre high risk) or 48 months after a previous 
exible sigmoidoscopy. Theres no minimum age requirement. If you initially have 
a non-invasive stool-based screening test (fecal occult blood tests or multi-target 
stool DNA test) and receive a positive result, Medicare also covers a follow-up 
colonoscopy as a screening test. You pay nothing for the screening test(s) if your 
doctor or other qualied health care practitioner accepts assignment. 
  Flexible sigmoidoscopies: Medicare covers this test once every 48 months if 
youre 45 or older, or 120 months after a previous screening colonoscopy if you 
arent at high risk. You pay nothing for the test if your doctor or other qualied 
health care practitioner accepts assignment.  36 SECTION 2: Find out what Medicare covers
If your doctor nds and removes a polyp or other tissue during 
the colonoscopy or exible sigmoidoscopy, you pay 15% of the 
Medicare-approved amount for your doctors services. In a hospital 
outpatient setting, you also pay the hospital a 15% coinsurance. The Part B 
deductible doesnt apply. 
  Fecal occult blood tests: Medicare covers this screening test once every 
12 months if youre 45 or older. You pay nothing for the test if your doctor 
or other qualied health care practitioner accepts assignment. 
  Multi-target stool DNA & blood-based biomarker tests: Medicare 
covers these screening tests once every 3 years if you meet all of these 
conditions: 
Youre between 4585. 
You show no symptoms of colorectal disease including, but not limited 
to, lower gastrointestinal pain, blood in stool, a positive guaiac fecal 
occult blood test or fecal immunochemical test.
Youre at average risk for developing colorectal cancer, meaning: 
  You have no personal history of adenomatous polyps, colorectal 
cancer, or inammatory bowel disease, including Crohns Disease and 
ulcerative colitis. 
  You have no family history of colorectal cancer or adenomatous 
polyps, familial adenomatous polyposis, or hereditary nonpolyposis 
colorectal cancer. 
Multi-target stool DNA tests are at-home lab tests. Blood-based biomarker 
tests are conducted in a lab. You pay nothing for these tests if your doctor 
or other qualied health care practitioner accepts assignment. 
Continuous Positive Airway Pressure (CPAP) devices, 
accessories, & therapy 
Medicare may cover a 3-month trial of CPAP therapy (including devices and 
accessories) if youve been diagnosed with obstructive sleep apnea. After 
the trial period, Medicare may continue to cover CPAP therapy, devices 
and accessories if you meet with your doctor in person, and your doctor 
documents in your medical record that you meet certain conditions and the 
therapy is helping you. 
You pay 20% of the Medicare-approved amount for the machine rental and 
purchase of related supplies (like masks and tubing). The Part B deductible 
applies. Medicare pays the supplier to rent the machine for 13 months if 
youve been using it without interruption. After youve rented the machine for 
13 months, you own it. 
Note: Medicare may cover a rental or replacement CPAP machine and/or 
CPAP accessories if you had a CPAP machine before you got Medicare, and 
you meet certain requirements. 
Preventive service  
Counseling to prevent tobacco use & tobacco-caused disease
Medicare covers up to 8 face-to-face visits in a 12-month period if you use 
tobacco. You pay nothing for the counseling sessions if your doctor or other 
qualified health practitioner accepts assignment.  SECTION 2: Find out what Medicare covers 37
COVID-19 (Coronavirus disease 2019) 
Many people with Medicare are at higher risk for serious COVID-19 illness, so its 
important to take the necessary steps to keep yourself and others safe.
Medicare covers several tests, items, and services related to COVID-19. Talk with 
your doctor or health care provider to nd out which are right for you:
Preventive service 
COVID-19 Vaccines: 
  FDA-approved and FDA-authorized vaccines help reduce the risk of illness 
from COVID-19 by working with the bodys natural defenses to safely develop 
immunity (protection) against the virus.
  You pay nothing for the COVID-19 vaccine.
  Be sure to bring your red, white, and blue Medicare card with you when you 
get the vaccine so your health care provider or pharmacy can bill Medicare. 
If youre in a Medicare Advantage Plan, you must use the card from your 
plan to get your Medicare-covered services and, like other covered services, 
your plan may require that you get the vaccine from an in-network provider. 
If youre in a Medicare Advantage Plan, you pay nothing when you get the 
vaccine from an in-network provider.
Diagnostic laboratory tests: 
  These FDA-authorized tests check to see if you have COVID-19.
  You pay nothing when a health care provider orders this test and the test is 
performed by a laboratory (including at a pharmacy, clinic or doctors oce), 
or hospital that takes Medicare. If youre in a Medicare Advantage Plan, you 
pay nothing when you get this test from an in-network provider.
Monoclonal antibody treatments and products:
  These FDA-authorized treatments can help ght the disease and keep you out 
of the hospital, if you test positive for COVID-19 and have mild to moderate 
symptoms. 
  You pay nothing for this treatment when you get it from a Medicare provider 
or supplier. You must meet certain conditions to qualify. If youre in a 
Medicare Advantage Plan, you pay nothing when you get these treatments 
from an in-network provider.
  Original Medicare will cover monoclonal antibody treatments if you have 
COVID-19 symptoms. 
Note: Certain monoclonal antibody products can protect you before youre 
exposed to COVID-19. If you have Part B and your doctor decides this type 
of product could work for you (like if you have a weakened immune system), 
you pay nothing for the product when you get it from a Medicare provider or 
supplier.
Get more information 
  Learn more about these covered services at Medicare.gov/medicare-
coronavirus. 
  For more on COVID-19, visit CDC.gov/coronavirus. 38 SECTION 2: Find out what Medicare covers
Defibrillators 
Medicare may cover an implantable automatic debrillator if youve been 
diagnosed with heart failure. If the surgery takes place in an outpatient 
setting, you pay 20% of the Medicare-approved amount for your doctors 
services. You also pay a copayment. In most cases, the copayment cant 
be more than the Part A hospital stay deductible. The Part B deductible 
applies. Part A covers surgeries to implant debrillators in an inpatient 
hospital setting. Go to inpatient hospital care on pages 2728.
Preventive service  
Depression screening 
Medicare covers one depression screening per year. The screening must 
be done in a primary care setting (like a doctors oce) that can provide 
follow-up treatment and/or referrals. You pay nothing for this screening if 
your doctor accepts assignment. 
If you or someone you know is struggling or in crisis and would like to talk to 
a trained crisis counselor, call or text 988, the free and condential Suicide 
& Crisis Lifeline. You can also connect with a counselor through web chat at 
988lifeline.org.
Preventive service  
Diabetes screenings 
Medicare covers up to 2 blood glucose (blood sugar) laboratory test 
screenings (with and without a carbohydrate challenge) each year if your 
doctor determines youre at risk for developing diabetes. You pay nothing 
for the test if your doctor or other qualied health care practitioner accepts 
assignment. 
Preventive service  
Diabetes self-management training 
Medicare covers diabetes outpatient self-management training to teach you 
to cope with and manage your diabetes. The program may include tips for 
eating healthy, being active, monitoring blood glucose (blood sugar), taking 
prescription drugs, and reducing risks. You must have been diagnosed with 
diabetes and have a written order from your doctor or other health care 
provider. Some patients may also be eligible for medical nutrition therapy 
services (go to page 46). You pay 20% of the Medicare-approved amount. 
The Part B deductible applies.  SECTION 2: Find out what Medicare covers 39
Diabetes equipment, supplies, & therapeutic shoes
Medicare covers meters and continuous glucose monitors that measure 
blood glucose (blood sugar) and related supplies, including test strips, 
lancets, lancet holders, sensors, and control solutions. Medicare also covers 
tubing, insertion sets, and insulin for patients using insulin pumps, and 
sensors, transmitters, and receivers for patients using continuous glucose 
monitors. In addition, Medicare covers one pair of extra-depth or custom 
shoes and inserts per year for people with specic diabetes-related foot 
problems. 
You pay 20% of the Medicare-approved amount if your supplier accepts 
assignment. The Part B deductible applies. 
Important! Medicare drug coverage (Part D) may cover insulin, certain medical 
supplies used to inject insulin (like syringes), disposable pumps, and some 
oral diabetes drugs. Check with your plan for more information. The cost 
of a one-month supply of each covered insulin product is capped at $35. 
Go to page 88. (Similar caps on costs apply for traditional insulin used in 
insulin pumps covered under Part B).
Doctor & other health care provider services 
Medicare covers medically necessary doctor services (including 
outpatient services and some inpatient hospital doctor services) and most 
preventive services. Medicare also covers services you get from other 
health care providers, like physician assistants, nurse practitioners, clinical 
nurse specialists, clinical social workers, physical therapists, occupational 
therapists, speech-language pathologists, and clinical psychologists. 
Except for certain preventive services (for which you may pay nothing if 
your doctor or other provider accepts assignment), you pay 20% of the 
Medicare-approved amount for most services. The Part B deductible applies. 
Important! If you havent received services from your doctor or group practice in the 
last 3 years, they may consider you a new patient. Check with the doctor 
or group practice to nd out if theyre accepting new patients.
Drugs 
Part B covers a limited number of outpatient prescription drugs, like: 
  Injections you get in a doctors oce
  Certain oral anti-cancer drugs
  Drugs used with some types of durable medical equipment (like a 
nebulizer or external infusion pump)
  Intravenous Immune Globulin for use in the home 
  Certain drugs you get in a hospital outpatient setting (under very limited 
circumstances) 
Note: Other than the examples above, you pay 100% for most drugs, unless 
you have Medicare drug coverage (Part D) or other drug coverage. Go to 
pages 7990 for more information about Medicare drug coverage. 40 SECTION 2: Find out what Medicare covers
For some drugs used with an external infusion pump, and for Intravenous 
Immune Globulin for use in the home, Medicare may also cover services (like 
nursing visits) under the home infusion therapy benet and the Intravenous 
Immune Globulin benet (go to page 44). Part B also covers some injectable 
or implantable drugs to treat substance use disorder when a provider 
administers it in a doctors oce or a hospital as an outpatient. You pay 20% 
of the Medicare-approved amount for these drugs. The Part B deductible 
applies. You wont have to pay any copayments for these services if you get 
them from a Medicare-enrolled opioid treatment program (go to page 47). 
Doctors and pharmacies must accept assignment for Part B-covered 
drugs, so you should never be asked to pay more than the coinsurance or 
copayment for the Part B drug itself. 
Important! Your coinsurance can change depending on your prescription drugs 
price. You might pay a lower coinsurance for certain drugs and biologicals 
covered by Part B that you get in a doctors oce or pharmacy, or in a 
hospital outpatient setting, if their prices have increased higher than the 
rate of ination. The specic drugs and potential savings change every 
quarter.
If the Part B-covered drugs you get in a hospital outpatient setting are part 
of your outpatient services, you pay a copayment for the services. Part B 
doesnt cover "self-administered drugs" in a hospital outpatient setting. 
"Self-administered drugs" are drugs youd normally take on your own.
What you pay for self-administered drugs in an outpatient hospital setting 
depends on whether you have Medicare drug coverage (Part D) or other 
drug coverage, and whether the hospitals pharmacy is in your drug plans 
network. If you have other drug coverage, your drug plan may cover drugs 
that Part B may not cover. Contact your drug plan to nd out what you pay 
for drugs you get in a hospital outpatient setting that Part B doesnt cover. 
Durable medical equipment (DME)
Medicare covers medically necessary items like oxygen and oxygen 
equipment, wheelchairs, walkers, and hospital beds when a Medicare-enrolled 
doctor or other health care provider orders for use in the home. You must 
rent most items, but you can also buy them. Some items become your 
property after youve made a number of rental payments. You pay 20% of 
the Medicare-approved amount. The Part B deductible applies. 
Make sure your doctors and DME suppliers are enrolled in Medicare. Its 
important to ask your suppliers if they participate in Medicare before you get 
DME. If suppliers are participating suppliers, they must accept assignment 
(which means, they can charge you only the coinsurance and Part B 
deductible for the Medicare-approved amount). If DME suppliers arent 
participating and dont accept assignment, theres no limit on the amount 
they can charge you.  SECTION 2: Find out what Medicare covers 41
Electrocardiogram (EKG or ECG) screenings 
Medicare covers a routine EKG/ECG screening if you get a referral from your 
doctor or other health care provider during your one-time Welcome to 
Medicare visit (go to page 54). After you meet the Part B deductible, you 
pay 20% of the Medicare-approved amount. Medicare also covers EKGs or 
ECGs as diagnostic tests (go to page 52). You also pay a copayment if you 
have the test at a hospital or a hospital-owned clinic. 
Emergency department services 
Medicare covers these services when you have an injury, a sudden illness, 
or an illness that quickly gets much worse. You pay a copayment for each 
emergency department visit and 20% of the Medicare-approved amount for 
doctors services. The Part B deductible applies. If your doctor admits you to 
the same hospital as an inpatient, your costs may be dierent.
E-visits
Medicare covers E-visits to allow you to talk with your provider using an 
online patient portal without going to the providers oce. Providers who 
can give these services include doctors, nurse practitioners, clinical nurse 
specialists, physician assistants, physical therapists, occupational therapists, 
speech-language pathologists, licensed clinical social workers (in specic 
circumstances), and clinical psychologists (in specic circumstances).
To get an E-visit, you must request one with your doctor or other provider. 
You pay 20% of the Medicare-approved amount for your doctors or other 
providers services. The Part B deductible applies.
Eyeglasses 
Medicare covers one pair of eyeglasses with standard frames (or one set 
of contact lenses) after each cataract surgery that implants an intraocular 
lens. Medicare will only pay for contact lenses or eyeglasses from a 
supplier enrolled in Medicare, no matter if you or your provider submits 
the claim. After you meet the Part B deductible, you pay 20% of the 
Medicare-approved amount for corrective lenses after cataract surgery with 
an intraocular lens.
Federally Qualified Health Center services 
Federally Qualied Health Centers provide many outpatient primary care 
and preventive health services. Theres no deductible, and you usually pay 
20% of the charges or the Medicare-approved amount. You pay nothing for 
most preventive services. All Federally Qualied Health Centers may oer 
discounts if your income is limited. Visit findahealthcenter.hrsa.gov to nd a 
health center near you. 
Note: You can get covered telehealth services at Federally Qualied Health 
Centers through December 31, 2024. Go to page 51. 42 SECTION 2: Find out what Medicare covers
Preventive service  
Flu shots 
Medicare covers the seasonal u shot (or vaccine). You pay nothing (and 
the Part B deductible doesnt apply) for the u shot if the doctor or other 
qualied health care provider accepts assignment for giving the shot.
Foot care 
Medicare covers yearly foot exams or treatment if you have diabetes-related 
lower leg nerve damage that can increase the risk of limb loss or 
need medically necessary treatment for foot injuries or diseases, like 
hammer toe, bunion deformities, and heel spurs. You pay 20% of the 
Medicare-approved amount for medically necessary treatment your doctor 
approves. The Part B deductible applies. You also pay a copayment for 
medically necessary treatment in a hospital outpatient setting. 
Preventive service  
Glaucoma screenings 
Medicare covers this screening once every 12 months if youre at high risk for 
the eye disease glaucoma. Youre at high risk if you have diabetes, a family 
history of glaucoma, are African American and 50 or older, or are Hispanic 
and 65 or older. An eye doctor whos legally allowed to do glaucoma 
screenings in your state must do or supervise the screening. You pay 20% of 
the Medicare-approved amount. The Part B deductible applies. You also pay 
a copayment in a hospital outpatient setting. 
Hearing & balance exams 
Medicare covers these diagnostic exams if your doctor or health care 
provider orders them to see if you need medical treatment. 
You can visit an audiologist once every 12 months without an order from 
a doctor or other health care provider, but only for non-acute hearing 
conditions (like hearing loss that occurs over many years) and for diagnostic 
services related to hearing loss thats treated with surgically implanted 
hearing devices. 
You pay 20% of the Medicare-approved amount. The Part B deductible 
applies. You also pay a copayment in a hospital outpatient setting.
Note: Medicare doesnt cover hearing aids or exams for tting hearing aids. 
Preventive service  
Hepatitis B shots 
Medicare covers these shots (or vaccines) if youre at medium or high risk 
for Hepatitis B. Some risk factors include hemophilia, End-Stage Renal 
Disease (ESRD), diabetes, if you live with someone who has Hepatitis B, or 
if youre a health care worker and have frequent contact with blood or body 
uids. Check with your doctor to nd out if youre at medium or high risk 
for Hepatitis B. You pay nothing for the shot if the doctor or other qualied 
health care provider accepts assignment.  SECTION 2: Find out what Medicare covers 43
Preventive service  
Hepatitis B Virus infection screenings 
Medicare covers Hepatitis B Virus infection screenings only if your doctor 
orders it. Medicare also covers the screenings: 
  Yearly, only if youre at continued high risk and dont get a Hepatitis B 
shot. 
  If youre pregnant: 
At the rst prenatal visit for each pregnancy
At the time of delivery for those with new or continued risk factors
At the rst prenatal visit for future pregnancies, even if you previously 
got the Hepatitis B shot or had negative Hepatitis B Virus screening 
results
You pay nothing for the screening test if the doctor or health care 
practitioner accepts assignment.
Preventive service  
Hepatitis C screenings 
Medicare covers one Hepatitis C screening test if you meet one of these 
conditions: 
  Youre at high risk because you use or have used illicit injection drugs. 
  You had a blood transfusion before 1992. 
  You were born between 19451965. 
Medicare also covers yearly repeat screenings if youre at high risk. 
Medicare will only cover a Hepatitis C screening test if your health care 
provider orders one. You pay nothing for the screening test if your 
primary care doctor or other qualied health care provider accepts 
assignment. 
Preventive service  
HIV (Human Immunodeficiency Virus) screenings 
Medicare covers HIV screenings once every 12 months if youre: 
  Between 1565. 
  Younger than 15 or older than 65, and at increased risk. 
Medicare also covers this test up to 3 times during a pregnancy. 
You pay nothing for the HIV screening if your doctor or other qualied health 
care provider accepts assignment.  44 SECTION 2: Find out what Medicare covers
Home health services 
Medicare covers home health services under Part A and/or Part B. Medicare 
covers medically necessary part-time or intermittent skilled nursing care, 
physical therapy, speech-language pathology services, or continued 
occupational therapy services. Home health services may also include 
medical social services, part-time or intermittent home health aide services, 
durable medical equipment, and medical supplies for use at home. Part-time 
or intermittent means you may be able to get skilled nursing care and 
home health aide services if they are provided less than 8 hours each day 
or less than 28 hours each week (or up to 35 hours a week in some limited 
situations). A doctor, or other health care provider (like a nurse practitioner), 
must assess you face-to-face before certifying that you need home health 
services. A doctor or health care provider must order your care, and a 
Medicare-certied home health agency must provide it. 
Medicare covers home health services as long as you need part-time or 
intermittent skilled services and as long as youre homebound, which 
means: 
  You have trouble leaving your home without help (like using a cane, 
wheelchair, walker, or crutches; special transportation; or help from 
another person) because of an illness or injury.
  Leaving your home isnt recommended because of your condition.
  Youre normally unable to leave your home because its a major eort.
You pay nothing for covered home health services. However, for 
Medicare-covered durable medical equipment, you pay 20% of the 
Medicare-approved amount. The Part B deductible applies. 
Home infusion therapy services & supplies
Medicare covers equipment and supplies (like pumps, IV poles, tubing, 
and catheters) for home infusion therapy to administer certain IV infusion 
drugs, like Intravenous Immune Globulin, at home. Medicare covers certain 
equipment and supplies (like the infusion pump) and the infusion drug under 
Durable Medical Equipment (go to page 40). Medicare also covers services 
(like nursing visits), training for caregivers, and patient monitoring. You 
pay 20% of the Medicare-approved amount for these services and for the 
equipment and supplies you use in your home.
Kidney (renal) dialysis services & supplies
Generally, Medicare covers 3 dialysis treatments (or equivalent 
continuous ambulatory peritoneal dialysis) per week if you have 
End-Stage Renal Disease (ESRD). This includes most renal dialysis drugs and 
biological products, and all laboratory tests, home dialysis training, support 
services, equipment, and supplies. The dialysis facility is responsible for 
coordinating your dialysis services (at home or in a facility). You pay 20% of 
the Medicare-approved amount. The Part B deductible applies.  SECTION 2: Find out what Medicare covers 45
Kidney disease education 
Medicare covers up to 6 sessions of kidney disease education services if you 
have Stage IV chronic kidney disease that will usually require dialysis or a 
kidney transplant, and your doctor or other health care provider refers you for 
the service. You pay 20% of the Medicare-approved amount per session if you 
get the service from a doctor or other qualified health care provider. The Part B 
deductible applies. 
Laboratory tests 
Medicare covers medically necessary clinical diagnostic laboratory tests when 
your doctor or provider orders them. These tests may include certain blood 
tests, urinalysis, certain tests on tissue specimens, and some screening tests. 
You generally pay nothing for these tests.
Preventive service  
Lung cancer screenings 
Medicare covers lung cancer screenings with low dose computed tomography 
once per year if you meet these conditions: 
  Youre 5077. 
  You dont have signs or symptoms of lung cancer (youre asymptomatic). 
  Youre either a current smoker or you quit smoking within the last 15 years. 
  You have a tobacco smoking history of at least 20 pack years 
(an average of one pack20 cigarettesper day for 20 years). 
  You get an order from your doctor. 
You pay nothing for this service if your doctor accepts assignment. 
Before your rst lung cancer screening, youll need to schedule an appointment 
with a health care provider to discuss the benets and risks of lung cancer 
screening to decide if the screening is right for you. 
New! Lymphedema compression treatment items 
If youve been diagnosed with lymphedema, Medicare will cover your 
prescribed gradient compression garments (standard and custom tted). You 
pay 20% of the Medicare-approved amount. The Part B deductible applies.
Preventive service  
Mammograms 
Medicare covers a mammogram screening to check for breast cancer once 
every 12 months if youre a woman 40 or older. Medicare covers one baseline 
mammogram if youre a woman between 3539. You pay nothing for the test if 
the doctor or other qualied health care provider accepts assignment. 
Part B also covers diagnostic mammograms more frequently than once a year 
when medically necessary. You pay 20% of the Medicare-approved amount for 
diagnostic mammograms. The Part B deductible applies.
Note: Medicare covers medically necessary breast ultrasounds only when your 
doctor or provider orders them.    46 SECTION 2: Find out what Medicare covers
Preventive service  
Medical nutrition therapy services 
Medicare covers medical nutrition therapy services if you have diabetes or kidney 
disease, or if youve had a kidney transplant in the last 36 months and a doctor 
refers you for services. Only a Registered Dietitian or nutrition professional who 
meets certain requirements can provide medical nutrition therapy services. If you 
have diabetes, you may also be eligible for diabetes self-management training 
(go to page 38). You pay nothing for medical nutrition therapy preventive 
services because the deductible and coinsurance dont apply. 
