Important decisions about your new Medicare coverage

Welcome to Medicare! You now have Medicare Part A and/or Part B. Your enclosed 

Medicare card shows when your coverage starts.

• Medicare Part A (Hospital Insurance)—helps cover hospital care, skilled nursing care, and 

more. Most people don’t need to pay a premium for Part A.

• Medicare Part B (Medical Insurance)—helps cover doctors’ services, outpatient care, and 

more. Part B is optional, and you pay a monthly premium for it.

Make these 2 important decisions now:

Decision 1: Should I sign up for Part B?

• If you’re already signed up for Part B—you don’t need to do anything. Medicare will 

automatically deduct the premium from your monthly Social Security or Railroad 

Retirement Board benefits (or federal civil service annuities). If your benefits or annuities 

aren’t enough to cover your premium or you don’t get benefits, you’ll get a bill for your 

Part B premium every 3 months.

• If you want Part B—contact Social Security to find out when you can sign up. 

• If you don’t want Part B now—you can sign up later. However, you may have to wait for 

your coverage to start and pay a monthly penalty (that’s added to your premium) for as 

long as you have Part B.

Read pages 3–8 in the booklet to find out if you should sign up for Part B (based on 

your situation).

Decision 2: If I signed up for Part B, which way should I get Medicare health coverage?

• Original Medicare—includes Part A and Part B. You can buy supplemental coverage from 

a private company to help pay your out-of-pocket costs. You can also add Medicare drug 

coverage (Part D).

• Medicare Advantage—a Medicare-approved plan from a private company that bundles 

your Part A, Part B, and usually drug coverage (Part D). Plans may offer some extra 

benefits that Original Medicare doesn’t cover, like vision, hearing, and dental services. 

Read pages 8–14 in the booklet for additional and important information to make 

your decision. Turn this page over for your options at-a-glance.

Soon, we’ll mail your official “Medicare & You” handbook with more information. You can 

also visit Medicare.gov anytime for details about getting started with Medicare. 

Enclosures

CMS Product No. 12020

December 2022

DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services

7500 Security Boulevard

Baltimore, Maryland 21244 -1850
Your Medicare options

There are 2 main ways to get your Medicare coverage:

Original Medicare

• Original Medicare includes Medicare 

Part A (Hospital Insurance) and Part B 

(Medical Insurance).

• You can join a separate Medicare drug plan 

to get Medicare drug coverage (Part D).

• You can use any doctor or hospital that 

takes Medicare, anywhere in the U.S.

• To help pay your out-of-pocket costs 

in Original Medicare (like your 20% 

coinsurance), you can also shop for and buy 

supplemental coverage.

Part A

Part B

 You can add:

Part D

 You can also add:

Supplemental 

coverage

This includes Medicare

Supplement Insurance

(Medigap). Or, you can use 

coverage from a former employer 

or union, or Medicaid.

Medicare Advantage

(also known as Part C)

• Medicare Advantage is a Medicareapproved plan from a private company 

that offers an alternative to Original 

Medicare for your health and drug 

coverage. These “bundled” plans include 

Part A, Part B, and usually Part D.

• In most cases, you can only use doctors 

who are in the plan’s network.

• Plans may have lower out-of-pocket costs 

than Original Medicare.

• Plans may offer some extra benefits that 

Original Medicare doesn’t cover—like 

vision, hearing, and dental services.

Part A

Part B

 Most plans include:

Part D

Some extra benefits

 Some plans also include:

Lower out-of-pocket costs
Important decisions about 

your Medicare coverage

2 0 2 3

Welcome

toMedicare
2

Now’s the time to make some important 

decisions about your Medicare coverage.

Read this booklet carefully before you 

make any decisions.

Medicare Overview

Medicare Part A (Hospital Insurance)

helps cover inpatient care in hospitals, 

skilled nursing facility care, hospice care, 

and home health care. 

Medicare Part B (Medical Insurance)

helps cover services from doctors and 

other health care providers, outpatient 

care, durable medical equipment (like 

wheelchairs, walkers, hospital beds, and 

other equipment), and many preventive 

services (like screenings, shots or vaccines, 

and yearly “Wellness” visits). 

Visit Medicare.gov/coverage, or use our 

“What’s covered” mobile app to find out if 

your test, item, or service. “What’s covered” 

is available for free on both the App 

Store and Google Play. You can also call 

1-800-MEDICARE (1-800-633-4227). TTY 

users can call 1-877-486-2048.

Note: If you’re not lawfully present in the 

U.S., Medicare won’t pay for your 

Part A and Part B claims, and you can’t join 

a Medicare Advantage Plan or a Medicare 

drug plan (Part D).
3

What does Part B cost?

You’ll pay a monthly premium for Part B. 