Preventive service  
Medicare Diabetes Prevention Program
Medicare covers a once-per-lifetime health behavior change program to help you 
prevent type 2 diabetes. The program begins with weekly core sessions oered 
in a group setting over a 6-month period. Once you complete the core sessions, 
youll get 6 monthly follow-up sessions to help you maintain healthy habits. If you 
started the Medicare Diabetes Prevention Program in 2021 or earlier, youll get an 
additional 12 monthly sessions if you meet certain weight loss goals.
You can get these services from an approved Medicare Diabetes Prevention 
Program supplier. These suppliers may be traditional health care providers 
or organizations like community centers or faith-based organizations. To nd 
a supplier or learn more about the program, visit Medicare.gov/coverage/
medicare-diabetes-prevention-program. 
If youre in a Medicare Advantage Plan, contact your plan to nd out where to 
get these services.
Mental health care (outpatient) 
Medicare covers mental health care services to help with conditions 
like depression and anxiety. These visits are often called counseling or 
psychotherapy, and can be done individually, in group psychotherapy or family 
settings, and in crisis situations. Coverage includes services generally provided 
in an outpatient setting (like a doctors or other health care providers oce, 
or hospital outpatient department), including visits with a psychiatrist or other 
doctor, clinical psychologist, clinical nurse specialist, clinical social worker, nurse 
practitioner, or physician assistant. 
New! Medicare covers mental health care services provided by marriage & family 
therapists and mental health counselors. 
Covered mental health care includes partial hospitalization services given 
by a community mental health center or by a hospital to outpatients. Partial 
hospitalization is a structured day program that oers outpatient psychiatric 
services as an alternative to inpatient psychiatric care.
New! Medicare covers intensive outpatient program services provided by hospitals, 
community mental health centers, federally qualied health centers, and Rural 
Health Clinics. 
Partial hospitalization and intensive outpatient services are more rigorous than 
care youd get in a doctors or therapists oce. Visit Medicare.gov/coverage/
mental-health-care-partial-hospitalization to learn more. SECTION 2: Find out what Medicare covers 47
Generally, you pay 20% of the Medicare-approved amount and the Part B 
deductible applies for mental health care services. 
Part A covers inpatient mental health care services you get in a hospital 
(go to page 27). 
Preventive service  
Obesity behavioral therapy 
If you have a body mass index (BMI) of 30 or more, Medicare covers obesity 
screenings and behavioral counseling to help you lose weight by focusing on 
diet and exercise. Medicare covers this counseling if your primary care doctor 
or other primary care practitioner gives the counseling in a primary care 
setting (like a doctors oce), where they can coordinate your personalized 
prevention plan with your other care. You pay nothing for this service if your 
primary care doctor or other provider accepts assignment. 
Occupational therapy services
Medicare covers medically necessary therapy to help you perform activities of 
daily living (like dressing or bathing). This therapy helps to improve or maintain 
current capabilities or slow decline when your doctor or other health care 
provider certies you need it. You pay 20% of the Medicare-approved amount. 
The Part B deductible applies. 
Opioid use disorder treatment services 
Medicare covers opioid use disorder treatment services in opioid treatment 
programs. The services include medication (like methadone, buprenorphine, 
naltrexone, and naloxone), substance use counseling, drug testing, individual 
and group therapy, intake activities, and periodic assessments. Medicare 
covers counseling, therapy services, and periodic assessments both in-person 
and, in certain circumstances, by virtual delivery (using audio and video 
communication technology, like your phone or a computer). Medicare also 
covers services given through opioid treatment program mobile units.
Medicare pays doctors and other providers for oce-based opioid use 
disorder treatment, including management, care coordination, psychotherapy, 
and counseling activities. 
Under Original Medicare, you wont have to pay any copayments for these 
services if you get them from an opioid treatment program provider thats 
enrolled in Medicare and meets other requirements. However, the Part B 
deductible still applies. Talk to your doctor or other health care provider to 
nd out where to go for these services. You can also visit Medicare.gov/
coverage/opioid-use-disorder-treatment-services to nd a program near you.
Medicare Advantage Plans must also cover opioid treatment program 
services, but may require you see an in-network opioid treatment program. 
Since Medicare Advantage Plans can apply copayments to opioid treatment 
program services, check with your plan to nd out if you have to pay a 
copayment. 48 SECTION 2: Find out what Medicare covers
Outpatient hospital services 
Medicare covers many diagnostic and treatment services you get as an 
outpatient from a Medicare-participating hospital. Generally, you pay 20% 
of the Medicare-approved amount for your doctors or other health care 
providers services. You may pay more for services you get in a hospital 
outpatient setting than youll pay for the same care in a doctors oce. 
In addition to the amount you pay the doctor, youll also usually pay the 
hospital a copayment for each service you get in a hospital outpatient setting 
(except for certain preventive services that dont have a copayment). In most 
cases, the copayment cant be more than the Part A hospital stay deductible 
for each service. The Part B deductible applies, except for certain preventive 
services. If you get hospital outpatient services in a critical access hospital, 
your copayment may be higher and may exceed the Part A hospital stay 
deductible. 
Cost & coverage: To get cost estimates for hospital outpatient 
procedures done in hospital outpatient departments, visit 
Medicare.gov/procedure-price-lookup.
Outpatient medical & surgical services & supplies 
Medicare covers approved procedures, like X-rays, casts, stitches, or 
outpatient surgeries. You pay 20% of the Medicare-approved amount for 
doctor or other health care provider services. You generally pay a copayment 
for each service you get in a hospital outpatient setting. In most cases, the 
copayment cant be more than the Part A hospital stay deductible for each 
service you get. The Part B deductible applies, and you pay all costs for 
items or services that Medicare doesnt cover. 
Physical therapy services
Medicare covers evaluation and treatment for injuries and diseases that 
change your ability to function, or to improve or maintain current function or 
slow decline, when your doctor or other health care provider, including a 
nurse practitioner, clinical nurse specialist or physician assistant certies 
you need it. You pay 20% of the Medicare-approved amount. The Part B 
deductible applies. 
Preventive service  
Pneumococcal shots
Medicare covers pneumococcal shots (or vaccines) to help prevent 
pneumococcal infections (like certain types of pneumonia). Talk with your 
doctor or other health care provider about this vaccine. You pay nothing for 
these shots if the provider accepts assignment for giving the shots. SECTION 2: Find out what Medicare covers 49
Principal care management services
Medicare covers disease-specic services to help you manage a single, 
complex chronic condition that puts you at risk of hospitalization, physical 
or cognitive decline, or death. If you have one chronic high-risk condition 
that you expect to last at least 3 months (like cancer and you arent being 
treated for any other complex conditions), Medicare may pay for a health 
care providers help to manage it. Your provider will create a disease-specic 
care plan and continuously monitor and adjust it, including the medicines 
you take. The Part B deductible and coinsurance apply.
Preventive service  
Prostate cancer screenings 
Medicare covers digital rectal exams and prostate specic antigen (PSA) 
tests once every 12 months for men over 50 (starting the day after 
your 50th birthday). For the digital rectal exam, you pay 20% of the 
Medicare-approved amount. The Part B deductible applies. You also pay a 
copayment in a hospital outpatient setting. You pay nothing for the PSA test.
Prosthetic/orthotic items 
Medicare covers these prosthetics/orthotics when a Medicare-enrolled 
doctor or other health care provider orders them: arm, leg, back, and neck 
braces; articial eyes; articial limbs (and their replacement parts); and 
prosthetic devices needed to replace an internal body organ or function 
of the organ (including ostomy supplies, parenteral and enteral nutrition 
therapy, and some types of breast prostheses after a mastectomy). 
For Medicare to cover your prosthetic or orthotic, you must go to a supplier 
thats enrolled in Medicare. You pay 20% of the Medicare-approved amount. 
The Part B deductible applies. 
Pulmonary rehabilitation programs
Medicare covers a comprehensive pulmonary rehabilitation program if you 
have: 
  Moderate to very severe chronic obstructive pulmonary disease (COPD) 
and have a referral from the doctor whos treating it. 
  Had conrmed or suspected COVID-19 and experience persistent 
symptoms that include respiratory dysfunction for at least 4 weeks. 
You pay 20% of the Medicare-approved amount if you get the service in a 
doctors oce. You also pay a copayment per session if you get the service 
in a hospital outpatient setting. The Part B deductible applies. 
Rural Health Clinic services 
Rural Health Clinics provide many outpatient primary care and 
preventive services in rural and underserved areas. Generally, you pay 20% 
of the charges. The Part B deductible applies. You pay nothing for most 
preventive services. 
Note: You can get covered telehealth services at Rural Health Clinics through 
December, 31, 2024. Go to page 51. 50 SECTION 2: Find out what Medicare covers
Second surgical opinions 
Medicare covers a second surgical opinion in some cases for medically 
necessary surgery that isnt an emergency. In some cases, Medicare covers 
third surgical opinions. You pay 20% of the Medicare-approved amount. The 
Part B deductible applies. 
Preventive service  
Sexually transmitted infection (STI) screenings & counseling 
Medicare covers STI screenings for chlamydia, gonorrhea, syphilis, 
and/or Hepatitis B. Medicare covers these screenings if youre pregnant or at 
increased risk for an STI when your primary care doctor or other health care 
provider orders the tests. Medicare covers these tests once every 12 months 
or at certain times during pregnancy. 
Medicare also covers up to 2 individual, 2030 minute, face-to-face, 
high-intensity behavioral counseling sessions each year if youre a sexually 
active adult at increased risk for STIs. Medicare will only cover these 
counseling sessions with a primary care doctor or health care practitioner in a 
primary care setting (like a doctors oce). Medicare wont cover counseling 
as a preventive service in an inpatient setting, like a skilled nursing facility. 
You pay nothing for these services if your primary care doctor or practitioner 
accepts assignment. 
Shots (or vaccines) 
Part B covers: 
  Flu shots. Go to page 42. 
  Hepatitis B shots. Go to page 42.
  Pneumococcal shots. Go to page 48.
  Coronavirus disease 2019 (COVID-19) vaccine. Go to page 37.
Important! Medicare drug coverage (Part D) generally covers all other recommended 
adult immunizations to prevent illness (like shingles, tetanus, diphteria, 
pertussis, and respiratory syncytial virus (RSV)) at no cost to you. If the 
shot isn't on your plan's drug list yet, you can ask for a coverage exception 
or get reimbursed. Contact your plan for details, and talk to your doctor or 
other health care provider about which vaccines are right for you. To learn 
more about other covered vaccines, visit Medicare.gov/coverage. 
Speech-language pathology services 
Medicare covers medically necessary evaluation and treatment to regain and 
strengthen speech and language skills. This includes cognitive and swallowing 
skills, or to improve or maintain current function or slow decline, when your 
doctor or other health care provider certies you need it. You pay 20% of the 
Medicare-approved amount. The Part B deductible applies.  SECTION 2: Find out what Medicare covers 51
Surgical dressing services 
Medicare covers medically necessary treatment of a surgical or surgically 
treated wound. You pay nothing for the supplies and 20% of the 
Medicare-approved amount for your doctor or other health care provider 
services. You pay a set copayment for these services when you get them in a 
hospital outpatient setting. The Part B deductible applies.
Telehealth
Medicare covers certain telehealth services provided by a doctor or other 
health care practitioner whos located elsewhere using audio and video 
communication technology (or audio-only telehealth services in some 
cases), like your phone or a computer. Telehealth can provide many services 
that generally occur in-person, including oce visits, psychotherapy, 
consultations, and certain other medical or health services. 
New! Through December 31, 2024, you can get telehealth services at any location 
in the U.S., including your home. After this period, you must be in an oce or 
medical facility located in a rural area for most telehealth services. However, 
youll still be able to get certain Medicare telehealth services without being 
in a rural health care setting. They include:
  Monthly End-Stage Renal Disease (ESRD) visits for home dialysis.
  Services for diagnosis, evaluation, or treatment of symptoms of an acute 
stroke wherever you are, including in a mobile stroke unit.
  Services to treat a substance use disorder or a co-occurring mental 
health disorder (sometimes called a dual disorder) or for the diagnosis, 
evaluation, or treatment of a mental health disorder, including in your 
home. 
  Behavioral health services, including in your home.
  Diabetes self-management training
  Medical nutrition therapy
You pay 20% of the Medicare-approved amount for your doctor or other 
health care provider or practitioners services. The Part B deductible applies. 
For most of these services, youll pay the same amount you would if you got 
the services in person.
Compare: Medicare Advantage Plans and some providers, like ones 
who are part of certain Medicare Accountable Care Organizations 
(ACOs), may oer more telehealth benets than Original Medicare. 
For example, you may be able to get some services from home, 
no matter where you live. Check with your plan to nd out what 
benets they oer. If your provider participates in an ACO, check 
with them to nd out what telehealth benets may be available. Go to 
pages 110111. 52 SECTION 2: Find out what Medicare covers
Tests (Non-laboratory)
Medicare covers X-rays, MRIs, CT scans, EKG/ECGs, and some other 
diagnostic tests. You pay 20% of the Medicare-approved amount. The Part B 
deductible applies.
If you get the test at a hospital as an outpatient, you also pay the hospital 
a copayment that may be more than 20% of the Medicare-approved 
amount. In most cases, this amount cant be more than the Part A 
hospital stay deductible. Go to Laboratory tests on page 45 for other 
Part B-covered tests. 
Transitional care management services 
Medicare may cover this service if youre returning to your community after 
a stay at certain facilities, like a hospital or skilled nursing facility. The health 
care provider whos managing your transition back into the community will 
work with you and your caregiver to coordinate and manage your care for the 
rst 30 days after you return home. The Part B deductible and coinsurance 
apply. Visit Medicare.gov/coverage/transitional-care-management-services 
to learn more.
Transplants & immunosuppressive drugs 
Medicare covers doctor services for heart, lung, kidney, pancreas, intestine, 
and liver transplants under certain conditions, but only in Medicare-certied 
facilities. Medicare also covers bone marrow and cornea transplants under 
certain conditions. 
Medicare covers immunosuppressive drugs if Medicare paid for the transplant. 
You must have Part A at the time of the covered transplant, and you must 
have Part B at the time you get immunosuppressive drugs (or qualify for 
the immunosuppressive drug benet described below). You pay 20% of the 
Medicare-approved amount for the drugs. The Part B deductible applies. 
Keep in mind, Medicare drug coverage (Part D) covers immunosuppressive 
drugs if Part B doesnt cover them.
If youre thinking about joining a Medicare Advantage Plan and are on a 
transplant waiting list or think you need a transplant, check with the plan 
before you join to make sure your doctors, other health care providers, and 
hospitals are in the plans network. Ask for information about covered drugs 
and their costs. Also, check the plans coverage rules for prior authorization 
and coverage for your living donors. 
Note: Medicare may cover transplant surgery as a hospital inpatient service 
under Part A. Go to pages 2728. 
Medicare pays the full cost of care for your kidney donor. You and your 
donor wont have to pay a deductible, coinsurance, or any other costs for 
their hospital stay. SECTION 2: Find out what Medicare covers 53
Immunosuppressive drug benefit
If you only have Medicare because of End-Stage Renal Disease (ESRD), your 
Medicare coverage (including immunosuppressive drug coverage) ends 36 
months after a successful kidney transplant. Medicare oers a benet that 
helps you pay for your immunosuppressive drugs beyond 36 months if you 
dont have certain types of other health coverage (like a group health 
plan, TRICARE, or Medicaid that covers immunosuppressive drugs). This 
benet only covers your immunosuppressive drugs and no other items 
or services. It isnt a substitute for full health coverage. You can sign up 
for this benet any time after your Medicare Part A coverage ends, as 
long as you had Medicare because of ESRD at the time of your kidney 
transplant. To sign up, call Social Security at 1-877-465-0355. TTY users can 
call 1-800-325-0788. 
Youll pay a monthly premium of $103 (or higher based on your income) and 
$240 deductible for this immunosuppressive drug benet in 2024. Once 
youve met the deductible, youll pay 20% of the Medicare-approved amount 
for immunosuppressive drugs. If you have limited income and resources, 
you may be able to get help from your state to pay for this benet. Go to 
page 94, or visit Medicare.gov/basics/end-stage-renal-disease to learn 
more.
Travel 
Medicare generally doesnt cover health care while youre traveling outside 
the U.S. (the U.S. includes the 50 states, the District of Columbia, Puerto 
Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and 
American Samoa). There are some limited exceptions. Visit Medicare.gov/
coverage/travel-outside-the-u.s. to learn more. 
Medicare may cover medically necessary ambulance transportation to 
a foreign hospital only with admission for medically necessary covered 
inpatient hospital services. You pay 20% of the Medicare-approved amount. 
The Part B deductible applies. 
Urgently needed care 
Medicare covers urgently needed care to treat a sudden illness or injury that 
isnt a medical emergency. You pay 20% of the Medicare-approved amount 
for your doctor or other health care provider services, and a copayment in a 
hospital outpatient setting. The Part B deductible applies. 
Virtual check-ins
Medicare covers virtual check-ins (also called brief communication 
technology-based services) with your doctor or certain other providers, like 
nurse practitioners, clinical nurse specialists, or physician assistants. Virtual 
check-ins use audio and video communication technology, like your phone 
or a computer, without you going to the doctors oce. Your doctor can 
also conduct remote assessments using photo or video images you send for 
review to determine whether you need to go to the doctors oce.
Your doctor or other provider can respond to you by phone, virtual delivery, 
secure text message, email, or patient portal. 54 SECTION 2: Find out what Medicare covers
You can use these services if you have met these conditions:
  You talked to your doctor or other provider about starting these types of 
visits.
  The virtual check-in doesnt relate to a medical visit youve had within the 
past 7 days and doesnt lead to the medical visit within the next 24 hours (or 
the soonest appointment available).
  You verbally consent to the virtual check-in, and your doctor documents 
your consent in your medical record. Your doctor may get one consent for a 
years worth of these services.
Compare: You pay 20% of the Medicare-approved amount for your 
doctor or other health care provider services. The Part B deductible 
applies. Medicare Advantage Plans may oer more virtual check-in 
services than Original Medicare. Check with your plan to nd out what 
they oer.
Preventive service  
Welcome to Medicare preventive visit 
During the rst 12 months that you have Part B, you can get a Welcome to 
Medicare preventive visit. The visit includes a review of your medical and 
social history related to your health. It also includes education and counseling 
about preventive services, including certain screenings, shots or vaccines (like 
u, pneumococcal, and other recommended shots or vaccines), and referrals 
for other care, if needed. 
When you make your appointment, let your doctors oce know that you 
would like to schedule your Welcome to Medicare preventive visit. You pay 
nothing for the Welcome to Medicare preventive visit if the doctor or other 
qualied health care provider accepts assignment. 
If you have a current prescription for opioids, your provider will review your 
potential risk factors for opioid use disorder, evaluate your severity of pain and 
current treatment plan, provide information on non-opioid treatment options, 
and may refer you to a specialist, if appropriate. Your provider will also review 
your potential risk factors for substance use disorder, like alcohol and tobacco 
use, and refer you for treatment, if needed. 
Important! If your doctor or other health care provider performs additional tests 
or services during the same visit that Medicare doesnt cover under this 
preventive benet, you may have to pay coinsurance, and the Part B 
deductible may apply. If Medicare doesnt cover the additional tests or 
services (like a routine physical exam), you may have to pay the full amount.
Preventive service  
Yearly Wellness visit 
If youve had Part B for longer than 12 months, you can get a yearly Wellness 
visit to develop or update your personalized plan to prevent disease or 
disability based on your current health and risk factors. The yearly Wellness 
visit isnt a physical exam. Medicare covers this visit once every 12 months.  SECTION 2: Find out what Medicare covers 55
Your doctor or health care practitioner will ask you to ll out a questionnaire, 
called a Health Risk Assessment, as part of this visit. Answering these 
questions can help you and your doctor develop a personalized prevention 
plan to help you stay healthy and get the most out of your visit. Your visit 
may include: routine measurements, health advice, a review of your medical 
and family history, your current prescriptions, advance care planning and 
more.
Your doctor or health care practitioner will also perform a cognitive 
assessment to look for signs of dementia, including Alzheimers disease. 
Signs of cognitive impairment include trouble remembering, learning new 
things, concentrating, managing nances, and making decisions about 
your everyday life. If your doctor or health care practitioner thinks you may 
have cognitive impairment, Medicare covers a separate visit to do a more 
thorough review of your cognitive function and check for conditions like 
dementia, depression, anxiety, or delirium and design a care plan. Go to 
page 35.
Your doctor or health care practitioner will also evaluate your potential risk 
factors for a substance use disorder and refer you for treatment, if needed. 
If you use opioid medication, your provider will review your pain treatment 
plan, share information about non-opioid treatment options, and refer you to 
a specialist, as appropriate. 
Note: Your rst yearly Wellness visit cant take place within 12 months 
of your Part B enrollment or your Welcome to Medicare preventive visit. 
However, you dont need to have had a Welcome to Medicare preventive 
visit to qualify for a yearly Wellness visit. 
You pay nothing for the yearly Wellness visit if the doctor or health care 
practitioner accepts assignment. 
Important! If your doctor or health care practitioner performs additional tests or 
services during your Wellness visit that Medicare doesnt cover under 
this preventive benet, you may have to pay a coinsurance, and the 
Part B deductible may apply. If Medicare doesnt cover the additional 
tests or services (like a routine physical exam), you may have to pay the 
full amount.
What ISN'T covered by Part A and Part B?
Medicare doesnt cover everything. If you need certain services Part A or 
Part B doesnt cover, youll have to pay for them yourself unless: 
  You have other coverage (including Medicaid) to cover the costs. 
  Youre in a Medicare Advantage Plan or Medicare Cost Plan that covers 
these services. Medicare Advantage Plans and Medicare Cost Plans may 
cover some extra benets, like tness programs and vision, hearing, and 
dental services. 
Some of the items and services that Original Medicare doesnt cover include: 
 Eye exams (for prescription eyeglasses) 
 Long-term care  56 SECTION 2: Find out what Medicare covers
 Cosmetic surgery 
 Massage therapy
 Routine physical exams
 Hearing aids and exams for tting them 
 Concierge care (also called concierge medicine, retainer-based medicine, 
boutique medicine, platinum practice, or direct care)
 Covered items or services you get from an opt-out doctor (go to page 60) 
or other provider (except in the case of an emergency or urgent need)
 Most dental care: In most cases, Original Medicare doesn't cover dental 
services like routine cleanings, llings, tooth extractions, or items like 
dentures. However, in some cases, Original Medicare may pay for some 
dental services related to specic medical procedures like: 
  A heart valve repair or replacement
  An organ transplant
  Cancer-related treatments
Paying for long-term care
Medicare and most health insurance, including Medicare Supplement 
Insurance (Medigap), dont pay for long-term care. This type of care 
(sometimes called long-term services and supports) includes medical and 
non-medical care for people who have a chronic illness or disability. This 
includes personal care assistance, like help with everyday activities, including 
dressing, bathing and using the bathroom. Long-term care may also include 
home-delivered meals, adult day health care, home and community-based 
services and others. You may be eligible for this care through Medicaid, or 
you can choose to buy private long-term care insurance. 
You can get long-term care at home, in the community, in an assisted living 
facility, or in a nursing home. Its important to start planning for long-term 
care now to maintain your independence and to make sure you get the care 
you may need, in the setting you want, now and in the future. 
Long-term care resources
Use these resources to get more information about long-term care: 
  Visit longtermcare.acl.gov to learn more about planning for long-term care. 
  Call your State Insurance Department to get information about long-term 
care insurance. Call 1-800-MEDICARE (1-800-633-4227) to get the phone
number. TTY users can call 1-877-486-2048. 
  Call your State Medical Assistance (Medicaid) oce or visit Medicaid.gov 
and ask for information about long-term care coverage.
 Get a copy of A Shoppers Guide to Long-Term Care Insurance from the
National Association of Insurance Commissioners at content.naic.org/sites/
default/files/publication-ltc-lp-shoppers-guide-long-term.pdf.
 Visit the Eldercare Locator at eldercare.acl.gov, or call 1-800-677-1116 to
nd help in your community.
  Call your State Health Insurance Assistance Program (SHIP). Go to 
pages 115118 for the phone number of your local SHIP. 57
SECTION 3  
Original Medicare
How does Original Medicare work? 
Original Medicare is one of your Medicare health coverage choices. Youll 
have Original Medicare unless you choose a Medicare Advantage Plan or
other type of Medicare health plan. Original Medicare includes two parts: 
Part A (Hospital Insurance) and Part B (Medical Insurance).
You generally have to pay a portion of the cost for each service Original 
Medicare covers. Theres no limit to what youll pay out of pocket in a year 
unless you have other coverage (like Medigap, Medicaid, employer, retiree, 
or union coverage) or join a Medicare Advantage Plan instead of Original 
Medicare.
Original Medicare 
Can I get my health care  In most cases, yes. You can go to any 
from any doctor, other  Medicare-enrolled doctor, other health 
health care provider, or  care provider, hospital, or other facility that 
hospital?  accepts Medicare patients anywhere in the 
U.S. Visit Medicare.gov/care-compare to 
nd and compare providers, hospitals, and 
facilities in your area.
Does it cover prescription  No, with a few exceptions (go to pages 26
drugs?  27, 44, 47, and 52), Original Medicare doesnt 
cover most drugs. You can add Medicare 
drug coverage (Part D) by joining a separate 
Medicare drug plan. Go to pages 7990.
Do I need to choose a  No. 
primary care doctor? 
Do I have to get a referral  In most cases, no. 
to use a specialist? 
Should I get a  You may already have Medicaid, or employer, 
supplemental policy?  retiree, or union coverage that may pay costs 
that Original Medicare doesnt. If not, you 
may want to buy a Medicare Supplement 
Insurance (Medigap) policy if youre eligible. 
Go to pages 7578. You can also check with 
your State Medical Assistance (Medicaid) 
oce to see if youre eligible for Medicaid.
 Note: Go to pages 119122 for definitions of blue words.  58 SECTION 3: Original Medicare
What else do I need to    You generally pay a set amount for your 
know about Original  health care (deductible) before Medicare 
Medicare?  begins to pay its share. Once Medicare 
pays its share, you pay a coinsurance 
or copayment for covered services and 
supplies. Theres no yearly limit for what 
you pay out of pocket unless you have 
other insurance (like Medigap, Medicaid, or 
employer, retiree, or union coverage). 
  You usually pay a monthly premium for 
Part B, which may change each year. 
  You generally dont need to le Medicare 
claims. Providers and suppliers must le 
your claims for the covered services and 
supplies you get. 
What do I pay? 
Your out-of-pocket costs in Original Medicare depend on: 
  Whether you have Part A and/or Part B. Most people have both. 
  Whether your doctor, other health care provider, or supplier accepts 
assignment. Go to pages 5960.
  The type of health care you need and how often you need it. 
  If you choose to get services or supplies Medicare doesnt cover. If so, you 
pay all costs unless you have other insurance that covers them. 
  Whether you have other health insurance that works with Medicare. Go to 
page 21.
  Whether you have full Medicaid or get help from your state to pay your 
Medicare costs through a Medicare Savings Program. Go to pages 9192.
  Whether you have Medicare Supplement Insurance (Medigap). 
  Whether you and your doctor or other health care provider sign a private 
contract. Go to page 60.  SECTION 3: Original Medicare 5599
How do I know what Medicare paid? 
If you have Original Medicare, youll get a Medicare Summary Notice (MSN) 
that lists all the services billed to Medicare. You can sign up to get this Notice 
electronically every month (review below) or a Medicare contractor will mail it 
to you every 3 months. Its not a bill. The MSN shows what Medicare paid and 
what you may owe the provider. Review your MSNs to be sure you got all the 
services, supplies, or equipment listed. If you disagree with Medicares decision 
not to pay for (cover) a service, the MSN will tell you how to appeal. Go to page 
99 for information on how to le an appeal.
If you need to change your address on your MSN, call Social Security at 
1-800-772-1213. TTY users can call 1-800-325-0778. If you get Railroad 
Retirement Board (RRB) benets, call the RRB at 1-877-772-5772. TTY users 
can call 1-312-751-4701. 
Your MSN will tell you if youre enrolled in the Qualied Medicare Beneciary 
(QMB) program. If youre in the QMB program, Medicare providers arent 
allowed to bill you for Medicare Part A and/or Part B deductibles, coinsurance, 
or copayments. In some cases, you may be billed a small copayment through 
Medicaid, if one applies. For more information about QMB and steps to take if a 
provider bills you for these costs, go to page 91.
Important! Get your Medicare Summary Notices electronically 
Sign up to get your Medicare Summary Notices, (also called eMSNs) 
electronically. Visit Medicare.gov to log into (or create) your secure Medicare 
account. If you sign up for eMSNs, well send you an email each month 
when theyre available in your Medicare account. The eMSNs have the same 
information as paper MSNs. You wont get printed copies in the mail if you 
choose eMSNs, but you can choose to print them yourself at home. As 
of mid-2023, people who signed up for eMSNs helped save the Medicare 
Program close to $30 million. 
You have options in how you get your Medicare claims information. You 
can access your claims in your account on Medicare.gov and share this 
information with doctors, pharmacies, and others using a Blue Button 
app of your choice. A growing number of computer and mobile apps are 
connected to Medicare through Blue Button 2.0. If you agree to share your 
information with one of these apps, it can show you the details of the claims 
that Medicare has paid on your behalf. Go to page 109 for more information.
Whats assignment?
Assignment means that your doctor, provider, or supplier agrees (or is required 
by law) to accept the Medicare-approved amount as full payment for covered
services. 
If your doctor, provider, or supplier accepts assignment: 
  Your out-of-pocket costs may be less. 
  They agree to charge you only the Medicare deductible and coinsurance 
amount and usually wait for Medicare to pay its share before asking you to 
pay your share. 
  They have to submit your claim directly to Medicare and cant charge you for 
submitting the claim.  60 SECTION 3: Original Medicare
Some providers havent agreed and arent required by law to accept 
assignment for all Medicare-covered services, but they can still choose to 
accept assignment for individual services. The providers who havent agreed 
to accept assignment for all services are called non-participating. You might 
have to pay more for their services if they dont accept assignment for the 
care they provide to you. Heres what happens if your doctor, provider, or 
supplier doesnt accept assignment: 
  You might have to pay the entire charge at the time of service. Your 
doctor, provider, or supplier is supposed to submit a claim to Medicare 
for any Medicare-covered services they provide to you. If they dont 
submit the Medicare claim once you ask them to, call 1-800-MEDICARE 
(1-800-633-4227). TTY users can call 1-877-486-2048.
  They can charge you more than the Medicare-approved amount. In many 
cases, the charge cant be more than an amount called the limiting 
charge. 
If you have Original Medicare, you can use any provider you want that takes 
Medicare, anywhere in the U.S.
Compare: If youre in a Medicare Advantage Plan, in most cases, youll 
need to use doctors and other providers who are in the plans network. 
To nd out if someone accepts assignment or participates in Medicare, visit
Medicare.gov/care-compare.
To nd out if a medical equipment supplier accepts assignment, visit 
Medicare.gov/medical-equipment-suppliers.
You can also call your State Health Insurance Assistance Program (SHIP) to 
get free help with these topics. Go to pages 115118 for the phone number of 
your local SHIP.
What if I want to use a provider who opts out of Medicare? 
Certain doctors and other health care providers who dont want to work with 
the Medicare Program may opt out of Medicare. Medicare doesnt pay for any 
covered items or services you get from an opt-out doctor or other provider, 
except in the case of an emergency or urgent need. If you still want to use an 
opt-out provider, you and your provider can set up payment terms that you both 
agree to through a private contract. 
A doctor or other provider who chooses to opt out must do so for 2 years, 
which automatically renews every 2 years unless the provider requests not to 
renew their opt-out status. You can still get care from these providers, but they 
must enter into a private contract with you (unless youre in need of emergency 
or urgently needed care).
If youre unsure if a provider has opted out of Medicare, check with them so 
youll know ahead of time if youll need to pay out of pocket for your care.
 Go to pages 1014 for an overview of your Medicare options. 61
SECTION 4  
Medicare Advantage 
Plans & other options
What are Medicare Advantage Plans?
A Medicare Advantage Plan is another way to get your Medicare Part A 
and Part B coverage. Medicare Advantage Plans, sometimes called Part C 
or MA Plans, are Medicare-approved plans oered by private companies  
that must follow rules set by Medicare. Most Medicare Advantage Plans 
include drug coverage (Part D). In many cases, youll need to use health 
care providers who participate in the plans network. These plans set a limit 
on what youll have to pay out-of-pocket each year for covered services. 
Some plans oer non-emergency coverage out of network, but typically at 
a higher cost. In many cases, you may need to get approval, also called prior 
authorization, from your plan before it covers certain drugs or services. 
Remember, you must use the card from your Medicare Advantage Plan to 
get your Medicare-covered services. Keep your red, white, and blue Medicare 
card in a safe place because you might need it later. 
If you join a Medicare Advantage Plan, youll still have Medicare but youll 
get most of your Part A and Part B coverage from your Medicare Advantage 
Plan, not Original Medicare. 
What are the different types of Medicare Advantage Plans? 
  Health Maintenance Organization (HMO) Plan: Go to page 66. 
  HMO Point-of-Service (HMOPOS) Plan: This HMO plan may allow you to 
get some services out of network for a higher copayment or coinsurance. 
Go to page 66.
  Medical Savings Account (MSA) Plans: Go to page 67.
  Preferred Provider Organization (PPO) Plan: Go to page 68. 
  Private Fee-for-Service (PFFS) Plan: Go to page 69. 
 Special Needs Plan (SNP): Go to page 70.
What do Medicare Advantage Plans cover? 
Medicare Advantage Plans provide all of your Part A and Part B benets, 
except for certain costs of clinical trials (clinical research studies), hospice 
care, the cost of getting a kidney transplant (like expenses for a living kidney 
donor), and, for a temporary time, some new benets that come from 
legislation or national coverage determinations. Contact your plan if you have 
questions about covered services.
 Note: Go to pages 119122 for definitions of blue words.  62 SECTION 4: Medicare Advantage Plans & other options
Plans may offer some extra benefits
With a Medicare Advantage Plan, you may have coverage for things Original 
Medicare doesnt cover, like tness programs (gym memberships or discounts) 
and some vision, hearing, and dental services (like routine check ups or 
cleanings). Plans can also choose to cover even more benets. For example, 
some plans may oer coverage for services like transportation to doctor 
visits, over-the-counter drugs that Part D doesnt cover, and other health care 
services. Check with the plan before you join to nd out what benets it oers, 
and if there are any limitations.
Plans can also tailor their benet packages to oer additional benets 
to certain chronically-ill enrollees. These packages will provide benets 
customized to treat specic conditions. Although you can check with a 
Medicare Advantage Plan before you join to nd out if they oer these benet 
packages, youll need to wait until you join the plan to nd out if you qualify. 
Get the most out of your dental benefits
If youre in a Medicare Advantage Plan, take charge of your oral health, and 
contact your plan to learn more about dental services that it may cover and 
what limitations may apply. 
Medicare Advantage Plans must follow Medicares rules
Medicare pays a xed amount for your coverage each month to the companies 
oering Medicare Advantage Plans. These companies must follow rules set
by Medicare. However, each Medicare Advantage Plan can charge dierent 
out-of-pocket costs and have dierent rules for how you get services (like
whether you need a referral to use a specialist or if you have to go to doctors, 
facilities, or suppliers that belong to the plans network for non-emergency or
non-urgent care). These rules can change each year. The plan must notify you 
about any changes before the start of the next enrollment year.
Remember, you have the option each year to keep your current plan, choose 
a dierent plan, or switch to Original Medicare. Go to page 71. 
Providers can join or leave a plans provider network any time during the year. 
Your plan can also change the providers in the network any time during the 
year. If this happens, you usually wont be able to change plans but you can 
choose a new provider. You generally cant change plans during the year.
New! Even though the network of providers may change during the year, the plan 
must still give you access to qualied doctors and specialists. Your plan will 
notify you that your provider is leaving your plan so you have time to choose a 
new one. Youll get this notice if its a primary care or behavioral health provider 
and you have gone to that provider in the past three years. If any of your other 
providers leave your plan, youll get this notice in certain situations. 
Your plan will also: 
  Help you choose a new provider to continue managing your health care 
needs.
  Help you continue needed care thats already in progress.
  Notify you about the dierent enrollment periods available to you and 
options you may have for changing plans. SECTION 4: Medicare Advantage Plans & other options 63
Read your notices carefully so youre aware of any changes and can change 
plans if you arent satised, either during Open Enrollment or a Special 
Enrollment Period, if you qualify.
When an in-network provider or benet isnt available or cant meet your 
medical needs, most plans will help you get any medically necessary care 
outside the provider network (at the in-network cost sharing).  
Compare: If you have Original Medicare, you dont need a referral to 
use a specialist in most cases (go to page 57). You can also use any 
provider you want that takes Medicare, anywhere in the U.S.
Important! Read the information you get from your plan 
If youre in a Medicare Advantage Plan, review the Annual Notice of 
Change and Evidence of Coverage from your plan each year:
  Annual Notice of Change: Includes any changes in coverage, costs, and 
more that will be eective starting in January. Your plan will send you a 
printed copy by September 30.
  Evidence of Coverage: Gives you details about what the plan covers, 
how much you pay, and more in the next year. Your plan will send you 
a notice (or printed copy) by October 15, which will include information 
on how to access the Evidence of Coverage electronically or request a 
printed copy.
If you decide to join a Medicare Advantage Plan, consider signing up for 
an electronic version of the Medicare & You handbook at Medicare.gov/
go-digital. Youll get cost and coverage information from your plan. If 
you dont get these important documents, contact your plan.
What should I know about Medicare Advantage Plans? 
Who can join?
To join a Medicare Advantage Plan you must: 
  Have Part A and Part B. 
  Live in the plans service area. 
  Be a U.S. citizen or lawfully present in the U.S.
Joining and leaving 
  You can join a Medicare Advantage Plan even if you have a pre-existing 
condition. 
  You can join or drop a Medicare Advantage Plan only at certain times 
during the year. Go to pages 7172. 
  Each year, Medicare Advantage Plans can choose to leave Medicare or 
make changes in coverage, costs, service area, and more. If the plan 
decides to stop participating in Medicare, youll have to join another 
Medicare Advantage Plan or return to Original Medicare. Go to page 98. 
  Medicare Advantage Plans must follow certain rules when giving you 
information about how to join their plan. Go to pages 105106 for 
more information about these rules and how to protect your personal 
information.  64 SECTION 4: Medicare Advantage Plans & other options
What if I have End-Stage Renal Disease (ESRD)? 
If you have ESRD, you can choose either Original Medicare or a Medicare 
Advantage Plan when deciding how to get Medicare coverage. If youre only 
eligible for Medicare because you have ESRD and you get a kidney transplant, 
your Medicare benets will end 36 months after the transplant. Go to page 53 
for more information about continuing coverage for immunosuppressive drugs.
Medicare drug coverage (Part D) 
Most Medicare Advantage Plans include Medicare drug coverage (Part D). In 
certain types of plans that dont include Medicare drug coverage (like Medical 
Savings Account (MSA) Plans and some Private Fee-for-Service (PFFS) Plans), 
you can join a separate Medicare drug plan. However, if you join a Health 
Maintenance Organization Plan or Preferred Provider Organization Plan which 
doesnt cover drugs, you cant join a separate Medicare drug plan. 
In this case, youll either need to use other prescription drug coverage you have 
(like employer or retiree coverage), or go without drug coverage. If you decide 
not to get Medicare drug coverage when youre rst eligible and your other 
drug coverage isnt creditable prescription drug coverage, you may have to pay 
a late enrollment penalty (go to pages 8384) if you join a Part D plan later.
What if I have other coverage? 
Talk to your employer, union, or other benets administrator about their rules 
before you join a Medicare Advantage Plan. In some cases, joining a Medicare 
Advantage Plan might cause you to lose your employer or union coverage for 
yourself, your spouse, and your dependents, and you may not be able to get it 
back. In other cases, if you join a Medicare Advantage Plan, you may still be able 
to use your employer or union coverage along with the Medicare Advantage 
Plan you join. Your employer or union may also oer a Medicare Advantage 
retiree health plan that they sponsor. You can only be in one Medicare 
Advantage Plan at a time.
What if I have Medicare Supplement Insurance (Medigap)? 
You cant buy Medigap while youre in a Medicare Advantage Plan. You cant 
use Medigap to pay for any costs (copayments, deductibles, and premiums) you 
have with a Medicare Advantage Plan. 
Important! If you already have Medigap and join a Medicare Advantage Plan, you may 
want to drop Medigap. Keep in mind, if you drop Medigap to join a Medicare 
Advantage Plan, you may not be able to get it back depending on your 
states Medigap enrollment rules and your situation. Go to page 78. 
What do I pay? 
Your out-of-pocket costs in a Medicare Advantage Plan depend on: 
  Whether the plan charges a monthly premium. Some Medicare Advantage 
Plans have a $0 premium (but you still may pay the Part B premium). If you 
join a plan that does charge a premium, you pay this in addition to the Part B 
premium (and the Part A premium if you dont have premium-free Part A). 
  Whether the plan pays any of your monthly Part B premiums. Some Medicare 
Advantage Plans will help pay all or part of your Part B premium. This is 
sometimes called a Medicare Part B premium reduction. SECTION 4: Medicare Advantage Plans & other options 65
  Whether the plan has a yearly deductible or any additional deductibles for 
certain services. 
  How much you pay for each visit or service (copayments or 
coinsurance). Medicare Advantage Plans cant charge more than 
Original Medicare for certain services, like chemotherapy, dialysis, and 
skilled nursing facility care. 
  The type of health care services you need and how often you get them. 
  Whether you get services from a network provider or a provider that 
doesnt contract with the plan. If you go to a doctor, other health care 
provider, facility, or supplier that doesnt belong to the plans network for 
non-emergency or non-urgent care services, your plan may not cover your 
services, or your costs could be higher.
  Whether you go to a doctor or supplier who accepts assignment (if youre 
in a Preferred Provider Organization Plan, Private Fee-for-Service Plan, or 
Medical Savings Account (MSA) Plan and you go out of network). Go to 
pages 5960 for more information about assignment. 
  Whether the plan oers extra benets (in addition to Original Medicare 
benets) and if you need to pay extra to get them. 
  The plans yearly limit on your out-of-pocket costs for all Part A and 
Part B-covered services. Once you reach this limit, youll pay nothing for 
Part A and Part B-covered services. 
  Whether you have Medicaid or get help from your state through a 
Medicare Savings Program. Go to pages 9192. 
To learn more about your costs in a specic Medicare Advantage Plan, 
contact the plan or visit Medicare.gov/plan-compare.
How do I find out if my plan covers a service, drug, or supply?
You or your provider can get a decision, either orally or in writing, from your 
plan in advance to nd out if it covers a service, drug, or supply. You can 
also nd out how much youll have to pay. This is called an organization 
determination. Sometimes you have to do this as prior authorization for 
your plan to cover the service, drug, or supply. Go to page 101.
You, your representative, or your doctor can request this organization 
determination. The requested organization determination can be either 
oral or written. Based on your health needs, you, your representative, or 
your doctor can ask for a fast decision on your organization determination 
request. If your plan denies coverage, the plan must tell you in writing, and 
you have the right to appeal. Go to pages 97100. 
If a plan provider refers you for a covered service or to a provider outside 
the network, but doesnt get an organization determination in advance, this 
is called plan directed care. In most cases, you wont have to pay more 
than the plans usual cost sharing. Check with your plan for more information 
about this protection. 66 SECTION 4: Medicare Advantage Plans & other options
Types of Medicare Advantage Plans
Health Maintenance Organization (HMO) Plan 
Can I get my health care from any doctor, other health care provider, or 
hospital? 
No. You generally must get your care and services from doctors, other health 
care providers, or hospitals in the plans network (except for emergency care,
out-of-area urgent care, or temporary out-of-area dialysis, which is covered 
whether its provided in the plans network or outside the plans network). 
However, some HMO plans, known as HMO Point-of-Service (HMOPOS) 
plans, oer an out-of-network benet for some or all covered benets for a 
higher copayment or coinsurance. 
Do these plans cover prescription drugs? 
In most cases, yes. If youre planning to enroll in an HMO and you want 
Medicare drug coverage (Part D), you must join an HMO plan that oers 
Medicare drug coverage. If you join an HMO plan without drug coverage, you 
cant join a separate Medicare drug plan.
Do I need to choose a primary care doctor? 
In most cases, yes. 
Do I have to get a referral to use a specialist? 
In most cases, yes. Certain services, like yearly screening mammograms, 
dont require a referral. 