In 2023, the standard Part B premium is 

$164.90. You’ll pay more if you have a higher 

income. The premium amount can change 

each year. (Get details on page 9.)

If you have limited income and resources, 

you may be able to get help from your state 

to pay your Part B premium if you meet 

certain conditions. (Get details on page 14.)

Decision 1: Should I sign up for 

Part B?

If you already signed up for Part B, skip to 

Decision 2 on page 8. If you don’t sign up for 

Part B and you don’t have other coverage 

based on active or current employment, 

there are some risks:

• You most likely will have to pay all of the 

costs for doctors’ services, outpatient care, 

medical supplies, and preventive services.

• If you change your mind and want to get 

Part B later, you may have to wait until 

the General Enrollment Period (January 

1– March 31 each year) to sign up. This 

may cause a gap in your health coverage.

• In most cases, if you decide you want 

Part B later, you’ll also have to pay a late 

enrollment penalty for as long as you 

have Part B coverage. The penalty
4

amount is added to your monthly Part B 

premium, and it goes up the longer you 

go without Part B coverage. (Get penalty 

details on page 8.)

Whether it’s best for you to sign up for 

Part B depends on your situation. The next 

few pages cover common situations and 

explain the risks for not signing up for Part B.

Common Situations

I’m still working and have coverage 

through my employer. Or, my spouse 

(or my family member, if I’m disabled) 

is still working and I have coverage 

through his or her employer:

• You may need to sign up for Part B right 

away if your employer has less than 20 

employees. Check with your benefits 

administrator to find out if they require 

you to sign up for Part B. If you don’t sign 

up for Part B and continue coverage with 

your employer, you may be able to sign up 

for Part B later during a Special Enrollment 

Period without a late enrollment penalty if:

– You’re 65 or older, you or your 

spouse is currently working, and 

you have employer or union group 

health plan coverage based on that 

current employment.

– You’re under 65 and disabled, you 

or a family member is currently 

working, and you have employer or 

union group health plan coverage 

based on that current employment. 
5

(If the group health plan coverage is 

based on the current employment 

of a family member, the employer 

must have 100 or more employees.)

If you’re eligible for this Special Enrollment 

Period, you can sign up for Part B:

• Anytime while you have employer or 

union group health plan coverage based 

on current employment.

• For up to 8 months after the group health 

plan coverage or the employment ends, 

whichever happens first.

I’m retired and have coverage through 

a former employer, or I have COBRA or 

VA coverage:

• You may need both Part A and Part B to 

get full benefits from this coverage, and 

your current coverage might not pay or 

only pay a small portion of your medical 

costs once you’re eligible for Medicare 

(even if you aren’t enrolled in Medicare). 

• Contact your State Health Insurance 

Assistance Program (SHIP) at shiphelp.

org, or call 1-877-486-2048 for free, 

personalized help deciding whether to 

sign up for Medicare.

• You aren’t eligible for a Special 

Enrollment Period when this coverage 

ends. This means:

– You may have to wait until the 

General Enrollment Period (January 

1–March 31 each year) to sign up 

for Part B.
6

– In most cases, you’ll pay a late 

enrollment penalty added to your 

monthly premium for as long as you 

have Part B coverage.

I have coverage through the Health 

Insurance Marketplace® for individuals 

or families:

You should consider these things when 

deciding whether to sign up for Part B and 

stop your Marketplace plan when your 

Medicare starts. Generally:

• You won’t qualify for help from the 

Marketplace to pay your Marketplace 

premiums or other medical costs. If 

you continue to get help to pay your 

Marketplace premiums after your 

Medicare Part A eligibility starts, you 

may have to pay back all or part of the 

help you got when you file your federal 

income taxes. 

• Your plan may not renew your 

Marketplace coverage at the end of the 

year. This means you and your family 

could have a gap in your coverage starting 

January 1 of the next year. 

• You may not be eligible for a Medicare 

Special Enrollment Period. This 

means you’ll have to wait for a General 

Enrollment Period (January 1–March 31 

each year) to sign up, and you may have 

to pay a late enrollment penalty for as 

long as you have Part B coverage.
7

I have employer coverage through the 

Marketplace (sometimes called Small 

Business Health Options Program or 

“SHOP” coverage): 

You may be able to wait until you stop 

working or no longer have SHOP coverage 

to sign up for Part B under a Special 

Enrollment Period without a penalty. (Get 

details on page 4.) Visit HealthCare.gov and 

Medicare.gov to learn more.

I have coverage through a private 

insurance plan (not through the 

Health Insurance Marketplace® or an 

employer):

• If you get Part B, Medicare will pay 

its part of the costs for any health care 

services you get, and then any amount 

Medicare doesn’t cover can be submitted 

to your private plan.