What else do I need to know about this type of plan? 
 If you get non-emergency health care outside the plans network without
authorization, you may have to pay the full cost. 
  Its important that you follow the plans rules, like getting prior approval 
for a certain service when needed.
 Visit Medicare.gov or check with the plan for more information. SECTION 4: Medicare Advantage Plans & other options 67
Medical Savings Account (MSA) Plan
Can I get my health care from any doctor, other health care provider, or 
hospital?
Yes. MSA plans usually dont have a network of doctors, other health care 
providers, or hospitals. 
Do these plans cover prescription drugs?
No. If you join a Medicare MSA Plan and want Medicare drug coverage 
(Part D), youll have to join a separate Medicare drug plan. 
Do I need to choose a primary care doctor?
No.
Do I have to get a referral to use a specialist?
No.
What else do I need to know about this type of plan?
The plan deposits money into a special savings account for you to use to 
pay health care expenses. The amount of the deposit varies by plan. You can 
use this money to pay your Medicare-covered costs before you meet the 
deductible. Money left in your account at the end of the year stays there. If 
you keep your plan the following year, your plan will add any new deposits to 
the amount left over. 
  MSA plans dont charge a premium, but you must continue to pay your 
Part B premium. 
  The plan will only begin to cover your Part A and Part B costs once you 
meet a high yearly deductible, which varies by plan.
  Some plans may cover some extra benets, like vision, hearing, and dental 
services. You may pay a premium for this extra coverage. 
  Visit Medicare.gov or check with the plan for more information. 68 SECTION 4: Medicare Advantage Plans & other options
Preferred Provider Organization (PPO) Plan 
Can I get my health care from any doctor, other health care provider, or 
hospital? 
Yes. PPO plans have network doctors, specialists, hospitals, and other health 
care providers you can use. You can also use out-of-network providers for 
covered services, usually for a higher cost, if the provider agrees to treat you 
and hasnt opted out of Medicare (for Medicare Part A and Part B items and 
services). Youre always covered for emergency and urgent care.
Do these plans cover prescription drugs? 
In most cases, yes. If youre planning to enroll in a PPO and you want 
Medicare drug coverage (Part D), you must join a PPO plan that oers 
Medicare drug coverage. If you join a PPO plan without drug coverage, you 
cant join a separate Medicare drug plan.
Do I need to choose a primary care doctor? 
No. 
Do I have to get a referral to use a specialist? 
In most cases, no. But if you use plan specialists (in network), your costs for 
covered services will usually be lower than if you use non-plan specialists 
(out of network).
What else do I need to know about this type of plan? 
  Because certain providers are preferred, you can save money by using 
them. 
  Visit Medicare.gov or check with the plan for more information. SECTION 4: Medicare Advantage Plans & other options 69
Private Fee-for-Service (PFFS) Plan 
Can I get my health care from any doctor, other health care provider, or 
hospital? 
Yes. You can go to any Medicare-approved doctor, other health care 
provider, or hospital that accepts the plans payment terms, agrees to treat 
you, and hasnt opted out of Medicare (for Medicare Part A and Part B items 
and services). If you join a Private Fee-for-Service Plan that has a network, 
you can also use any of the network providers who have agreed to always 
treat plan members. If you choose an out-of-network doctor, hospital, or 
other provider who accepts the plans terms, you may pay more. 
Do these plans cover prescription drugs? 
Sometimes. If your PFFS Plan doesnt oer Medicare drug coverage, you can 
join a separate Medicare drug plan to get Medicare drug coverage (Part D). 
Do I need to choose a primary care doctor? 
No. 
Do I have to get a referral to use a specialist? 
No. 
What else do I need to know about this type of plan? 
  The plan decides how much you pay for services. The plan will tell you 
about your cost sharing in the Annual Notice of Change and Evidence 
of Coverage documents that it sends each year.
  Some PFFS Plans contract with a network of providers who agree to 
always treat you, even if youve never used them before.
  Out-of-network doctors, hospitals, and other providers may decide not to 
treat you, even if youve used them before. 
  In a medical emergency, doctors, hospitals, and other providers must treat 
you. 
  For each service you get, make sure to show your plan member card 
before you get treated. 
  Visit Medicare.gov or check with the plan for more information. 70 SECTION 4: Medicare Advantage Plans & other options
Special Needs Plan (SNP) 
A SNP provides benets and services to people with specic diseases, 
certain health care needs, or who also have Medicaid coverage. SNPs include 
care coordination services and tailor their benets, provider choices, and 
list of drugs (formularies) to best meet the specic needs of the groups they 
serve.
Can I get my health care from any doctor, other health care provider, or 
hospital? 
Some SNPs cover services out of network and some dont. Check with the 
plan to nd out if they cover services out of network, and if so, how it aects 
your costs. 
Do these plans cover prescription drugs? 
Yes. All SNPs must provide Medicare drug coverage (Part D). 
Do I need to choose a primary care doctor? 
Some SNPs require primary care doctors and some dont. Check with the 
plan to nd out if you need to choose a primary care doctor. 
Do I have to get a referral to use a specialist? 
Some SNPs require referrals and some dont. Certain services, like yearly 
screening mammograms, dont require a referral. Check with the plan to nd 
out if you need a referral. 
What else do I need to know about this type of plan? 
  These groups are eligible to enroll in a SNP:
People who live in certain institutions (like nursing homes) or who live 
in the community but require nursing care at home (also called an 
Institutional SNP or I-SNP). 
People who are eligible for both Medicare and Medicaid (also called 
a Dual Eligible SNP or D-SNP). D-SNPs contract with your state 
Medicaid program to help coordinate your Medicare and Medicaid 
benets. Some D-SNPs may provide Medicaid services in addition to 
Medicare services. Call your State Medical Assistance (Medicaid) oce 
to verify your Medicaid eligibility.
People who have specic severe or disabling chronic conditions (like 
diabetes, End-Stage Renal Disease (ESRD), HIV/AIDS, chronic heart 
failure, or dementia) (also called a Chronic condition SNP or C-SNP). 
Plans may further limit membership to a single chronic condition or a 
group of related chronic conditions. 
  To nd and compare SNPs or other Medicare Advantage Plans in your 
area, visit: 
Medicare.gov/plan-compare.
Filter your search results by Special Needs Plans to nd out if a SNP is 
available in your area. Check with the plan for more information. SECTION 4: Medicare Advantage Plans & other options 71
You can join, switch, drop, or make changes to your
Medicare Advantage Plan
Initial  When you  When you rst become eligible for Medicare, 
Enrollment  rst become  you can join a Medicare Advantage Plan. 
eligible for  If you joined a Medicare Advantage Plan 
Period 
Medicare  during your Initial Enrollment Period, you 
Go to page 17.
can switch to another Medicare Advantage 
Plan (with or without drug coverage) or go 
back to Original Medicare (with or without a 
separate Medicare drug plan) within the rst 
3 months you have Medicare.
General  January 1 to   If you have Part A coverage and you get 
Enrollment  March 31 Part B for the rst time during this period, 
you can also join a Medicare Advantage 
Period 
Plan. 
Go to page 18.
Your coverage starts the rst day of the 
month after you sign up.
Remember, you must have both Part A and 
Part B to join a Medicare Advantage Plan.
Open  October 15 to   You can join, switch, or drop a Medicare 
Enrollment  December 7 Advantage Plan during the Open Enrollment 
Period each year. 
Period
Your coverage starts on January 1 (as long 
as the plan gets your enrollment request by 
December 7).
If you join a Medicare Advantage Plan 
during this period but change your mind, 
you can switch back to Original Medicare or 
change to a dierent Medicare Advantage 
Plan (depending on which coverage 
works better for you) during the Medicare 
Advantage Open Enrollment Period 
(January 1  March 31) described on the 
next page. 72 SECTION 4: Medicare Advantage Plans & other options
Medicare  January 1 to  If youre in a Medicare Advantage Plan 
Advantage  March 31 (with or without drug coverage), during this 
period you can:
Open 
Note: You can 
  Switch to another Medicare Advantage 
Enrollment 
only switch 
Plan (with or without drug coverage).
Period plans once 
  Drop your Medicare Advantage Plan and 
during this 
return to Original Medicare. Youll also 
period. 
be able to join a separate Medicare drug 
Coverage  plan.
starts the rst 
During this period, you cant:
of the month 
  Switch from Original Medicare to a 
after the plan 
Medicare Advantage Plan.
gets your 
request.   Join a separate Medicare drug plan if you 
have Original Medicare.
  Switch from one Medicare drug plan to 
another if you have Original Medicare.
You can only make one change during this 
period, and any changes you make will be 
eective the rst of the month after the 
plan gets your request. If youre returning 
to Original Medicare and joining a separate 
Medicare drug plan, you dont need to 
contact your Medicare Advantage Plan to 
disenroll. The disenrollment will happen 
automatically when you join the drug plan.
Special  Qualifying  In most cases, if you join a Medicare 
Enrollment  Life Event Advantage Plan, you must keep it for 
the calendar year starting the date your 
Period
coverage begins. However, in certain 
Go to page 17.
situations, like if you move or you lose other 
insurance coverage, you may be able to join, 
switch, or drop a Medicare Advantage Plan 
during a Special Enrollment Period. Go to 
page 80.
5-star Special  December 8  Medicare uses ratings from 15 stars to help 
Enrollment  to November  you compare plans based on quality and 
30 the  performance. 
Period
following year
If a Medicare Advantage Plan, Medicare 
Note: You can  drug plan, or Medicare Cost Plan with a 
only switch  5-star quality rating is available in your area, 
plans once  you can use the 5-star Special Enrollment 
during this  Period to switch from your current 
period. Medicare plan to a Medicare plan with a 
5-star quality rating.
Visit Medicare.gov for more information. SECTION 4: Medicare Advantage Plans & other options 73
Important! If you drop your Medicare Supplement Insurance (Medigap) policy to join 
a Medicare Advantage Plan, you may not get the same policy back. Also, 
if you dont drop your Medicare Advantage Plan and return to Original 
Medicare within 12 months of joining, you may be limited in your ability to 
get a Medigap policy when you return to Original Medicare. Go to page 78.
Does Medicare offer other types of plans or programs to 
get health coverage?
Yes, Medicare may oer some other plans and programs in your area. Some 
provide both Part A (Hospital Insurance) and Part B (Medical Insurance) 
coverage, while others provide only Part B coverage. Some also provide 
Medicare drug coverage (Part D). They have some (but not all) of the same 
rules as Medicare Advantage Plans. However, each has special rules and 
exceptions, so you should contact any plans youre interested in to get more 
details. 
Cost Plans 
Cost Plans are a type of Medicare health plan available in certain, limited areas 
of the country.
  In general, you can join even if you only have Part B. 
  If you have Part A and Part B and go to a non-network provider, Original 
Medicare covers the services. Youll pay the Part A and Part B coinsurance 
and deductibles. 
  You can join any time the Cost Plan is accepting new members. 
  You can leave any time and return to Original Medicare. 
  You can join a separate Medicare drug plan, or you can get Medicare drug 
coverage (Part D) from the Cost Plan (if oered). You can choose to get 
a separate Medicare drug plan even if the Cost Plan oers Medicare drug 
coverage. You can only add or drop drug coverage at certain times (go to 
pages 8081).
To nd out if there are Cost Plans in your area, visit Medicare.gov/plan-
compare. You can contact the plan youre interested in for more information. 
Your State Health Insurance Assistance Program (SHIP) can also help you. Go 
to pages 115118 for the phone number of your local SHIP. A trusted agent or 
broker may also be able to help. 74 SECTION 4: Medicare Advantage Plans & other options
Program of All-inclusive Care for the Elderly (PACE) 
PACE is a Medicare and Medicaid program oered in many states that allows 
people who otherwise need a nursing home-level of care to remain in the 
community, like a home, apartment, or other appropriate setting. To qualify 
for PACE, you must meet these conditions: 
  Youre 55 or older. 
  You live in the service area of a PACE organization. 
  Youre certied by your state as needing a nursing home-level of care. 
  At the time you join, youre able to live safely in the community with the 
help of PACE services. 
PACE covers all Medicare- and Medicaid-covered care and services, and 
other services that the PACE team of health care professionals decides are 
necessary to improve and maintain your health. This includes drugs, as well 
as any other medically necessary care, like doctor or health care provider 
visits, transportation, home care, hospital visits, and even nursing home stays 
when necessary. 
If you have Medicaid, you wont have to pay a monthly premium for the 
long-term care portion of the PACE benet. If you have Medicare but not 
Medicaid, youll be charged a monthly premium to cover the long-term care 
portion of the PACE benet and a premium for Medicare drug coverage 
(Part D). However, in PACE, theres never a deductible or copayment for 
any drug, service, or care that the PACE team of health care professionals 
approves. 
Visit Medicare.gov/pace to nd out if theres a PACE organization that serves 
your community. 
Medicare Innovation Projects 
Medicare develops innovative models, demonstrations, and pilot projects 
to test and measure the eect of potential changes in Medicare. These 
projects help to nd new ways to improve health care quality and reduce 
costs, and sometimes oer you extra benets and services. Usually, 
they operate only for a limited time and for a specic group of people 
and/or are oered only in specic areas. Examples of current models, 
demonstrations, and pilot projects include innovations in primary care, care 
related to specic procedures (like hip and knee replacements), cancer care, 
skilled nursing facility care or rehabilitation care, and care for people with 
chronic kidney disease and End-Stage Renal Disease (ESRD). Medicare also 
explores innovations through Accountable Care Organizations (ACOs).
Ask your doctor if they participate in these models, and what it means for 
your care. To learn more about the current Medicare models, demonstrations, 
and pilot projects, call 1-800-MEDICARE (1-800-633-4227). TTY users can 
call 1-877-486-2048.
 Go to pages 1014 for an overview of your Medicare options. 75
SECTION 5  
Medicare Supplement 
Insurance (Medigap) 
How does Medigap work?
Original Medicare doesnt pay all of the cost for covered health care services 
and supplies. Medicare Supplement Insurance (Medigap) policies sold by 
private insurance companies can help pay some of the remaining health care 
costs for covered services and supplies, like copayments, coinsurance, and 
deductibles. 
Some Medigap policies also oer coverage for services that Original 
Medicare doesnt cover, like medical care when you travel outside the U.S. 
Generally, Medigap doesnt cover long-term care (like care in a nursing 
home), vision or dental services, hearing aids, eyeglasses, or private-duty 
nursing.
Medigap plans are standardized 
Medigap must follow federal and state laws designed to protect you, 
and they must be clearly identied as Medicare Supplement Insurance. 
Insurance companies can sell you only a standardized plan, identied 
in most states as plans AD, F, G, and KN. All plans oer the same basic 
benets, no matter where you live or which insurance company you buy the 
policy from. Some oer additional benets. Compare the benets of each 
lettered plan to help you nd one that meets your needs. In Massachusetts, 
Minnesota, and Wisconsin, Medigap plans are standardized in a dierent way. 
For more information or to nd Medigap policies in your area, visit
Medicare.gov/medigap-supplemental-insurance-plans. 
 
You can also visit Medicare.gov/publications to review the booklet, 
Choosing a Medigap Policy: A Guide to Health Insurance for People with 
Medicare.
Important! Medigap plans sold to people who are new to Medicare on or after 
January 1, 2020 arent allowed to cover the Part B deductible. Because of 
this, Plans C and F are no longer available to people new to Medicare on 
or after January 1, 2020. However, if you were eligible for Medicare before 
January 1, 2020, but haven't yet enrolled, you may be able to buy Plan C or 
Plan F. People new to Medicare on or after January 1, 2020, have the right 
to buy Plans D and G instead of Plans C and F.
 Note: Go to pages 119122 for definitions of blue words.  76 SECTION 5: Medicare Supplement Insurance (Medigap) 
How do I compare Medigap plans?
The chart below shows basic information about the dierent benets 
that Medicare Supplement Insurance (Medigap) plans cover for 2024. If a 
percentage appears, the Medigap plan covers that percentage of the benet, 
and youre responsible for the rest. 
Medigap plans
Benefits A B C D F* G* K L M N
Medicare Part A   100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
coinsurance and 
hospital costs (up 
to an additional 365 
days after Medicare 
benets are used) 
Medicare Part B   100% 100% 100% 100% 100% 100% 50% 75% 100% 100%***
coinsurance or 
copayment 
Blood (rst 3 pints)  100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
Part A hospice care  100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
coinsurance or 
copayment 
Skilled nursing facility  100% 100% 100% 100% 50% 75% 100% 100%
care coinsurance 
Part A deductible  100% 100% 100% 100% 100% 50% 75% 50% 100%
Part B deductible  100% 100%
Part B excess charges  100% 100%
Foreign travel  80% 80% 80% 80% 80% 80%
emergency (up to plan 
limits) 
Out-of-pocket 
limit in 2024**
$7,060 $3,530
  * Plans F and G also oer a high-deductible plan in some states. With this option, you 
must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up 
to the deductible amount of $2,800 in 2024 before your policy pays anything. (You 
cant buy Plans C and F if you were new to Medicare on or after January 1, 2020. Go to 
page 75 for more information.)
 ** For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly 
Part B deductible ($240 in 2024), the Medigap plan pays 100% of covered services for 
the rest of the calendar year. 
 ***Plan N pays 100% of the Part B coinsurance. You must pay a copayment of up to $20 
for some oce visits and up to a $50 copayment for emergency room visits that dont 
result in an inpatient admission.  SECTION 5: Medicare Supplement Insurance (Medigap)  77
What else should I know about Medigap? 
Before you can buy Medicare Supplement Insurance (Medigap), you must 
generally have Part A and Part B. With Medigap, you pay a monthly premium 
to a private insurance company in addition to the monthly Part B premium 
you pay to Medicare. If you're thinking about buying Medigap, be sure to 
compare plans. The costs can vary between plans oered by dierent 
companies for exactly the same coverage, and may go up as you get older. 
Some states limit Medigap premium costs. A Medigap policy only covers 
one person. Spouses must buy separate coverage. 
Can I buy Medigap and a separate Medicare drug plan from the same 
company? 
Yes. But you may need to make 2 separate premium payments. Contact the 
company to nd out how to pay your premiums. 
Can I have drug coverage in both Medigap and my Medicare drug plan?
No. Go to page 89 for more information.
Note: In some states, you may be able to buy another type of Medigap policy 
called Medicare SELECT. Medicare SELECT is a type of Medigap policy sold 
in some states that requires you to use hospitals and, in some cases, doctors 
within its network to be eligible for full insurance benets (except in an 
emergency). If you buy Medicare SELECT, you have rights to change your 
mind within 12 months and switch to standard Medigap.
When's the best time to buy a Medigap policy? 
  The best time to buy a Medigap policy is during your Medigap Open 
Enrollment Period. This 6-month period begins the rst month you have 
Medicare Part B (Medical Insurance), and youre 65 or older. (Some 
states have additional Open Enrollment Periods.) After this enrollment 
period, you may not be able to buy a Medigap policy or it may cost 
more. In certain situations, you may have rights to buy a Medigap policy 
(guaranteed issue rights) outside of your Medigap Open Enrollment 
Period. 
  If you delay signing up for Part B because you have group health coverage 
based on your (or your spouses) current employment, your Medigap Open 
Enrollment Period wont start until you sign up for Part B. 
  Federal law generally doesnt require insurance companies to sell Medigap 
to people under 65. If youre under 65, you might not be able to buy the
policy you want, or any policy, until you turn 65. However, some states 
require Medigap insurance companies to sell Medigap policies to people 
under 65. If youre able to buy one, it may cost more.
Call your State Health Insurance Assistance Program (SHIP) (go to 
pages 115118 for the phone number of your local SHIP), or your State 
Insurance Department to learn more about your rights to buy a Medigap 
policy. A trusted agent or broker may also be able to help. 78 SECTION 5: Medicare Supplement Insurance (Medigap) 
Can I have Medigap and a Medicare Advantage Plan? 
  If youre in a Medicare Advantage Plan, its illegal for anyone to sell you a 
Medigap policy unless youre switching back to Original Medicare. If you 
arent planning to drop your Medicare Advantage Plan, and someone tries 
to sell you a Medigap policy, report it to your State Insurance Department. 
  If you have Medigap and join a Medicare Advantage Plan, you may want 
to drop Medigap. You cant use Medigap to pay your Medicare Advantage 
Plan copayments, deductibles, and premiums. 
Important! If you want to cancel your Medigap policy, contact your insurance 
company. In most cases, if you drop your Medigap policy to join a 
Medicare Advantage Plan, you may not be able to get the same policy 
back, or in some cases, any Medigap policy unless you leave your Medicare 
Advantage Plan during your trial period.
  If you joined a Medicare Advantage Plan when you were rst eligible for 
Medicare at 65, you can choose from any Medigap policy thats sold by 
an insurance company in your state when you switch to Original Medicare 
within the rst year of joining. You may also have an opportunity to enroll 
in a Medicare drug plan at this time.
  If you drop a Medigap policy to join a Medicare Advantage Plan for the 
rst time, youll have a single 12-month period (your trial right period) to 
get your Medigap policy back if the same insurance company still sells 
it once you return to Original Medicare. If it isnt available, you can buy a 
Medigap policy you qualify for thats sold by an insurance company in your 
state (except for Plans M or N). You may also have an opportunity to enroll 
in a Medicare drug plan at this time.  
Note: If you dont drop your Medicare Advantage Plan and return to 
Original Medicare within 12 months of joining, generally, you must keep 
your Medicare Advantage Plan for the rest of the year. You can disenroll 
or change Medicare Advantage Plans during the Open Enrollment Period 
or if you qualify for a Special Enrollment Period. Depending on the type 
of Special Enrollment Period, you may or may not have the right to buy a 
Medigap policy.
  Some states provide additional special rights to buy a Medigap policy. 
Where can I get more information? 
  Call your State Insurance Department. Call 1-800-MEDICARE 
(1-800-633-4227) to get the phone number. TTY users can call 
1-877-486-2048.
  Visit Medicare.gov/medigap-supplemental-insurance-plans to nd 
policies and pricing in your area. 
  Visit Medicare.gov/publications to review the booklet, Choosing a 
Medigap Policy: A Guide to Health Insurance for People with Medicare.
  Call your State Health Insurance Assistance Program (SHIP). Go to 
pages 115118 for the phone number of your local SHIP. A trusted agent or 
broker in your area may also be able to help.
 Go to pages 1014 for an overview of your Medicare options. 79
SECTION 6  
Medicare drug 
coverage (Part D)
How does Medicare drug coverage work?
Medicare drug coverage (Part D) helps pay for prescription drugs you 
need. Its optional and oered to everyone with Medicare. Even if you dont 
take prescription drugs now, consider getting Medicare drug coverage. 
If you decide not to get it when youre rst eligible, and you dont have 
other creditable prescription drug coverage (like drug coverage from an 
employer or union) or get Extra Help, youll likely pay a late enrollment 
penalty if you join a plan later. Generally, youll pay this penalty for as long 
as you have Medicare drug coverage (go to pages 8385). To get Medicare 
drug coverage, you must join a Medicare-approved plan that oers drug 
coverage. Each plan can vary in cost and specic drugs covered. Visit
Medicare.gov/plan-compare to nd and compare plans in your area. 
There are 2 ways to get Medicare drug coverage (Part D): 
1. Medicare drug plans. These plans add Medicare drug coverage (Part D) to 
Original Medicare, some Medicare Cost Plans, some Medicare Advantage 
Private Fee-for-Service Plans, and Medicare Advantage Medical Savings 
Account (MSA) Plans. You must have Part A and/or Part B to join a 
separate Medicare drug plan.
2. Medicare Advantage Plans or other Medicare health plans with drug 
coverage. You get your Part A, Part B, and Medicare drug coverage 
(Part D) through these plans. Remember, you must have Part A and Part B 
to join a Medicare Advantage Plan, and not all Medicare Advantage Plans 
offer drug coverage. 
In either case, you must live in the service area of the plan you want to join 
and be lawfully present in the U.S. Medicare drug plans and Medicare health 
plans with drug coverage are called Medicare drug coverage in this 
handbook.
 Note: Go to pages 119122 for definitions of blue words.  80 SECTION 6: Medicare drug coverage (Part D)
Important! If you have employer or union coverage 
Call your benets administrator before you make any changes, or 
sign up for any other coverage. If you sign up for other coverage, you 
could lose your employer or union health and drug coverage for you 
and your dependents. If this happens, you may not be able to get your 
employer or union coverage back. If you want to know how Medicare drug 
coverage (Part D) works with other drug coverage you may have, go to 
pages 8890. 
When can I join, switch, or drop a plan?
You can join, switch, or drop a Medicare drug plan or a 
Medicare Advantage Plan with drug coverage during these times:
  Initial Enrollment Period. When you rst become eligible for Medicare, 
you can join a plan. Go to page 17. 
  Open Enrollment Period. From October 15  December 7 each year, you 
can join, switch, or drop a plan. Your coverage will begin on January 1 (as 
long as the plan gets your request by December 7). Go to page 71.
  Medicare Advantage Open Enrollment Period (only if you're already in 
a Medicare Advantage Plan). From January 1  March 31 each year, you 
can switch to a dierent Medicare Advantage Plan or switch to Original 
Medicare (and join a separate Medicare drug plan) once during this time. 
Go to page 72.
New! If you have to pay for Part A, and you sign up for Part B during the General 
Enrollment Period (January 1  March 31), you can also join a Medicare drug 
plan when you sign up for Part B. Youll have 2 months after signing up for 
Part B to join a drug plan. Your drug coverage will start the month after the 
plan gets your request to join.
Special Enrollment Periods 
Generally, you must stay in your plan for the entire year. But when certain 
events happen in your life, like if you move or lose other insurance coverage, 
you may qualify for a Special Enrollment Period. You may be able make 
changes to your plan mid-year if you qualify. Check with your plan for more 
information. 
New! If you sign up for Part A or Part B during a Special Enrollment Period 
because of an exceptional condition (go to page 18), youll have 2 months 
to join a Medicare Advantage Plan (with or without drug coverage) or a 
Medicare drug plan (Part D). Your coverage will start the rst day of the 
month after the Medicare Advantage Plan gets your request to join.
Visit Medicare.gov, or check with your plan for more information. You can 
also call your State Health Insurance Assistance Program (SHIP) for help. Go 
to pages 115118 for the phone number of your local SHIP. SECTION 6: Medicare drug coverage (Part D) 81
How do I switch plans? 
You can switch to a new Medicare drug plan or Medicare Advantage Plan 
with drug coverage simply by joining another plan during one of the times 
listed above. Your old drug coverage will end when your new drug coverage 
begins. You should get a letter from your new plan telling you when your 
coverage begins, so you dont need to cancel your old plan. You can also 
switch plans by calling 1-800-MEDICARE (1-800-633-4227). TTY users can 
call 1-877-486-2048.
How do I drop my plan? 
If you want to drop your Medicare drug plan or Medicare Advantage 
Plan with drug coverage and dont want to join a new plan, you can only 
do so during certain times (go to page 80). You can disenroll by calling 
1-800-MEDICARE. You can also send a letter to the plan to tell them you 
want to disenroll. If you drop your plan and want to join another Medicare 
drug plan or Medicare health plan with drug coverage later, you have to wait 
for an enrollment period. You may also have to pay a late enrollment penalty 
if you dont have creditable prescription drug coverage. Go to pages 8385. 
Read the information you get from your plan 
Review the Evidence of Coverage and Annual Notice of Change your plan 
sends you each year. The Evidence of Coverage gives you details about what 
the plan covers, how much you pay, and more. The Annual Notice of Change 
includes any changes in coverage, costs, provider networks, service area, 
and more that will be eective in January. If you dont get these important 
documents in early fall, contact your plan.
How much do I pay?
Your drug costs will vary based on the plan you choose. Remember, plan 
coverage and costs can change each year. You may have to pay a premium, 
deductible, copayments, or coinsurance throughout the year. Learn more 
about these costs on the next page.
Your actual drug coverage costs will vary depending on: 
  Your prescriptions and whether theyre on your plans list of covered drugs 
(formulary). Go to page 85. 
  What tier a drug is in. Go to page 85.
  Which drug benet phase youre in (like whether youve met your 
deductible, or if youre in the catastrophic coverage phase). Go to page 83.
  Which pharmacy you use (whether it oers preferred or standard cost 
sharing, is out of network, or is mail order). Your out-of-pocket drug costs 
may be less at a preferred pharmacy because it has agreed with your plan 
to charge less.
  Whether you get Extra Help paying your Medicare drug costs. Go to 
page 92.  82 SECTION 6: Medicare drug coverage (Part D)
Cost & coverage: Some ways you may be able to lower the cost of 
your drugs include choosing generics over brand name or paying the 
non-insurance cost of a drug. Ask your pharmacistthey can tell you 
if theres a less expensive option available. Check with your doctor to 
make sure the generic option is best for you.
Monthly premium 
Most drug plans charge a monthly fee that varies by plan. You pay this in 
addition to the Part B premium. If youre in a Medicare Advantage Plan or a 
Medicare Cost Plan with drug coverage, the monthly premium may include 
an amount for drug coverage. 
Note: Contact your plan (not Social Security or the Railroad Retirement 
Board (RRB)) if you want your drug premium deducted from your monthly 
Social Security or RRB payment. If you want to stop premium deductions 
and get billed directly, contact your plan. 
Important! If you have a higher income, you might pay more for your Medicare 
drug coverage (Part D). If your income is above a certain limit (in 2024: 
$103,000 if you le individually or $206,000 if youre married and le 
jointly), youll pay an extra amount in addition to your plan premium 
(sometimes called Part D IRMAA). Youll also have to pay this extra 
amount if youre in a Medicare Advantage Plan that includes drug 
coverage. This doesnt aect everyone, so most people wont have to pay 
an extra amount.
Usually, the extra amount will be deducted from your Social Security 
or RRB payment. If Medicare or the RRB bills you for the extra amount 
instead of deducting it from your Social Security or RRB payment, then 
you must pay the extra amount to Medicare or the RRB, not your plan. 
If you dont pay the extra amount, you could lose your Medicare drug 
coverage (Part D). You may not be able to join another plan right away, 
and you may have to pay a late enrollment penalty for as long as you have 
drug coverage. 
Youll pay Part D IRMAA payments separately, even if your employer or 
another third party (like a retirement system) pays your plan premiums.
If you have to pay an extra amount and you disagree (for example, you 
have one or more life-changing events that lower your income), visit 
SSA.gov or call Social Security at 1-800-772-1213. TTY users can call 
1-800-325-0778. 
Yearly deductible 
This is the amount you must pay before your plan begins to pay its share of 
your covered drugs. Some plans dont have a deductible. In some plans that 
do have a deductible, drugs on some tiers are covered before the deductible. SECTION 6: Medicare drug coverage (Part D) 83
Copayments or coinsurance 
These are the amounts you pay for your covered drugs after the deductible 
(if the plan has one). You pay your share and your plan pays its share for 
covered drugs. If you pay coinsurance, these amounts may vary because 
drug plans and manufacturers can change what they charge at any time 
throughout the year. The amount you pay will also depend on the tier level 
assigned to your drug. Go to page 85.
Once you and your plan spend $5,030 combined on drugs (including 
deductible), youll generally pay no more than 25% of the cost for 
prescription drugs until your out-of-pocket spending is $8,000.
Catastrophic coverage 
New! Once your out-of-pocket spending in 2024 reaches $8,000, (including 
certain payments made by other people or entities, including Medicares 
Extra Help program, on your behalf), you wont have to pay a copayment or 
coinsurance for covered Part D drugs for the rest of the calendar year. 
Note: If you get Extra Help, you wont have some of these costs. Go to 
pages 9294.
Important! Visit Medicare.gov/plan-compare to get specic Medicare drug plan and 
Medicare Advantage Plan costs, and call the plans youre interested in to 
get more details. For help comparing plan costs, call your State Health 
Insurance Assistance Program (SHIP). Go to pages 115118 for the phone 
number of your local SHIP. A trusted agent or broker may also be able 
to help.
Whats the Medicare drug coverage (Part D) late enrollment 
penalty? 
The late enrollment penalty is an amount thats permanently added to your 
Medicare drug coverage (Part D) premium. You may have to pay a late 
enrollment penalty if you enroll at any time after your Initial Enrollment 
Period is over and theres a period of 63 or more days in a row when you 
dont have Medicare drug coverage or other creditable prescription drug 
coverage. Youll generally have to pay the penalty for as long as you have 
Medicare drug coverage. 
Note: If you get Extra Help, you dont pay a late enrollment penalty.  84 SECTION 6: Medicare drug coverage (Part D)
There are 3 ways to avoid paying a penalty: 
1. Get Medicare drug coverage (Part D) when youre first eligible for it. Even 
if you dont take drugs now, you should consider joining a separate Medicare 
drug plan or a Medicare Advantage Plan with drug coverage to avoid a 
penalty. You may be able to find a plan that meets your needs with little to 
no monthly premiums. Go to pages 1014 to learn more about your choices. 
2. Add Medicare drug coverage (Part D) if you lose other creditable 
coverage. Creditable prescription drug coverage could include drug 
coverage from a current or former employer or union, TRICARE, Indian 
Health Service, the Department of Veterans Affairs, or individual 
health insurance coverage. Your plan must tell you each year if your 
non-Medicare drug coverage is creditable coverage. If you go 63 days 
or more in a row without Medicare drug coverage or other creditable 
prescription drug coverage, you may have to pay a penalty if you sign 
up for Medicare drug coverage later. 
3. Keep records showing when you had other creditable prescription drug 
coverage, and tell your plan when they ask about it. If you dont tell your 
plan about your previous creditable prescription drug coverage, you may 
have to pay a penalty for as long as you have Medicare drug coverage. 
How much more will I pay for a late enrollment penalty? 
The cost of the late enrollment penalty depends on how long you didnt have 
creditable prescription drug coverage. Currently, the late enrollment penalty is 
calculated by multiplying 1% of the national base beneciary premium  
($34.70 in 2024) by the number of full, uncovered months that you were 
eligible but didnt have Medicare drug coverage (Part D) and went without 
other creditable prescription drug coverage. The nal amount is rounded to 
the nearest $.10 and added to your monthly premium. The national base 
beneciary premium may increase or decrease each year. If that occurs, the 
penalty amount may also increase or decrease. After you get Medicare drug 
coverage, the plan will tell you if you owe a penalty and what your premium 
will be. 
Example: 
Mrs. Martinez is currently eligible for Medicare, and her Initial Enrollment 
Period ended on May 31, 2020. She doesnt have prescription drug coverage 
from any other source. She didnt join by May 31, 2020, and instead joined 
during the Open Enrollment Period that ended December 7, 2022. Her drug 
coverage was eective January 1, 2023.
2023
Since Mrs. Martinez was without creditable prescription drug coverage from 
June 2020December 2022, her penalty in 2023 was 31% (1% for each of the  
31 months) of $32.74 (the national base beneciary premium for 2023) or 
$10.14. Since the monthly penalty is always rounded to the nearest $0.10, 
she paid $10.10 each month in addition to her plans monthly premium.
Heres the math:
.31 (31% penalty)  $32.74 (2023 base beneciary premium) = $10.14
$10.14 rounded to the nearest $0.10 = $10.10
$10.10 = Mrs. Martinezs monthly late enrollment penalty for 2023 SECTION 6: Medicare drug coverage (Part D) 85
2024
In 2024, Medicare recalculated Mrs. Martinezs penalty using the 2024 
base beneciary premium ($34.70). So, Mrs. Martinezs new monthly 
penalty in 2024 is 31% of $34.70, or $10.75 each month. Since the monthly 
penalty is always rounded to the nearest $0.10, she pays $10.80 each 
month in addition to her plans monthly premium.
Heres the math:
.31 (31% penalty)  $34.70 (2024 base beneciary premium) = $10.75
$10.75 rounded to the nearest $0.10 = $10.80
$10.80 = Mrs. Martinezs monthly late enrollment penalty for 2024
What if I dont agree with the late enrollment penalty? 
Your Medicare drug plan or Medicare Advantage Plan with drug coverage 
will send you a letter stating you have to pay a late enrollment penalty. 
If you disagree with your penalty, you can request a review (generally 
within 60 days from the date on the letter). Fill out the reconsideration 
request form you get with your letter by the date listed in the letter. You 
can provide proof that supports your case, like information about previous 
creditable prescription drug coverage. If you need help, call your plan. 
Which drugs are covered?
All plans must cover a wide range of prescription drugs that people with 
Medicare take, including most drugs in certain protected classes, like drugs 
to treat cancer or HIV/AIDS. Information about a plans list of covered drugs 
(called a formulary) isnt included in this handbook because each plan 
has its own formulary. A plan can make some changes to its drug list during 
the year if it follows guidelines set by Medicare. For example, your plan may 
change its drug list during the year because drug therapies change, new 
drugs are released, or new medical information becomes available. Your plan 
coinsurance may increase for a particular brand name drug or generic drug 
when the manufacturer raises the price. Your copayment or coinsurance may 
increase when a plan starts to oer a generic form of a brand name drug, 
but you continue to take the brand name drug. In some cases, the plan may 
cover a drug for one health condition but not another.
Note: Medicare Part B covers a limited number of outpatient prescription 
drugs. Go to page 39 for more information.
Your Medicare drug coverage (Part D) typically places drugs into dierent 
levels called tiers on their formularies. Drugs in each tier have a dierent 
cost. For example, a drug in a lower tier will generally cost you less than a 
drug in a higher tier. 
What happens if my drug is in a higher tier? 
In some cases, if your drug is in a higher tier and your prescriber (your 
doctor or other health care provider whos legally allowed to write 
prescriptions) thinks you need that drug instead of a similar drug in a lower 
tier, you or your prescriber can ask your plan for an exception to get a lower 
coinsurance or copayment for the drug in the higher tier. Go to page 100 for 
more information on exceptions.  86 SECTION 6: Medicare drug coverage (Part D)
Plans can change their formularies at any time. Your plan may notify you of 
any formulary changes that aect drugs youre taking. 
Contact your plan for its current formulary, or visit the plans website. 
You can also visit Medicare.gov/plan-compare or call 1-800-MEDICARE 
(1-800-633-4227). TTY users can call 1-877-486-2048. 
Important! Each month you ll a prescription, your plan sends you an Explanation 
of Benets notice. Review your notice and check it for mistakes. 
Contact your plan if you have questions or nd mistakes. If you suspect 
fraud, call the Medicare Drug Integrity Contractor at 1-877-7SAFERX 
(1-877-772-3379). Go to page 106. 
Plans may have coverage rules for certain drugs 
  Prior authorization: You and/or your prescriber must contact your plan 
before you can ll certain prescriptions. Your prescriber may need to show 
that the drug is medically necessary for the plan to cover it. 
Plans may also use prior authorization when they cover a drug for only 
certain medical conditions its approved for, but not others. When this 
occurs, plans will likely have alternative drugs on their list of covered drugs 
(formulary) for the other medical conditions the drug is approved to treat. 
  Quantity limits: Limits on how much medicine you can get at a time. 
  Step therapy: You may need to try one or more similar, lower-cost drugs 
before the plan will cover the prescribed drug. 
  Medication safety checks at the pharmacy: Before the pharmacy lls your 
prescriptions, your plan and pharmacy perform additional safety checks, 
like checking for drug interactions and incorrect dosages. 
  These safety checks also include checking for possible unsafe amounts 
of opioid pain medications, limiting the days supply of a rst prescription 
for opioids, and use of opioids at the same time as benzodiazepines 
(commonly used for anxiety and sleep). Opioid pain medicine (like 
oxycodone and hydrocodone) can help with certain types of pain, 
but have risks and side eects (like addiction, overdose, and death). 
These can increase when you take opioids with certain other drugs, like 
benzodiazepines, anti-seizure medications, gabapentin, muscle relaxers, 
certain antidepressants, and drugs for sleeping problems. Check with your 
doctor or pharmacist if you have questions about risks or side eects.
  Drug Management Programs: Medicare drug coverage (Part D) has 
programs in place to help you use these opioids and benzodiazepines 
safely. If your opioid use could be unsafe (for example, due to getting 
opioid prescriptions from multiple doctors or pharmacies, or if you had 
a recent overdose from opioids), your plan will contact the doctors who 
prescribed them for you to make sure theyre medically necessary and 
youre using them appropriately. SECTION 6: Medicare drug coverage (Part D) 87
If your plan decides your use of prescription opioids and benzodiazepines 
may not be safe, the plan will send you a letter in advance. This letter will 
tell you if the plan will limit coverage of these drugs for you, or if youll be 
required to get the prescriptions for these drugs only from one doctor or 
pharmacy you select. You and your doctor have the right to appeal these 
limitations if you disagree with the plans decision (go to page 99). The 
letter will also tell you how to contact the plan if you have questions or 
would like to appeal. 
The opioid safety reviews at the pharmacy and Drug Management 
Programs generally dont apply if you have cancer or sickle cell disease, 
are getting palliative or end-of-life care, are in hospice, or live in a 
long-term care facility.
If you or your prescriber believe that your plan should waive one of these 
coverage rules, you can ask for an exception. Go to page 100. 
Important tips if youre prescribed opioids:
  Opioid medications can be an important part of pain management, but 
they also can have serious health risks if misused.
  Medicare covers naloxone, a drug that your doctor may prescribe as 
a safety measure in case you need to rapidly reverse the eects of an 
opioid overdose. Talk with your doctor about having naloxone at home.
  Talk with your doctor about your dosage and the length of time youll 
be taking opioids. You and your doctor may decide later you dont need 
to take all of your prescription.
  Talk with your doctor about other options that Medicare covers to treat 
your pain, like non-opioid medications and devices, physical therapy, 
acupuncture for lower back pain, individual and group psychotherapy, 
behavioral health integration services, and more. 
  Never take more opioids than prescribed. Also, talk with your doctor 
about any other pain medicines youre taking.
  Safely store and discard unused prescription opioids through your
community drug take-back program or your pharmacy mail-back 
program.
For more information on safe and eective pain management and 
opioid use, visit Medicare.gov/coverage/pain-management or call 
1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
Can I get automatic prescription refills in the mail? 
Some people with Medicare get their drugs through an automatic rell 
service that automatically delivers prescription drugs before they run out. 
To make sure you still need a prescription before they send you a rell, drug 
plans may oer a voluntary auto-ship program. Contact your plan for more 
information.
Note: Medicare drug coverage (Part D) includes drugs, like buprenorphine, 
to treat opioid use disorders. It also covers drugs, like methadone, when 
prescribed for pain. 88 SECTION 6: Medicare drug coverage (Part D)
Medication Therapy Management program 
Plans with Medicare drug coverage (Part D) must oer Medication Therapy 
Management services to help members if they meet certain requirements 
or are in a Drug Management Program. If you qualify, you can get these 
services at no cost to help you understand how to manage your medications 
and take them safely. Medication Therapy Management services usually 
include a discussion with a pharmacist or health care provider to review your 
medications. These services may vary by plan. Contact your plan for specic 
details and to nd out if youre eligible.
Part D coverage for insulin
Part D covers insulin, including insulin used with either a disposable or 
non-traditional insulin pump. It also covers certain medical supplies used 
to inject insulin, like syringes, gauze, and alcohol swabs. Covered insulin 
products are included on your plans formulary.
Important! Plans cant charge you more than $35 for a one-month supply of each 
Part D-covered insulin you take, and you dont have to pay a deductible 
for insulin. This applies to everyone who takes insulin, even if you get 
Extra Help.
Similar caps on costs apply for traditional insulin used in insulin pumps 
(covered under Part B). Visit Medicare.gov/coverage/insulin to learn more. 
How do other insurance and programs work with 
Medicare drug coverage (Part D)? 
Medicaid
If you have Medicare and full Medicaid coverage, Medicare covers your 
prescription drugs. However, Medicaid may still cover some drugs that 
Medicare doesnt cover. 
Note: You automatically qualify for Extra Help if you have Medicare and 
Medicaid. Go to page 92.
Employer or union coverage
This is health coverage from your, your spouses, or other family members 
current or former employer or union. When you have employer or union 
coverage or other health insurance (like a retiree health plan) and Medicare, 
there are rules for whether Medicare or your other coverage pays rst. Go 
to page 21 for more information. If you have drug coverage based on your 
current or previous employment, your employer or union will notify you 
each year to let you know if your drug coverage is creditable. Keep the 
information you get. Call your benets administrator for more information 
before making any changes to your coverage. 
Important! If you get Medicare drug coverage, you, your spouse, or your dependents 
may lose your employer or union health coverage. SECTION 6: Medicare drug coverage (Part D) 89
COBRA 
This federal law may allow you to temporarily keep employer or union 
health coverage after the employment ends or after you lose coverage as a 
dependent of the covered employee. There may be reasons why you should 
take Part B instead of, or in addition to, COBRA coverage (go to page 18). 