• If you choose to sign up for Part B later, 

you may not be eligible for a Special 

Enrollment Period, so you’ll have to wait 

to sign up. Also, you may have to pay a 

late enrollment penalty for as long as you 

have Part B coverage. (See page 8.)

I have TRICARE coverage (insurance 

for active-duty military, military retirees, 

and their families) or CHAMPVA:

Military retirees and their families must have 

Part B to keep their coverage. However, if 

you’re an active-duty service member or the 

spouse or dependent child of an active-duty 

service member, you can get Part A, but don’t 

have to get Part B right away.
8

I have Medicaid:

You should sign up for Part B. Medicare will 

pay first, and Medicaid will pay second. Your 

state may also help pay for your Medicare 

premiums. (Get details on page 14.)

I don’t have other medical insurance:

You should sign up for Part B, so you have 

coverage for things like doctors’ services or 

preventive services. Be aware of the risks for 

not signing up for Part B. (Details on page 13.)

How much is the penalty if I 

sign up later?

If you sign up for Part B later and you aren’t 

eligible for a Special Enrollment Period, 

you’ll pay 10% more for each full 12-month 

period you could’ve had Part B but didn’t 

take it. In most cases, you’ll have to pay this 

late enrollment penalty each time you pay 

your premiums, for as long as you have Part 

B. The penalty increases the longer you go 

without Part B coverage.

Decision 2: Choose which way to 

get Medicare health coverage.

If you signed up for Part B, you have 2 main 

ways to get your Medicare coverage:

Original Medicare

 or

Medicare Advantage
9

Original Medicare

Original Medicare includes Part A and 

Part B. When you get services, you’ll pay 

a deductible, and you usually pay 20% of 

the cost of the Medicare-approved service, 

called coinsurance.

The deductible for Part B is $226 in 2023.

With Original Medicare, you:

• Can go to any doctor or hospital that 

takes Medicare, anywhere in the U.S.

• Don’t need a referral to see a specialist, in 

most cases.

• Generally pay a portion of the cost for 

each covered service. There’s no yearly 

limit on what you pay out of pocket, 

unless you have supplemental coverage 

(like a Medigap policy, Medicaid, or 

employer or union coverage).

• Can join a separate Medicare drug plan 

(Part D). (Get details on page 11.)

• Can get supplemental coverage (like 

a Medigap policy) to help pay your 

remaining out-of-pocket costs (like your 

20% coinsurance). (Get details on 

page 13.)

When you sign up for Part B, you’ll have 

Original Medicare unless you join a 

Medicare Advantage Plan.
10

Medicare Advantage (also 

known as Part C)

Medicare Advantage is an alternative to 

Original Medicare. These “bundled” plans 

include Part A, Part B, and usually drug 

coverage (Part D). These plans are approved 

and follow the rules set by Medicare. The 

costs in plans vary, and plans may have 

lower out-of-pocket costs than Original 

Medicare. You must have both Medicare 

Part A and Part B to join.

You can join a Medicare Advantage Plan 

when you first become eligible for Medicare. 

For most, this period starts 3 months before 

you turn 65 and ends 3 months after the 

month you turn 65. (Get details on page 12 

for other times you can join.)

With Medicare Advantage, you:

• Can get some extra benefits that Original 

Medicare doesn’t cover—like vision, 

hearing, and dental services.

• Need to use providers who are in the 

plan’s network (for non-emergency or 

non-urgent care) in most cases.

• May pay a premium for the plan in 

addition to the monthly Part B premium. 

Plans may have a $0 premium or may help 

pay all or part of your Part B premiums.

• Don’t need and can’t buy a Medigap 

policy.
11

Do I need Medicare 

drug coverage (Part D)?

If you don’t have prescription drug 

coverage, or the coverage you have isn’t at 

least as good as Medicare drug coverage 

(called creditable coverage), you should 

consider joining a Part D plan. Your 

plan must tell you each year if your drug 

coverage is creditable coverage. 

If you want Medicare drug coverage, 

you can join a Medicare drug plan or a 

Medicare Advantage Plan that includes 

drug coverage.

You have up to 3 months after your 

Medicare coverage first starts to get 

Medicare drug coverage.

If you don’t get Medicare drug coverage 

when you’re first eligible for Medicare, and 

you don’t have creditable prescription drug 

coverage or Extra Help (get details on page 

15), you may have to pay a late enrollment 

penalty, if you join later. Generally, you’ll 

pay this penalty for as long as you have 

Medicare drug coverage. And, the penalty 

goes up the longer you wait to join.

Note: Medicare drug coverage (Part D) 

is included in most Medicare Advantage 

Plans. In most types of Medicare Advantage 

Plans, you can’t join a separate Medicare 

drug plan.
12

Choosing and joining a plan

You can compare ways to get your 

Medicare coverage and explore how 

different plans work together. You can 

also shop and compare plans to find ones 

that meet your needs. Visit Medicare.gov/

plan-compare, call 1-800-MEDICARE, or 

contact the plan directly.