However, if you take COBRA and youre eligible for Medicare, COBRA may 
only pay a small portion of your medical costs, and you may have to pay 
most of the costs yourself. Contact your COBRA plan and ask what percent 
they pay. To avoid unexpected medical bills, you may need to sign up for 
Medicare right away. Talk with your State Health Insurance Assistance 
Program (SHIP) for free, personalized help with this decision. Go to 
pages 115118 for the phone number of your local SHIP. 
If you have COBRA that includes creditable prescription drug coverage, 
youll have a Special Enrollment Period to get Medicare drug coverage 
(Part D) without paying a penalty when the COBRA coverage ends. If you 
have questions about Medicare and COBRA, call the Benets Coordination 
& Recovery Center at 1-855-798-2627. TTY users can call 1-855-797-2627. A 
trusted agent or broker may also be able to help.
Medicare Supplement Insurance (Medigap) with drug coverage
Medigap policies can no longer be sold with drug coverage, but if you have 
an older Medigap policy that was sold with drug coverage, you can keep 
it. You may choose to join a separate Medicare drug plan because most 
Medigap drug coverage isnt creditable, and you may pay more if you join a 
drug plan later. Go to page 83. 
You cant have drug coverage in both Medigap and your Medicare drug 
plan. If you decide to join a separate Medicare drug plan, tell your Medigap 
insurance company so they can remove the drug coverage and adjust your 
premiums. Call your Medigap insurance company for more information.
How does other government insurance work with 
Medicare drug coverage (Part D)? 
The types of insurance listed below are all considered creditable prescription 
drug coverage. In most cases, its to your advantage to keep this coverage if 
you have it. 
Federal Employee Health Benefits Program (FEHB)
This is health coverage for current and retired federal employees and
covered family members. These plans usually include creditable prescription 
drug coverage, so you dont need to get Medicare drug coverage (Part D).
However, if you decide to get Medicare drug coverage, you can keep
your FEHB plan, and in most cases, Medicare will pay rst. For more
information, visit opm.gov/healthcare-insurance/healthcare, or call the 
Oce of Personnel Management at 1-888-767-6738. TTY users can call 711.
If youre an active federal employee, contact your Benets Ocer. Visit 
apps.opm.gov/abo for a list of Benets Ocers. You can also call your plan
if you have questions. 90 SECTION 6: Medicare drug coverage (Part D)
Veterans benefits
This is health coverage for veterans and people who have served in the U.S. 
military. You may be able to get drug coverage through the U.S. Department 
of Veterans Aairs (VA) program. You may join a separate Medicare drug 
plan, but if you do, you cant use both types of coverage for the same 
drug at the same time. For more information, visit va.gov or call the VA at 
1-800-827-1000. TTY users can call 711.
CHAMPVA (Civilian Health and Medical Program of the 
Department of Veterans Affairs)
This is a comprehensive health care program in which the Department 
of Veterans Aairs (VA) shares the cost of covered health care services 
and supplies with eligible people with Medicare. You may join a separate 
Medicare drug plan, but if you do, you wont be able to use the Meds by 
Mail program which can provide your maintenance drugs at no charge 
(no premiums, deductibles, and copayments). For more information, visit 
va.gov/communitycare/programs/dependents/champva or call CHAMPVA 
at 1-800-733-8387.
TRICARE (military health benefits)
This is a health care program for active-duty service members, military 
retirees, and their families. Most people with TRICARE who are entitled 
to Part A must also have Part B to keep their TRICARE drug benets. If 
you have TRICARE, you dont need to join a separate Medicare drug plan. 
However, if you do, your Medicare drug plan pays rst, and TRICARE pays 
second. 
If you join a Medicare Advantage Plan with drug coverage, your 
Medicare Advantage Plan and TRICARE may coordinate benets if your 
Medicare Advantage Plan network pharmacy is also a TRICARE network 
pharmacy. Otherwise, you can le your own claim to get paid back for 
your out-of-pocket costs. For more information, visit tricare.mil, or call 
the TRICARE Pharmacy Program at 1-877-363-1303. TTY users can call 
1-877-540-6261.
Indian Health Service (IHS)
The IHS is the primary health care provider to the American Indian/Alaska 
Native Medicare population. The Indian health care system, consisting of 
tribal, urban, and federally operated IHS health programs, delivers several 
clinical and preventive health services through a network of hospitals, clinics, 
and other entities. Many Indian health facilities participate in Medicare drug 
coverage (Part D). If you get prescription drugs through an Indian health 
facility, youll continue to get them at no cost to you, and your coverage 
wont be interrupted. Joining a Medicare drug plan or Medicare Advantage 
Plan with drug coverage may help your Indian health facility because the 
plan pays the Indian health facility for the cost of your prescription drugs. 
Talk to your local Indian health benets coordinator who can help you 
choose a plan that meets your needs and tell you how Medicare works with 
the Indian health care system.
 Go to pages 1014 for an overview of your Medicare options. 91
SECTION 7  
Get help paying your 
health & drug costs 
Medicare Savings Programs (MSPs)
If you have limited income and resources, you may be able to get help
from your state to pay your Medicare costs if you meet certain conditions. 
There are 4 kinds of Medicare Savings Programs: 
1. Qualified Medicare Beneficiary (QMB) Program: If youre eligible, the 
QMB Program pays for Part A and/or Part B premiums. In addition, 
Medicare providers arent allowed to bill you for services and items 
Medicare covers, including deductibles, coinsurance, and copayments. 
If you get a bill for these charges, tell your provider or the debt collector 
that youre in the QMB Program and cant be charged for Medicare 
deductibles, coinsurance, and copayments. If youve already made 
payments on a bill for services and items Medicare covers, you have the 
right to a refund. If youre in a Medicare Advantage Plan, you should 
also contact the plan to ask them to stop the charges. In some cases, 
you may be billed a small copayment through Medicaid, if one applies.
To make sure your provider knows youre in the QMB Program, show 
both your Medicare and Medicaid or QMB card each time you get care. 
If you have Original Medicare, you can also give your provider a copy 
of your Medicare Summary Notice (MSN). Your MSN will show youre 
in the QMB Program and shouldnt be billed. Log into (or create) your 
secure Medicare account at Medicare.gov to sign up to get your MSNs 
electronically.
If your provider wont stop billing you, call 1-800-MEDICARE 
(1-800-633-4227). TTY users can call 1-877-486-2048. We can also 
conrm that youre in the QMB Program.
2. Specified Low-Income Medicare Beneficiary (SLMB) Program: Pays 
Part B premiums only. 
3. Qualifying Individual (QI) Program: Helps pay Part B premiums only. 
You must apply each year for QI benefits. Apply as soon as possible 
since applications are granted on a first-come, first-served basis. 
4. Qualified Disabled and Working Individuals (QDWI) Program: Pays 
Part A premiums only. You may qualify for this program if you have a 
disability, youre working, and you lost your Social Security disability 
benefits and premium-free Part A because you returned to work.
 Note: Go to pages 119122 for definitions of blue words.  92 SECTION 7: Get help paying your health & drug costs
If you sign up for the immunosuppressive drug benet (go to page 53) 
and have limited income and resources, but dont have full Medicaid 
coverage, you may qualify for help paying the costs through a QMB, 
SLMB, or QI Program. Contact your state to apply. 
If you qualify for a QMB, SLMB, or QI Program, you automatically qualify 
to get Extra Help paying for Medicare drug coverage (Part D). Go to 
pages 9194.
Important! Medicare Savings Programs are available through your state. The names of 
these programs and how they work may vary by state. Medicare Savings 
Programs arent available in Puerto Rico or the U.S. Virgin Islands. 
How do I qualify? 
  In most cases, to qualify for a Medicare Savings Program, you must have 
income and resources below a certain limit. 
  Even if you dont think you qualify, you should still apply. Contact your 
State Medical Assistance (Medicaid) oce to get started.
  Call 1-800-MEDICARE (1-800-633-4227) or visit Medicaid.gov/about-us/
beneficiary-resources/index.html#statemenu to get the phone number 
for your states Medicaid oce. TTY users can call 1-877-486-2048.
Get Extra Help paying your Medicare drug costs
If you have limited income and resources, you may qualify for Extra Help, a 
program to help pay for some drug costs. 
You may qualify for Extra Help if your yearly income and resources are below 
these limits in 2023:
Yearly income Resources
Single person less than $21,870 less than $16,600
Married person living  less than $29,580 less than $33,240
with a spouse and no 
other dependents
New! Extra Help has expanded to cover more drug costs for certain people with 
limited income and resources. 
You may qualify even if you have a higher income (like if you still work, live in 
Alaska or Hawaii, or have dependents living with you). 
Resources
  Include money in a checking or savings account, stocks, bonds, mutual 
funds, and Individual Retirement Accounts (IRAs). 
  Dont include your home, car, household items, burial plot, up to $1,500 
for burial expenses (per person), or life insurance policies.
You can nd 2024 income and resource limits on Medicare.gov beginning 
spring 2024.   SECTION 7: Get help paying your health & drug costs 93
If you qualify for Extra Help and join a separate Medicare drug plan or 
Medicare Advantage Plan with Medicare drug coverage (Part D): 
  Youll get help paying your drug coverage costs. 
  You wont pay a Part D late enrollment penalty. 
Note: Extra Help isnt available in Puerto Rico, the U.S. Virgin Islands, Guam, 
the Northern Mariana Islands, or American Samoa. But there are other 
programs available in these areas to help people with limited income and 
resources. Go to page 96 for more information.
Cost & coverage: Most people with Medicare can only switch plans at 
certain times of the year. If you have Medicaid or get Extra Help, you 
may be able to change your drug coverage one time during each of 
these periods:
  January  March
  April  June
  July  September
If you make a change, it will begin the rst day of the following 
month. 
You automatically qualify for Extra Help if you have Medicare and meet 
any of these conditions: 
  You have full Medicaid coverage. 
  You may get help from your state Medicaid program to pay your Part B 
premiums and other Medicare costs. Go to pages 9196. 
  You get Supplemental Security Income (SSI) benets. 
Medicare will mail you a purple letter to let you know you automatically 
qualify for Extra Help. Keep this for your records. You dont need to apply for 
Extra Help if you get this letter.
  If you dont already have Medicare drug coverage (Part D), you must get it 
to use this Extra Help. 
  If you dont have drug coverage, Medicare may enroll you in a separate 
Medicare drug plan so youll be able to use the Extra Help. If Medicare 
enrolls you in a plan, youll get a yellow letter letting you know when your 
coverage begins, and youll have a Special Enrollment Period to change 
plans if you want to join a dierent plan than the one Medicare enrolled 
you in. 
  Dierent plans cover dierent drugs. Check to nd out if the plan youre 
enrolled in covers the drugs you use and if you can go to the pharmacies 
you want. Visit Medicare.gov/plan-compare or call 1-800-MEDICARE 
(1-800-633-4227) to compare your plan with other plans in your area. 
TTY users can call 1-877-486-2048. 
  If you have Medicaid and live in certain institutions (like a nursing home) 
or get home and community-based services, you pay nothing for your 
covered drugs.  94 SECTION 7: Get help paying your health & drug costs
If you dont want to join a separate Medicare drug plan (for example, 
because you want only your employer or union coverage), call the plan listed 
in your letter, or call 1-800-MEDICARE (1-800-633-4227). TTY users can 
call 1-877-486-2048. Tell them you dont want to be in a Medicare drug plan 
(you want to opt out). If you continue to qualify for Extra Help or if your 
employer or union coverage is creditable prescription drug coverage, you 
wont have to pay a penalty if you join later. 
Important! If you have employer or union coverage and you get Medicare drug 
coverage (Part D), you may lose your employer or union coverage (for 
you and your dependents) even if you qualify for Extra Help. Call your 
employers benets administrator before you get Medicare drug coverage.  
New! Drug costs for people who qualify will generally be no more than $4.50 for 
each generic drug and $11.20 for each brand-name drug. Look at the Extra 
Help letters you get, or contact your plan if you have questions about costs.
If you didnt automatically qualify for Extra Help, you can apply any time: 
  Visit secure.ssa.gov/i1020/start to apply online. 
  Call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778. 
When you apply for Extra Help, you can also begin the application process 
for a Medicare Savings Program (MSP). These state programs provide help 
with other Medicare costs. Social Security will send information to your state 
to initiate an MSP application, unless you tell them not to on the Extra Help 
application.
To get answers to your questions about Extra Help and help choosing drug 
coverage, call your State Health Insurance Assistance Program (SHIP). Go 
to pages 115118 for the phone number of your local SHIP. You can also call 
1-800-MEDICARE.
How can I save on my Medicare health care costs? 
Medicaid 
Medicaid is a joint federal and state program that helps pay health care costs 
if you have limited income and (in some cases) resources and meet other 
requirements. Some people qualify for both Medicare and Medicaid. 
What does Medicaid cover? 
  If you have Medicare and full Medicaid coverage, most of your health care 
costs are covered. You can get your Medicare coverage through Original 
Medicare or a Medicare Advantage Plan. 
  If you have Medicare and full Medicaid coverage, Medicare covers your 
prescription drugs. You automatically qualify for Extra Help paying your 
Medicare drug costs (go to page 92). Medicaid may still cover some drugs 
that Medicare doesnt cover.  SECTION 7: Get help paying your health & drug costs 95
  People with full Medicaid coverage may get coverage for services 
that Medicare doesnt cover or only partially covers, like nursing home 
care, personal care, transportation to medical services, home and 
community-based services, home-delivered meals, and dental, vision, and 
hearing services. 
How do I qualify? 
  Medicaid programs vary from state to state. They may also have dierent 
names, like Medical Assistance or Medi-Cal. 
  Each state has dierent income and resource requirements. 
  Call your State Medical Assistance (Medicaid) oce to nd out if you 
qualify. Visit Medicaid.gov/about-us/beneficiary-resources/index.
html#statemenu or call 1-800-MEDICARE (1-800-633-4227) to get 
the phone number for your states Medicaid oce. TTY users can call 
1-877-486-2048.
Medicare-Medicaid Plans 
Medicare is working with some states and health plans to oer 
demonstration plans for certain people who have both Medicare and 
Medicaid and make it easier for them to get the services they need. Theyre 
called Medicare-Medicaid Plans. These plans include drug coverage 
and are only available in certain states. If youre interested in joining a 
Medicare-Medicaid Plan, visit Medicare.gov/plan-compare to nd out if one 
is available in your area.
State Pharmaceutical Assistance Programs 
Many states have State Pharmaceutical Assistance Programs that
help certain people pay for prescription drugs based on nancial 
need, age, or medical condition. To nd out if theres a State
Pharmaceutical Assistance Program in your state and how it works, call 
your State Health Insurance Assistance Program (SHIP). Go to pages
115118 for the phone number of your local SHIP. You can also visit 
Medicare.gov/pharmaceutical-assistance-program/#state-programs.
Pharmaceutical Assistance Programs (also called Patient 
Assistance Programs) 
Many major drug manufacturers oer assistance programs for people with 
Medicare drug coverage (Part D) who meet certain requirements. Visit 
Medicare.gov/pharmaceutical-assistance-program to learn more about 
Pharmaceutical Assistance Programs. 
Program of All-inclusive Care for the Elderly (PACE)
PACE is a Medicare and Medicaid program oered in many states that allows 
people who need a nursing home-level of care to remain in the community.
Go to page 74.  96 SECTION 7: Get help paying your health & drug costs
Supplemental Security Income (SSI) benefits 
SSI provides monthly payments to adults and children who are blind or have 
a disability and have limited income and resources. SSI payments are also 
provided to people 65 and older without disabilities who meet the nancial 
qualications. These benets arent the same as Social Security retirement 
benets. You may be able to get both SSI and Social Security benets at the 
same time if your Social Security benet is less than the SSI federal benet rate. 
If youre eligible for SSI, you automatically qualify for Extra Help and are usually 
eligible for Medicaid.
You can visit ssabest.benefits.gov, and use the Benet Eligibility Screening 
Tool to nd out if youre eligible for SSI or other benets. Call Social Security at 
1-800-772-1213. TTY users can call 1-800-325-0778. 
Note: People who live in Puerto Rico, the U.S. Virgin Islands, Guam, or American 
Samoa cant get SSI. 
Programs for people who live in the U.S. territories 
There are programs in Puerto Rico, the U.S. Virgin Islands, Guam, the 
Northern Mariana Islands, and American Samoa to help people with limited 
income and resources pay their Medicare costs. Programs vary in these 
areas. Call your State Medical Assistance (Medicaid) oce to learn more. 
Visit Medicaid.gov/about-us/beneficiary-resources/index.html#statemenu 
or call 1-800-MEDICARE (1-800-633-4227) to get the phone number. 
TTY users can call 1-877-486-2048. 97
SECTION 8  
Your Medicare rights  
& protections 
What are my Medicare rights?
All people with Medicare have certain rights and protections. You have the right 
to: 
  Be treated with courtesy, dignity, and respect at all times. 
  Be protected from discrimination. 
  Have your personal and health information kept private. 
  Get information in a way you understand from Medicare, health care 
providers, and, under certain circumstances, contractors. 
  Learn about your treatment choices in clear language you can understand, 
and participate in treatment decisions. 
  Get Medicare information and health care services in a language you 
understand.
  Get your Medicare information in an accessible format, like braille or large 
print. Go to Accessible Communications on page 123. 
Note: If you need plan information in a language other than English or in an 
accessible format, contact your plan.
  Get answers to your Medicare questions.
  Have access to doctors, specialists, and hospitals for medically necessary 
services.
  Get Medicare-covered services in an emergency. 
  Get a decision about health care payment, coverage of items and services, 
or drug coverage. When you or your provider les a claim, youll get a notice 
letting you know what will and wont be covered. This notice comes from one 
of these:
Medicare
Your Medicare Advantage Plan (Part C) or other Medicare health plan
Your Medicare drug plan
If you disagree with the decision on your claim, you have the right to le an 
appeal. You can:
Request a review (appeal) of certain decisions about health care payment, 
coverage of items and services, or drug coverage. 
File a complaint (sometimes called a "grievance") if you have concerns 
about the quality of care and other services you get from a Medicare 
provider. 
 Note: Go to pages 119122 for definitions of blue words.  98 SECTION 8: Your Medicare rights & protections
Work with End-Stage Renal Disease (ESRD) Networks and State Survey 
Agencies to help you with complaints (grievances) about your dialysis 
or kidney transplant care. 
Visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to learn more
about ling a complaint. TTY users can call 1-877-486-2048.
What are my rights if my plan stops participating in 
Medicare?
Medicare health and drug plans can decide not to participate in Medicare for 
the coming year. In these cases, your coverage under the plan will end after 
December 31. Your plan will send you a letter explaining your options. If this 
happens:
  You can choose another plan from October 15  December 7. Your 
coverage will begin January 1. 
  You also have a special right to join another Medicare plan until the last 
day in February. 
  You may have the right to buy certain Medigap policies within 63 days 
after your plan coverage ends. 
Whats an appeal?
An appeal is the action you can take if you disagree with a coverage or 
payment decision by Medicare or your Medicare plan. For example, you can 
appeal if Medicare or your plan denies: 
  A request for a health care service, supply, item, or drug you think 
Medicare should cover. 
  A request for payment of a health care service, supply, item, or drug you 
already got. 
  A request to change the amount you must pay for a health care service, 
supply, item, or drug. 
You can also appeal:
  If Medicare or your plan stops providing or paying for all or part of a health 
care service, supply, item, or drug you think you still need.
  An at-risk determination made under a Drug Management Program that 
limits access to coverage for frequently abused drugs, like opioids and 
benzodiazepines. Go to page 86.
  If your claim is denied because of an open accident record and the claim 
isnt related to the accident.
If you decide to le an appeal, you can ask your doctor, supplier, or other 
health care provider for any information that may help your case. This will 
make your appeal stronger. Keep a copy of everything related to your 
appeal, including what you send to Medicare or your plan.  SECTION 8: Your Medicare rights & protections 99
How do I file an appeal? 
How you le an appeal depends on the type of Medicare coverage you have. 
If you have Original Medicare 
  Get the Medicare Summary Notice (MSN) that shows the item or service 
youre appealing. Go to page 59 for more information about MSNs. 
  Circle the item(s) on the MSN you disagree with. Write an explanation of 
why you disagree with the decision. You can write on the MSN or on a 
separate piece of paper and attach it to the MSN. 
  Include your name, phone number, and Medicare number on the MSN. 
Keep a copy for your records. 
  Send the MSN, or a copy, to the company that handles bills for Medicare 
(Medicare Administrative Contractor) listed on the MSN. You can include 
any information you have about your appeal, like information from 
your health care provider. Or, you can use Form CMS-20027. To get 
this form, visit CMS.gov/cmsforms/downloads/cms20027.pdf, or call 
1-800-MEDICARE (1-800-633-4227) to have a copy mailed to you. TTY 
users can call 1-877-486-2048. 
  You must le your appeal by the date in the MSN. If you missed the 
deadline for appealing, you may still le an appeal and get a decision if 
you can show good cause for missing the deadline (for example, if you had 
an illness or accident that delayed you from sending it by the deadline).
  Youll generally get a decision from the Medicare Administrative 
Contractor within 60 days after they get your request. If Medicare will 
cover the item(s) or service(s), it will be listed on your next MSN.
  You may have the right to a fast appeal if you think your Medicare services 
from a hospital or other facility are ending too soon. Go to page 100.
If youre in a Medicare Advantage or other Medicare health plan
The timeframe for ling an appeal may be dierent than Original Medicare. 
To learn more, look at the materials your plan sends you, call your plan, or
visit Medicare.gov/claims-appeals/how-do-i-file-an-appeal. 
In some cases, you can le a fast appeal. Review materials from your plan
and the information on page 100. 
If you have a separate Medicare drug plan 
Even before you buy a certain drug, you have the right to:
  Get a written explanation for drug coverage decisions (called a coverage 
determination) from your Medicare drug plan. A coverage determination 
is the rst decision your Medicare drug plan (not the pharmacy) makes 
about your benets. This can be a decision about if the plan covers your 
drug, if you met the plans requirements to cover the drug, or how much 
you pay for the drug. Youll also get a coverage determination decision if 
you ask your plan to make an exception to its rules to cover your drug. 
  Ask for an exception if you or your prescriber (your doctor or other health 
care provider whos legally allowed to write prescriptions) believe you 
need a drug that isnt on your plans list of covered drugs (formulary). 
  Ask for an exception if you or your prescriber believe that your plan should 
waive a coverage rule (like prior authorization).  100 SECTION 8: Your Medicare rights & protections
  Ask for an exception if you think you should pay less for a higher tier drug 
because you or your prescriber believe you cant take any of the lower tier 
drugs for the same condition. 
How can I get help filing an appeal? 
You can appoint a representative to help you. Your representative can be a 
family member, friend, advocate, attorney, nancial advisor, doctor, or someone 
else who will act on your behalf. For more information, visit Medicare.gov/
claims-appeals/file-an-appeal/can-someone-file-an-appeal-for-me. You can 
also get help ling an appeal from your State Health Insurance Assistance 
Program (SHIP). Go to pages 115118 for the phone number of your local SHIP. 
How do I ask for a coverage determination or exception? 
You or your prescriber must contact your plan to ask for a coverage 
determination or an exception. If your network pharmacy cant ll a prescription, 
the pharmacist will give you a notice that explains how to contact your Medicare 
drug plan so you can make your request. If the pharmacist doesnt give you this 
notice, ask for a copy. 
If youre asking for a prescription you havent gotten yet, you or your prescriber 
may make a standard request or an expedited (fast) request by phone or in 
writing. If youre asking to get paid back for prescription drugs you already 
bought, your plan can require you or your prescriber to make the standard 
request in writing. 
You or your prescriber can call or write your plan for an expedited (fast) request. 
Your request will be expedited if you havent gotten the prescription and your 
plan determines, or your prescriber tells your plan, that your life or health may 
be at risk by waiting. 
Important! If youre requesting an exception, your prescriber must provide a statement 
explaining the medical reason why your plan should approve the exception. 
What are my rights if I think my services are ending too soon? 
If youre getting Medicare services from a hospital, skilled nursing facility, home 
health agency, comprehensive outpatient rehabilitation facility, or hospice, and 
you think your Medicare-covered services are ending too soon (or that youre 
being discharged too soon), you can ask for a fast appeal (also known as an 
immediate appeal or an expedited appeal). Your provider will give you a 
notice before your services end telling you how to ask for a fast appeal. Read 
this notice carefully. If you dont get this notice, ask your provider for it. With a 
fast appeal, an independent reviewer, called a Beneciary and Family Centered 
Care-Quality Improvement Organization (BFCC-QIO), will decide if your covered 
services should continue. You can contact your BFCC-QIO for help with ling an 
appeal. Go to page 113.
A fast appeal only covers the decision to end services or discharge you from 
the hospital. You may need to start a separate appeals process for any items 
or services you may have gotten after the decision to end services. Visit 
Medicare.gov/publications to review the booklet, Medicare Appeals. SECTION 8: Your Medicare rights & protections 101
Whats an Advance Beneficiary Notice of
Non-coverage (ABN)?
If you have Original Medicare, your doctor, other health care provider, or 
supplier may give you a written notice if they think Medicare wont pay for 
the items or services youll get. This notice is called an Advance Beneciary 
Notice of Non-coverage, or ABN. The ABN lists the items or services that 
your doctor or health care provider expects Medicare will not pay for, along 
with an estimate of the costs for the items and services and the reasons why
Medicare may not pay. 
What happens if I get this notice? 
  Youll be asked to choose whether to get the items or services listed on 
the notice. 
  If you choose to get the items or services listed on the notice, youre 
agreeing to pay if Medicare doesnt. 
  Youll be asked to sign the notice to say that youve read and understood it. 
  Doctors, other health care providers, and suppliers dont have to 
(but still may) give you a notice for services that Medicare never covers. 
Go to page 55. 
  An ABN isnt an ocial denial of coverage by Medicare. If Medicare denies 
payment, you can still le an appeal once you get the Medicare Summary 
Notice (MSN) showing the item or service in question. However, youll 
have to pay for the items or services if Medicare decides that the items or 
services arent covered (and no other insurer is responsible for payment). 
Can I get a notice like this for other reasons? 
You may get a Skilled Nursing Facility ABN when the facility believes 
Medicare will no longer cover your stay or other items and services. 
What if I didnt get this notice? 
If your provider was required to give you this notice but didnt, in most 
cases, your provider must give you a refund for what you paid for the item or 
service. 
Where can I get more information? 
Visit Medicare.gov/basics/your-medicare-rights/your-protections to learn 
more about the dierent types of ABNs and what to do if you get one.
Note: If youre in a Medicare Advantage Plan, you have the right to ask 
the plan in advance if it covers a certain service, drug, or supply. Contact 
your plan to request and submit a pre-service request for an organization 
determination. The plans response will include instructions to le a timely 
appeal, if you want one. You also may get plan directed care. This is when a 
plan provider refers you for a service or to a provider outside the network 
without getting an organization determination in advance. Go to page 65. 102 SECTION 8: Your Medicare rights & protections
Your right to access your personal health information
By law, you or your legal representative generally have the right to review 
and/or get copies of your personal health information from health care 
providers who treat you and bill Medicare for your care. You also generally 
have a right to get this information from health plans that pay for your care, 
including Medicare. 
These types of personal health information include: 
  Claims and billing records 
  Information related to your enrollment in health plans, including Medicare 
  Medical and case management records 
  Other records that doctors or health plans use to make decisions about 
you 
Generally, you can get your information on paper or electronically. If your 
providers or plans store your information electronically, they generally must 
give you electronic copies, if you ask for them. You have the right to get 
your information in a timely manner, but it may take up to 30 days to get a 
response. If your information is electronic, you also may request to have it 
sent to a third party of your choosing, like a health care provider who treats 
you, a family member, or a researcher.
You may have to ll out a form to request copies of your information and pay 
a fee. This fee typically cant be more than the total cost of: 
  Labor for copying the information requested
  Supplies for creating the copy
  Postage (if you ask your health care provider to mail you a copy)
In most cases, you wont be charged for reviewing, searching, downloading, 
or sending your information through an electronic portal.
For more information, visit 
HHS.gov/hipaa/for-individuals/guidance-materials-for-consumers. 
If you need help getting and using your health records, the Oce of the 
National Coordinator for Health Information Technology (ONC) in the U.S. 
Department of Health & Human Services (HHS) created The Guide to 
Getting & Using Your Health Records. This guide can help you through the 
process of getting your health records and show you how to make sure your 
records are accurate and complete, so you can get the most out of your 
health care. Visit healthit.gov/how-to-get-your-health-record to review the 
guide.
How does Medicare use my personal information? 
Medicare protects the privacy of your health information. The next 2 pages 
describe how Medicare may use and give out your information and explain 
how you can get this information.  SECTION 8: Your Medicare rights & protections 103
Notice of Privacy Practices for Original Medicare 
This notice describes how medical information about you may be used 
and disclosed and how you can get access to this information. Please 
review it carefully. 
The law requires Medicare to protect the privacy of your personal medical 
information. It also requires us to give you this notice so you know how 
we may use and share (disclose) the personal medical information we 
have about you. 
We must provide your information to: 
  You, to someone you name (designate), or someone who has the 
legal right to act for you (your personal representative)
  The Secretary of the Department of Health & Human Services, if 
necessary 
  Anyone else that the law requires to have it 
We have the right to use and provide your information to pay for your 
health care and to operate Medicare. For example: 
  Medicare Administrative Contractors use your information to pay or 
deny your claims, collect your premiums, share your benet payment 
with your other insurer(s), or prepare your Medicare Summary Notice. 
  We may use your information to provide you with customer services, 
resolve complaints you have, contact you about research studies, and 
make sure you get quality care. 
We may use or share your information under these limited 
circumstances: 
  To state and other federal agencies that have the legal right to get 
Medicare data (like to make sure Medicare is making proper payments 
and to help federal/state Medicaid programs) 
  For public health activities (like reporting disease outbreaks) 
  For government health care oversight activities (like investigating fraud 
and abuse) 
  For judicial and administrative proceedings (like responding to a court 
order) 
  For law enforcement purposes (like providing limited information to 
nd a missing person) 
  For research studies that meet all privacy law requirements (like 
research to prevent a disease or disability) 
  To avoid a serious and imminent threat to health or safety 
  To contact you about new or changed Medicare benets 
  To create a collection of information that no one can trace to you 
  To health care providers and their business associates for care 
coordination and quality improvement purposes, like participation in an 
Accountable Care Organization (ACO) 104 SECTION 8: Your Medicare rights & protections
We dont sell or use and share your information to tell you about 
health products or services (marketing). We must have your written 
permission (an authorization) to use or share your information for any 
purpose that isnt described in this notice. 
You may take back (revoke) your written permission at any time, unless 
weve already shared information because you gave us permission. 
You have the right to: 
  Review and get a copy of the information we have about you. 
  Have us change your information if you think its wrong or incomplete, 
and we agree. If we disagree, you may have a statement of your 
disagreement added to your information. 
  Get a list of people who get your information from us. The listing wont 
cover information that we gave to you, your personal representative, or 
law enforcement, or information that we used to pay for your care or 
for our operations. 
  Ask us to communicate with you in a dierent manner or at a dierent 
place (for example, by sending materials to a PO Box instead of your 
home address). 
  Ask us to limit how we use your information and how we give it out 
to pay claims and run Medicare. We may not be able to agree to your 
request. 
  Get a letter that tells you about the likely risk to the privacy of your 
information (breach notication). 
  Get a separate paper copy of this notice. 
  Speak to a Customer Service Representative about our privacy 
notice. Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 
1-877-486-2048. 
If you believe your privacy rights have been violated, you may le a 
privacy complaint with: 
  The Centers for Medicare & Medicaid Services (CMS). Visit 
Medicare.gov or call 1-800-MEDICARE. 
  The U.S. Department of Health & Human Services (HHS), Oce for 
Civil Rights (OCR). Visit hhs.gov/hipaa/filing-a-complaint. 
Filing a complaint wont aect your coverage under Medicare.
The law requires us to follow the terms in this notice. We have the right to 
change the way we use or share your information. If we make a change, 
well mail you a notice within 60 days of the change. 
The Notice of Privacy Practices for Original Medicare became eective 
September 23, 2013. SECTION 8: Your Medicare rights & protections 105
How can I protect myself from fraud and medical
identity theft?
Medical identity theft is when someone steals or uses your personal 
information (like your name, Social Security Number, or Medicare number) to 
submit fraudulent claims to Medicare and other health insurance companies 
without your permission. When you get health care services, record the dates 
on a calendar and save the receipts and statements you get from providers 
to check for mistakes. If you think theres an error or a provider bills you for 
services you didnt get, take these steps to nd out what was billed: 
  Check your Medicare Summary Notice (MSN) if you have Original 
Medicare to nd out if the service was billed to Medicare. If youre in a 
Medicare health plan, check the statements you get from your plan. 
  Log into (or create) your secure Medicare account at Medicare.gov to 
review your Medicare claims if you have Original Medicare. Your claims 
are generally available online within 24 hours after processing. You can 
also use Medicares Blue Button to download your claims information. Go 
to page 109. You can also call 1-800-MEDICARE (1-800-633-4227). TTY 
users can call 1-877-486-2048. 
  If you know the health care provider or supplier, call and ask for an 
itemized statement. They should give this to you within 30 days. 
If youve contacted the provider and you suspect that Medicare is being 
charged for a service or supply that you didnt get, or you dont know the 
provider on the claim, call 1-800-MEDICARE. 
You can also call 1-800-MEDICARE if you believe your Medicare number has 
been used fraudulently. 
Only give personal information, like your Medicare number, to doctors, 
insurance companies (and their licensed agents or brokers), or plans acting 
on your behalf; or trusted people in the community who work with Medicare 
like your State Health Insurance Assistance Program (SHIP). Dont share 
your Medicare number or other personal information with any unsolicited 
person who contacts you by phone, email, or in person. Medicare, or your 
Medicare plan representative, will only call you in limited situations: 
  A Medicare plan can call you if youre already a member of the plan. The 
agent who helped you join can also call you.
  A customer service representative from 1-800-MEDICARE can call you if 
youve left a message, or a representative said that someone would call 
you back. 
  If you led a report of suspected fraud, you may get a call from someone 
representing Medicare to follow up on your investigation.
For more information about Medicare fraud, visit Medicare.gov or contact 
your local Senior Medicare Patrol. Learn more about the Senior Medicare 
Patrol and nd help in your state by going to smpresource.org or call 
1-877-808-2468. 106 SECTION 8: Your Medicare rights & protections
Plans must follow marketing rules 
Medicare plans and agents must follow certain rules when marketing their 
plans and getting your enrollment information. Plans dont need your 
personal information to provide a quote. Medicare plans cant sign you up 
for a plan over the phone unless you call them and ask to sign up, or youve 
given them permission to contact you. 
Important! Call 1-800-MEDICARE to report any plans or agents that: 
  Ask for your personal information over the phone or email 
  Call to enroll you in a plan 
  Visit you unexpectedly
  Use false information to mislead you 
You can also call the Medicare Drug Integrity Contractor (MEDIC) at 
1-877-7SAFERX (1-877-772-3379). The MEDIC ghts fraud, waste, and abuse 
in Medicare Advantage Plans and Medicare drug plans. 
Investigating fraud takes time 
Every tip counts. Medicare takes all reports of suspected fraud seriously. 
When you report fraud, you may not hear of an outcome right away. It takes 
time to investigate your report and build a case, but rest assured that your 
information is helping us protect Medicare. 
How the Medicare Beneficiary Ombudsman can help you 
A Medicare Beneciary Ombudsman helps you and your representatives with 
questions and complaints, and makes sure Medicare information is available 
to you. You can also provide feedback to the Ombudsman to help improve 
your experiences with Medicare. Visit Medicare.gov to learn more. 107
SECTION 9  
Get more information 
Get personalized help
1. Call us at 1-800-MEDICARE (1-800-633-4227); TTY users can call 
1-877-486-2048 
2. Live chat with us at Medicare.gov/talk-to-someone
3. Write us at PO Box 1270, Lawrence, KS 66044 
Get information 24 hours a day, including weekends 
  Speak clearly and follow the voice prompts to pick the category that best 
meets your needs.
  Have your Medicare card in front of you, and be ready to give your Medicare 
number.
  When asked for your Medicare number, say the numbers and letters clearly 
one at a time.
  If you need help in a language other than English or Spanish, or need to 
request a Medicare publication in an accessible format (like large print or 
braille), let the customer service representative know.
Important! If you need someone to be able to call 1-800-MEDICARE on your behalf 
You can complete an Authorization to Disclose Personal Health Information 
form that lets Medicare give your personal health information to someone 
other than you. To get this form, visit Medicare.gov/basics/forms-
publications-mailings/forms/other or call 1-800-MEDICARE. You can also 
submit this form at Medicare.gov in your Medicare account. Medicare must 
process the form before the authorization becomes eective. 
If your household got more than one copy of Medicare & You 
To get only one copy of this handbook in the future, call 1-800-MEDICARE. If you 
want to stop getting paper copies in the mail, you can request this by logging 
into (or creating) your Medicare account at Medicare.gov. 
If you need a new copy of your 
Medicare card
If you need to replace your card because its 
damaged or lost, visit Medicare.gov to log into 
(or create) your secure Medicare account to 
print or order an ocial copy of your Medicare 
card. You can also call 1-800-MEDICARE 
and ask for a replacement card to be sent in 
the mail. 
If you need to replace your card because you think that someone else is using 
your Medicare number, call 1-800-MEDICARE.
 Note: Go to pages 119122 for definitions of blue words.  108 SECTION 9: Get more information
State Health Insurance Assistance Programs (SHIPs) 
SHIPs are state programs that get money from the federal government to 
give local health insurance counseling to people with Medicare at no cost to 
you. SHIPs arent connected to any insurance company or health plan. They 
provide free, personalized counseling to you and your family to help with 
these and other Medicare questions: 
  Your Medicare rights 
  Billing problems
  Complaints about your medical care or treatment
  Plan comparison and enrollment
  How Medicare works with other insurance
  Finding help paying for health care costs
Call a SHIP in your state to get free personalized help with your Medicare 
questions, or learn how to become a volunteer SHIP counselor. Go to 
pages 115118 for the phone number of your local SHIP. 
Find general Medicare information online
Visit Medicare.gov 
  Get information about the Medicare health and drug plans in your area, 
including what they cost and what services they provide. 
  Find Medicare-participating doctors or other health care providers and 
suppliers. 
  Find out what Medicare covers, including preventive services (like 
screenings, shots or vaccines, and yearly Wellness visits). 
  Get Medicare appeals information and forms. 
  Get information about the quality of care provided by plans, nursing 
homes, hospitals, doctors, home health agencies, dialysis facilities, hospice 
centers, inpatient rehabilitation facilities, and long-term care hospitals. 
  Look up helpful websites and phone numbers. 
You can get this handbook in other languages, like Spanish, Chinese, 
Korean, or Vietnamese. Visit Medicare.gov/about-us/information-in-other-
languages.  SECTION 9: Get more information 109
Get personal Medicare information online
Create your own Medicare account
Visit Medicare.gov to log into (or create) your secure Medicare account. You 
can also:
  Add your prescriptions and pharmacies to help you better compare 
Medicare health and drug plans in your area.
  Sign up to get your yearly Medicare & You handbook and claims 
statements, called Medicare Summary Notices, electronically.
  Review your Original Medicare claims as soon as theyre processed. 
  Print a copy of your ocial Medicare card.
  Find a list of preventive services youre eligible to get in Original Medicare.
  Learn about your Medicare premiums, and pay them online if you get a bill 
from Medicare. 
Medicares Blue Button & Blue Button 2.0
Medicares Blue Button makes it easy for you to download your personal 
health information (like your Part A, Part B, and Part D claims) to a le on 
your computer or other device. By getting your information through Blue 
Button, you can:
  Print or email the information to share with others.
  Import your saved le into other computer-based personal health 
management tools.
Visit Medicare.gov and log into (or create) your secure Medicare account to 
use Blue Button. 
Medicares Blue Button 2.0 is a data service that makes it easy for you to 
share your Part A, Part B, and Part D claim information with authorized apps, 
services, and research programs. You authorize each app individually and you 
can return to your secure Medicare account online at Medicare.gov any time 
to change the way an app uses your information. 
Note: If youre enrolled in a Medicare Advantage Plan, only Part D 
information is available through Blue Button 2.0. Check with your plan to find 
out if they offer a similar data service to Blue Button 2.0. 
Remember: Treat your personal and health information the same way you 
treat other confidential information. 
To learn about how to use Blue Button to save your claim information, visit: 
  Medicare.gov/manage-your-health/share-your-medicare-claims  
  Medicare.gov/manage-your-health/medicares-blue-button-blue-
button-20/blue-button-apps 110 SECTION 9: Get more information
Find & compare health care providers
Visit Medicare.gov/care-compare to nd and compare the quality of care health 
care providers like nursing homes, hospitals, and doctors give their patients and 
residents. You can nd information about providers and facilities based on your 
individual needs, and get helpful resources to make more informed decisions 
about where you get your health care. Talk to your doctor or other health care 
provider when choosing a new provider. You can also ask what they think about 
the quality of care of other providers.
Find & compare Medicare health & drug plans
Visit Medicare.gov/plan-compare to nd and compare Medicare health and 
drug plans, including your current plan, if youve already joined one. You can 
compare the prices based on the drugs you take now and the pharmacies you 
choose to use, including monthly and yearly estimated drug costs. An overall 
star rating for each plan provides details about its quality and performance for 
the types of services it oers. 
Did you know that you can compare the quality of health care providers and 
Medicare plan services nationwide? Call your State Health Insurance Assistance 
Program (SHIP). Go to pages 115118 for the phone number of your local SHIP.
Medicare is working to better coordinate your care
Medicare continues to look for ways to better coordinate your care and to make 
sure that you get the best health care possible. 
Here are examples of how your health care providers can better coordinate your 
care: 
Accountable Care Organizations
An Accountable Care Organization (ACO) is a group of doctors, hospitals, and 
other health care providers that have teamed up to coordinate your health care.
Working as part of an ACO helps your doctors and other health care 
providers understand your health history and talk to one another about 
your care and your health care needs. This may save you time, money, 
and frustration by avoiding repeated tests and appointments. More 
coordination also helps prevent medical errors and unexpected drug 
interactions that may happen if one provider isnt aware of what another 
has prescribed you.
Important! An ACO wont limit your choice of health care providers. If your doctor or 
other provider is part of an ACO, you still have the right to visit any doctor, 
hospital, or other provider that accepts Medicare at any time.  SECTION 9: Get more information 111
In addition, if your primary care doctor participates in an Accountable 
Care Organization (ACO), you may be able to get expanded benets. For 
example, in some ACOs, your provider may oer more telehealth services. 
This means you may be able to get some services from home using 
technology, like your phone or a computer, to communicate in real time with 
your health care provider. 
In addition, a doctor or other provider who is part of an ACO may be able to 
send their patients for skilled nursing facility care or rehabilitation services 
even if they havent stayed in a hospital for 3 days rst, which is usually a 
requirement in Medicare. For you to qualify for this benet, your doctor or 
other provider has to decide that you need skilled nursing facility care and 
meet certain other eligibility requirements.
If your primary care doctor participates in an ACO and you have Original 
Medicare, youll get a written notice and nd a poster in their oce about 
their ACO participation. There are now hundreds of ACOs across the country. 
Log into (or create) your secure Medicare account at Medicare.gov and 
choose a primary care doctor who will help manage your health care in 
an ACO. 
Sharing your health care information with ACOs 
One of the most important benets of an ACO is that your doctors and 
other providers can communicate and coordinate your care. To help with 
that, Medicare allows your health care providers ACO to ask for certain 
information about your care. Having Medicare share your data in this way 
helps make sure all the people involved in your care have access to your 
health information when they need it to help you. 
If you dont want Medicare to share your health information with your 
doctors for care coordination, call 1-800-MEDICARE (1-800-633-4227) and 
let the representative know. TTY users can call 1-877-486-2048. Medicare 
may still share general information to measure provider quality.
To learn more about ACOs, visit Medicare.gov/manage-your-health/
coordinating-your-care/accountable-care-organizations or call 
1-800-MEDICARE.
Electronic Health Records
Electronic health records are a history of your medical conditions, health 
care, and treatment that your doctor, other health care provider, medical 
oce sta, or hospital keeps on a computer. 
  They can help lower the chances of medical errors, eliminate duplicate 
tests, and may improve your overall quality of care. 
  Your doctors electronic health records may be able to link to a hospital, 
lab, pharmacy, other doctors, or immunization information systems 
(registries), so the people who care for you can have a more complete 
picture of your health.  112 SECTION 9: Get more information
Electronic prescribing
This is an electronic way for your prescriber (your doctor or other health 
care provider whos legally allowed to write prescriptions) to send your 
prescriptions directly to your pharmacy. Electronic prescribing can save you 
money and time, and help keep you safe. 
Other ways to get Medicare information
Medicare emails
Visit Medicare.gov to create your secure Medicare account. Include your 
email address to get important reminders and information about Medicare.