If you didn’t join a Medicare Advantage 

Plan or a Medicare drug plan when you 

were first eligible, you’ll have at least one 

chance each year to make changes to your 

Medicare coverage:

October 15-December 7: You can join, 

switch, or drop a Medicare Advantage 

Plan or a Medicare drug plan during this 

period each year. Your new coverage will 

begin on January 1 of the following year.

January 1-March 31: If you’re in a 

Medicare Advantage Plan, you can change 

to a different Medicare Advantage Plan or 

switch base to Original Medicare (and join 

a stand-alone Medicare drug plan) once 

during this time.

Special Enrollment Periods: You may 

be able to join, switch, or drop Medicare 

Advantage or Medicare drug plans when 

certain events happen in your life (like if 

you move, lose other insurance coverage, 

or for exceptional circumstances). For 

more information, visit Medicare.gov, or 

call 1-800-MEDICARE (1-800-633-4227). 

TTY users can call 1-877-486-2048. 
13

Do I need Medicare Supplement 

Insurance (Medigap)?

Original Medicare pays for much, but 

not all, of the cost for covered health care 

services and supplies. If you choose Original 

Medicare, you may be able to buy a Medicare 

Supplement Insurance (Medigap) policy 

from a private company to help pay your outof-pocket costs in Original Medicare (like 

your 20% coinsurance). You need both 

Part A and Part B to buy a Medigap policy.

Medigap policies:

• Can cover costs like coinsurance, 

copayments, and deductibles.

• May offer coverage for services that Original 

Medicare doesn’t cover, like medical care 

when you travel outside the U.S.

• Generally don’t cover long-term care (like 

care in a nursing home), vision, dental, 

hearing aids, private-duty nursing, or 

prescription drugs.

When can I get Medigap?

The best time to buy a Medigap policy is 

during your Medigap Open Enrollment 

Period. This 6-month period begins on the 

first day of the month in which you’re 65 

or older and have Part B. (Some states have 

additional Open Enrollment Periods.) After 

this enrollment period, you may not be 

able to buy a Medigap policy. If you’re able 

to buy one, it may cost more.
14

Tip: If you buy a Medigap policy during 

this time, you can buy any Medigap policy 

sold in your state, even if you have health 

problems.

If you’re under 65, you might not be able 

to buy the Medigap policy you want, or 

any Medigap policy, until you turn 65. 

If you’re able to buy one when you’re 

under 65, it may cost more.

Visit Medicare.gov/plan-compare to learn 

more and compare Medigap policies in 

your area, or call 1-800-MEDICARE.

Help for People with Limited 

Income and Resources

You may be able to get help paying for 

some of your health care and prescription 

drug costs.

• Medicaid and Medicare Savings 

Programs—States have programs that 

help pay Medicare costs for people with 

limited income and resources. Visit 

Medicare.gov to learn more. You can 

also call 1-800-MEDICARE 

(1-800-633-4227) to get the number for 

your state Medicaid office. TTY users 

can call 1-877-486-2048.
15

• Extra Help with Part D prescription 

drug costs—If you have limited income 

and resources, you may qualify to get 

help paying your Medicare drug costs. 

To apply for this program, visit ssa.gov/

i1020, or call Social Security at 

1-800-772-1213. TTY users can call 

1-800-325-0778.

• Supplemental Security Income (SSI)— 

SSI is a monthly benefit paid by Social 

Security to people with limited income 

and resources who are disabled, blind, 

or 65 or older. For more information, 

contact Social Security.

Note: If you live in a U.S. Territory, there 

are different programs to help you pay your 

Medicare costs. Call your local Medicaid 

office to learn more.

Get answers to your Medicare 

questions:

For questions about signing up for Medicare, 

visit ssa.gov, or call Social Security at 

1-800-772-1213. 

For general Medicare information and to 

find plans in your area, visit Medicare.gov, 

or call 1-800-MEDICARE (1-800-633-4227) 

TTY users can call 1-877-486-2048.

For free, personalized health insurance 

counseling, visit shiphelp.org to contact 

your State Health Insurance Assistance 

Program (SHIP).
CMS Product No. 12020 

December 2022

This product was produced at 

U.S. taxpayer expense.

You have the right to get Medicare 

information in an accessible format, like large 

print, braille, or audio. You also have the right 

to file a complaint if you feel you’ve been 

discriminated against. Visit Medicare.gov/

about-us/accessibility-nondiscriminationnotice, or call 1-800-MEDICARE 

(1-800-633-4227) for more information. 

TTY users can call 1-877-486-2048.

Health Insurance Marketplace® is a 

registered service mark of the U.S. 

Department of Health & Human Services.