Publications 
Visit Medicare.gov/publications to review, print, or download copies of 
publications on dierent Medicare topics. You can also call 1-800-MEDICARE 
(1-800-633-4227). TTY users can call 1-877-486-2048. Go to page 123 for 
information about getting publications in accessible formats at no cost.
Social media 
Stay up to date and connect with other people with Medicare by 
following us on Facebook (facebook.com/Medicare) and Twitter 
(twitter.com/MedicareGov). 
Videos 
Find videos about Medicare and other health care topics at 
YouTube.com/cmshhsgov.  SECTION 9: Get more information 113
Other helpful contacts
Social Security
Visit SSA.gov to apply for and sign up for Original Medicare, and nd out if 
you qualify for Extra Help with Medicare drug costs. Also, when you open a
personal my Social Security account, you can review your Social Security 
Statement, verify your earnings, change your direct deposit information,
request a replacement Medicare card, update your address, and more. Visit 
SSA.gov/myaccount to open your personal account. You can also call Social
Security at 1-800-772-1213. TTY users can call 1-800-325-0778.
Benefits Coordination & Recovery Center 
Contact the Benets Coordination & Recovery Center at 1-855-798-2627 to 
report changes in your insurance information or to let Medicare know if you 
have other insurance. TTY users can call 1-855-797-2627.
Beneficiary and Family Centered Care-Quality Improvement 
Organization
Contact your Beneciary and Family Centered Care-Quality Improvement 
Organization (BFCC-QIO) if you think Medicare coverage for your service
is ending too soon (like if your hospital says that you must be discharged 
and you disagree). You may have the right to a fast appeal. You can also
contact the BFCC-QIO or your states survey agency to ask questions, 
report complaints about the quality of care you or a loved one got for a
Medicare-covered service, or if you arent satised with your providers 
response to your concern. Call 1-800-MEDICARE (1-800-633-4227) to get
the phone number of your BFCC-QIO or your states survey agency. TTY 
users can call 1-877-486-2048. For more information, visit Medicare.gov/
claims-appeals/file-a-complaint-grievance/filing-a-complaint-about-your-
quality-of-care.
Department of Defense 
Get information about TRICARE For Life (TFL) and the TRICARE Pharmacy 
Program. 
TFL: 
1-866-773-0404, TTY: 1-866-773-0405  
tricare.mil/tfl 
tricare4u.com
TRICARE Pharmacy Program:
1-877-363-1303, TTY: 1-877-540-6261  
tricare.mil/pharmacy 
militaryrx.express-scripts.com 114 SECTION 9: Get more information
Department of Veterans Affairs (VA) 
Contact the VA if youre a veteran or have served in the U.S. military and you 
have questions about veteran benets. 
1-800-827-1000, TTY: 711  
va.gov  
eBenefits.va.gov 
Office of Personnel Management 
Get information about the Federal Employee Health Benets Program for 
current and retired federal employees. 
Federal retirees: 
1-888-767-6738, TTY: 711  
opm.gov/healthcare-insurance/Guide-Me/Retirees-Survivors 
Active federal employees: 
Contact your Benets Ocer. Visit apps.opm.gov/abo for a list of Benets 
Ocers. 
Railroad Retirement Board (RRB) 
If you get benets from the RRB, call them to change your address or name,
check eligibility, sign up for Medicare, replace your Medicare card, or report a 
death.
1-877-772-5772, TTY: 1-312-751-4701  
rrb.gov  SECTION 9: Get more information 115
State Health Insurance Assistance Programs (SHIPs)
For free, personalized help with questions about appeals, buying other 
insurance, choosing a health plan, buying a Medigap policy, and Medicare 
rights and protections.
Alabama Connecticut
State Health Insurance Assistance  Connecticuts Program for Health 
Program (SHIP)  Insurance Assistance, Outreach, 
1-800-243-5463 Information and Referral, 
Counseling, Eligibility Screening
(CHOICES) 
Alaska
1-800-994-9422
Medicare Information Oce 
1-800-478-6065 
Delaware
TTY: 1-800-770-8973
Delaware Medicare Assistance 
Bureau 
Arizona
1-800-336-9500
Arizona State Health Insurance 
Assistance Program (SHIP) 
Florida
1-800-432-4040
Serving Health Insurance Needs of 
Elders (SHINE) 
Arkansas
1-800-963-5337 
Senior Health Insurance  TTY: 1-800-955-8770
Information Program (SHIIP) 
1-800-224-6330
Georgia
Georgia State Health Insurance 
California
Assistance Program (SHIP) 
California Health Insurance  1-866-552-4464 (option 4)
Counseling & Advocacy Program 
(HICAP) 
Guam
1-800-434-0222
Guam Medicare Assistance 
Program (GUAM MAP) 
Colorado
1-671-735-7415
State Health Insurance Assistance 
Program (SHIP) 
Hawaii
1-888-696-7213
Hawaii SHIP 
1-888-875-9229 
TTY: 1-866-810-4379 116 SECTION 9: Get more information
Idaho Maine
Senior Health Insurance Benets  Maine State Health Insurance 
Advisors (SHIBA)  Assistance Program (SHIP) 
1-800-247-4422 1-800-262-2232
Illinois Maryland
Senior Health Insurance Program  State Health Insurance Assistance 
(SHIP)  Program (SHIP) 
1-800-252-8966  1-800-243-3425
TTY: 1-888-206-1327
Massachusetts
Indiana
Serving Health Insurance Needs 
State Health Insurance Assistance  of Everyone (SHINE) 
Program (SHIP)  1-800-243-4636 
1-800-452-4800  TTY: 1-877-610-0241
TTY: 1-866-846-0139
Michigan
Iowa
MMAP, Inc. 
Senior Health Insurance  1-800-803-7174
Information Program (SHIIP) 
1-800-351-4664 
Minnesota
TTY: 1-800-735-2942
Minnesota State Health 
Insurance Assistance Program/ 
Kansas
Senior LinkAge Line 
Senior Health Insurance  1-800-333-2433
Counseling for Kansas (SHICK) 
1-800-860-5260
Mississippi
MS State Health Insurance 
Kentucky
Assistance Program (SHIP) 
State Health Insurance Assistance  844-822-4622  
Program (SHIP) 
1-877-293-7447
Missouri
Missouri SHIP 
Louisiana
1-800-390-3330
Senior Health Insurance 
Information Program (SHIIP) 
Montana
1-800-259-5300
Montana State Health Insurance 
Assistance Program (SHIP) 
1-800-551-3191 SECTION 9: Get more information 117
Nebraska North Dakota
Nebraska SHIP  State Health Insurance 
1-800-234-7119 Counseling (SHIC) 
1-888-575-6611 
TTY: 1-800-366-6888
Nevada
Nevada Medicare Assistance 
Ohio
Program (MAP) 
1-800-307-4444 Ohio Senior Health Insurance 
Information Program (OSHIIP) 
1-800-686-1578 
New Hampshire
TTY: 1-614-644-3745
NH SHIP  ServiceLink 
Resource Center 
Oklahoma
1-866-634-9412
Oklahoma Medicare Assistance 
Program (MAP) 
New Jersey
1-800-763-2828
State Health Insurance Assistance 
Program (SHIP) 
Oregon
1-800-792-8820
Senior Health Insurance Benets 
Assistance (SHIBA) 
New Mexico
1-800-722-4134
New Mexico ADRC-SHIP 
1-800-432-2080
Pennsylvania
Pennsylvania Medicare Education 
New York
and Decision Insight (PA MEDI) 
Health Insurance Information  1-800-783-7067
Counseling and Assistance 
Program (HIICAP) 
Puerto Rico
1-800-701-0501
State Health Insurance Assistance 
Program (SHIP) 
North Carolina
1-877-725-4300 
Seniors Health Insurance  TTY: 1-878-919-7291
Information Program (SHIIP) 
1-855-408-1212
Rhode Island
Senior Health Insurance Program 
(SHIP) 
1-888-884-8721 
TTY: 401-462-0740 118 SECTION 9: Get more information
South Carolina Virginia
(I-CARE) Insurance Counseling  Virginia Insurance Counseling 
Assistance and Referrals for Elders  and Assistance Program (VICAP) 
1-800-868-9095 1-800-552-3402
South Dakota Washington
Senior Health Information &  Statewide Health Insurance 
Insurance Education (SHIINE)  Benets Advisors (SHIBA) 
1-800-536-8197 1-800-562-6900 
TTY: 1-360-586-0241
Tennessee
Washington D.C.
TN SHIP 
1-877-801-0044  DC SHIP 
TTY: 1-800-848-0299 202-727-8370
Texas West Virginia
Health Information Counseling  West Virginia State Health 
and Advocacy Program (HICAP)  Insurance Assistance Program 
1-800-252-9240 (WV SHIP) 
1-877-987-4463
Utah
Wisconsin
Senior Health Insurance 
Information Program (SHIP)  WI State Health Insurance
1-800-541-7735 Assistance Program (SHIP) 
1-800-242-1060 
TTY: 711
Vermont
Vermont State Health Insurance 
Wyoming
Assistance Program 
1-800-642-5119 Wyoming State Health Insurance 
Information Program (WSHIIP) 
1-800-856-4398
Virgin Islands
Virgin Islands State Health 
Insurance Assistance Program 
(VISHIP) 
1-340-772-7368 St. Croix area; 
1-340-714-4354 St. Thomas area 119
SECTION 10
Definitions 
Accountable Care Organization (ACO)
Groups of doctors, hospitals, and other health care professionals working 
together to give you high-quality, coordinated service and health care.
Assignment
An agreement by your doctor, provider, or supplier to be paid directly 
by Medicare, to accept the payment amount Medicare approves for the 
service, and not to bill you for any more than the Medicare deductible and
coinsurance. 
Benefit period
The way that Original Medicare measures your use of hospital and skilled 
nursing facility services. A benet period begins the day youre admitted 
as an inpatient in a hospital or skilled nursing facility. The benet period 
ends when you havent gotten any inpatient hospital care (or skilled care 
in a skilled nursing facility) for 60 days in a row. If you go into a hospital or 
a skilled nursing facility after one benet period has ended, a new benet 
period begins. You must pay the inpatient hospital deductible for each 
benet period. Theres no limit to the number of benet periods. 
Coinsurance
An amount you may be required to pay as your share of the cost for 
benets after you pay any deductibles. Coinsurance is usually a percentage 
(for example, 20%). 
Copayment
An amount you may be required to pay as your share of the cost for 
benets after you pay any deductibles. A copayment is a xed amount, like
$30.
Creditable prescription drug coverage
Prescription drug coverage thats expected to pay, on average, at least as 
much as Medicare drug coverage. This could include drug coverage from a 
current or former employer or union, TRICARE, Indian Health Service, VA, or 
individual health insurance coverage.
Critical access hospital
A small facility located in a rural area more than 35 miles (or 15 miles if 
mountainous terrain or in areas with only secondary roads) from another 
hospital or critical access hospital. This facility provides 24/7 emergency 
care, has 25 or fewer inpatient beds, and maintains an average length of 
stay of 96 hours or less for acute care patients. 120 SECTION 10: Definitions
Deductible
The amount you must pay for health care or prescriptions before Original 
Medicare, your Medicare Advantage Plan, your Medicare drug plan, or your
other insurance begins to pay. 
Demonstrations
Special projects, sometimes called pilot programs or research studies, 
that test improvements in Medicare coverage, payment, and quality of care. 
They usually operate only for a limited time, for a specic group of people, 
and in specic areas. 
Extra Help
A Medicare program to help people with limited income and resources pay 
Medicare prescription drug program costs, like premiums, deductibles, and 
coinsurance. 
Formulary
A list of prescription drugs covered by a prescription drug plan or another
insurance plan oering prescription drug benets. Also called a drug list. 
Inpatient rehabilitation facility
A hospital, or part of a hospital, that provides an intensive rehabilitation 
program to inpatients. 
Lifetime reserve days
In Original Medicare, these are additional days that Medicare will pay for 
when youre in a hospital for more than 90 days. You have a total of 60 
reserve days that can be used during your lifetime. For each lifetime reserve 
day, Medicare pays all covered costs except for a daily coinsurance. 
Long-term care hospital
Acute care hospitals that provide treatment for patients who stay, on 
average, more than 25 days. Most patients are transferred from an intensive
or critical care unit. 
Medicaid
A joint federal and state program that helps with medical costs for some 
people with limited income and (in some cases) resources. Medicaid 
programs vary from state to state, but most health care costs are covered if 
you qualify for both Medicare and Medicaid.
Medically necessary
Health care services or supplies needed to diagnose or treat an illness, 
injury, condition, disease, or its symptoms and that meet accepted 
standards of medicine.  SECTION 10: Definitions 112211
Medicare Advantage Plan (Part C)
A type of Medicare health plan oered by a private company that contracts 
with Medicare. Medicare Advantage Plans provide all of your Part A and
Part B benets, with a few exclusions, for example, certain aspects of clinical 
trials which are covered by Original Medicare even though youre still in the
plan. Medicare Advantage Plans include:
  Health Maintenance Organizations
  Preferred Provider Organizations
  Private Fee-for-Service Plans 
  Special Needs Plans 
  Medicare Medical Savings Account Plans
If youre enrolled in a Medicare Advantage Plan: 
  Most Medicare services are covered through the plan 
  Most Medicare services arent paid for by Original Medicare
  Most Medicare Advantage Plans oer prescription drug coverage
Medicare-approved amount
The payment amount that Original Medicare sets for a covered service or 
item. When your provider accepts assignment, Medicare pays its share and 
you pay your share of that amount. 
Medicare health plan
Plans oered by private companies that contract with Medicare to provide 
Part A, Part B, and in many cases, Part D benets. Includes Medicare 
Advantage Plans and certain other types of coverage (like Medicare Cost 
Plans, PACE programs, and demonstration/pilot programs).
Medicare plan
Any way other than Original Medicare that you can get your Medicare health 
or drug coverage. This term includes all Medicare health plans and Medicare 
drug plans. 
Medigap
Medicare Supplement Insurance sold by private insurance companies to ll 
gaps in Original Medicare coverage. 122 SECTION 10: Definitions
Premium
The periodic payment to Medicare, an insurance company, or a health care 
plan for health or prescription drug coverage.
Preventive services
Health care to prevent illness or detect illness at an early stage, when 
treatment is likely to work best (for example, preventive services include Pap 
tests, u shots, and screening mammograms). 
Primary care doctor
The doctor you go to rst for most health problems. They may talk with 
other doctors and health care providers about your care and refer you to 
them. 
Referral
A written order from your primary care doctor for you to visit a specialist or
get certain medical services. Without a referral, your plan may not pay for 
services from a specialist.
Service area
An area you must live in for the plan to accept you as a member. For plans 
that limit which doctors and hospitals you may use, its also generally the 
area where you can get routine (non-emergency) services. Plans can, and in 
some cases must, disenroll you if you move outside their service area. 
Skilled nursing facility (SNF) 
A nursing facility with the sta and equipment to give skilled nursing care 
and, in most cases, skilled rehabilitative services and other related health 
services.
Skilled nursing facility (SNF) care
Skilled nursing care and therapy services provided on a daily basis in a skilled 
nursing facility. Examples of skilled nursing facility care include physical
therapy or intravenous injections that can only be given by a physical 
therapist or a registered nurse. 123
Accessible Communications
Medicare provides free auxiliary aids and services, including information 
in accessible formats like braille, large print, data or audio les, relay 
services and TTY communications. If you request information in an 
accessible format, you wont be disadvantaged by any additional time 
necessary to provide it. This means youll get extra time to take any 
action if theres a delay in fullling your request. 
To request Medicare or Marketplace information in an accessible format 
you can:
1. Call us: 
For Medicare: 1-800-MEDICARE (1-800-633-4227) 
TTY: 1-877-486-2048 
For Marketplace: 1-800-318-2596 
TTY: 1-855-889-4325
2. Email us: altformatrequest@cms.hhs.gov
3. Send us a fax: 1-844-530-3676 
4. Send us a letter: 
Centers for Medicare & Medicaid Services 
Oces of Hearings and Inquiries (OHI) 
7500 Security Boulevard, Mail Stop DO-01-20 
Baltimore, MD 21244-1850 
Attn: Customer Accessibility Resource Sta (CARS)
Your request should include your name, phone number, type of 
information you need (if known), and the mailing address where we 
should send the materials. We may contact you for additional information.
Note: If youre enrolled in a Medicare Advantage Plan or Medicare drug 
plan, contact your plan to request its information in an accessible format. 
For Medicaid, contact your State Medical Assistance (Medicaid) oce. 124
Nondiscrimination Notice 
The Centers for Medicare & Medicaid Services (CMS) doesnt exclude, 
deny benets to, or otherwise discriminate against any person on the 
basis of race, color, national origin, disability, sex (including sexual 
orientation and gender identity), or age in admission to, participation 
in, or receipt of the services and benets under any of its programs and 
activities, whether carried out by CMS directly or through a contractor or 
any other entity with which CMS arranges to carry out its programs and 
activities.
You can contact CMS in any of the ways included in this notice if you have 
any concerns about getting information in a format that you can use. 
You may also le a complaint if you think youve been subjected to 
discrimination in a CMS program or activity, including experiencing issues 
with getting information in an accessible format from any Medicare 
Advantage Plan, Medicare drug plan, state or local Medicaid oce, or 
Marketplace Qualied Health Plans. There are 3 ways to le a complaint 
with the U.S. Department of Health & Human Services, Oce for Civil 
Rights:
1. Online:  
hhs.gov/civil-rights/filing-a-complaint/complaint-process/index.html
2. By phone:  
Call 1-800-368-1019. TTY users can call 1-800-537-7697.
3. In writing: Send information about your complaint to:
Oce for Civil Rights 
U.S. Department of Health & Human Services 
200 Independence Avenue, SW 
Room 509F, HHH Building 
Washington, D.C. 20201 125
Looking for help in other languages?
If you, or someone youre helping, has questions about Medicare, you have the right 
to get help and information in your language at no cost. To talk to an interpreter, call 
1-800-MEDICARE (1-800-633-4227).
       Medicare          (Arabic) 
.(1-800-633-4227) 1-800-MEDICARE      .     
(Armenian)
Medicare-,

1-800-MEDICARE (1-800-633-4227)
(Chinese-Traditional)
1-800-MEDICARE  
(1-800-633-4227).
                  (Farsi) 
         .            
.(1-800-633-4227) 1-800-MEDICARE
Francais (French) Si vous, ou quelquun que vous etes en train daider, a des questions au sujet de 
lassurance-maladie Medicare, vous avez le droit dobtenir de laide et de linformation dans votre 
langue a aucun cout. Pour parler a un interprete, composez le 1-800-MEDICARE (1-800-633-4227).
Deutsch (German) Falls Sie oder jemand, dem Sie helfen, Fragen zu Medicare haben, haben Sie das 
Recht, kostenlose Hilfe und Informationen in Ihrer Sprache zu erhalten. Um mit einem Dolmetscher 
zu sprechen, rufen Sie bitte die Nummer 1-800-MEDICARE (1-800-633-4227) an.
Kreyol (Haitian Creole) Si oumenm oswa yon moun w ap ede, gen kesyon konsenan Medicare,se 
dwa w pou jwenn ed ak enfomasyon nan lang ou pale a, san pou pa peye pou sa. Pou w pale avek yon 
entepret, rele nan 1-800-MEDICARE (1-800-633-4227).
Italiano (Italian) Se voi, o una persona che state aiutando, vogliate chiarimenti a riguardo del 
Medicare, avete il diritto di ottenere assistenza e informazioni nella vostra lingua a titolo gratuito. 
Per parlare con un interprete, chiamate il numero 1-800-MEDICARE (1-800-633-4227).
 (Japanese) Medicare () 
 ()1-800-MEDICARE  
(1-800-633-4227) 126
(Korean)          
             
.    1-800-MEDICARE(1-800-633-4227) .
Polski (Polish) Jezeli Panstwo lub ktos komu Panstwo pomagaja macie pytania dotyczace Medicare, 
maja Panstwo prawo do uzyskania bezpatnej pomocy i informacji w swoim jezyku. Aby rozmawiac z 
tumaczem, prosimy dzwonic pod numer telefonu 1-800-MEDICARE (1-800-633-4227).
Portugues (Portuguese) Se voce (ou alguem que voce esteja ajudando) tiver duvidas sobre a 
Medicare, voce tem o direito de obter ajuda e informacoes em seu idioma, gratuitamente. Para falar 
com um interprete, ligue para 1-800-MEDICARE (1-800-633-4227).
 (Russian)     ,   ,     
   (Medicare),        
   .    ,  
  1-800-MEDICARE (1-800-633-4227).
Espanol (Spanish) Si usted,o alguien que esta ayudando, tiene preguntas sobre Medicare, usted 
tiene el derecho a obtener ayuda e informacion en su idioma sin costo alguno. Para hablar con un 
interprete, llame al 1-800-MEDICARE (1-800-633-4227).
Tagalog (Tagalog) Kung ikaw, o ang isang tinutulungan mo, ay may mga katanungan tungkol sa 
Medicare, ikaw ay may karapatan na makakuha ng tulong atimpormasyon sa iyong lenguwahe ng 
walang gastos. Upang makipag-usap sa isang tagasalin ng wika, tumawag sa 1-800-MEDICARE  
(1-800-633-4227).
Tieng Viet (Vietnamese) Neu quy vi, hay nguoi ma quy vi ang giup o, co cau hoi ve Medicare, quy 
vi se co quyen uoc giup va co them thong tin bang ngon ngu cua minh mien phi. e noi chuyen 
qua thong dich vien, goi so 1-800-MEDICARE (1-800-633-4227).
Health Insurance Marketplace is a registered service mark of the U.S. Department of 
Health & Human Services.
Medicare & You isnt a legal document. Ocial Medicare Program legal guidance is 
contained in the relevant statutes, regulations, and rulings.
This product was produced at U.S. taxpayer expense.
Copies of this product are available free of charge at Medicare.gov  
or by calling 1-800-MEDICARE.  U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Blvd. 
Baltimore, MD 21244-1850
Ocial Business 
Penalty for Private Use, $300
CMS Product No. 10050  
January 2024
National Medicare Handbook
Moving? 
Visit SSA.gov, or call Social Security at 1-800-772-1213. 
TTY users can call 1-800-325-0778. If you get RRB benets, 
contact the RRB at 1-877-772-5772. TTY users can call 
1-312-751-4701. 
Necesita usted una copia de este manual en Espanol?
Llame al 1-800-MEDICARE (1-800-633-4227). Los usuarios de 
TTY pueden llamar al 1-877-486-2048.