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 civil service benefit

payments. If your benefits 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.

Read pages 3–8 in the booklet to see 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 choose to 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 get 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) into one plan. Most plans include

extra benefits, like vision, hearing, dental, and more.

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 2020

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).

• If you want drug coverage, you can join a 

separate Medicare drug plan (Part D).

• To help pay your out-of-pocket costs 

in Original Medicare (like your 20% 

coinsurance), you can also shop for and 

buy supplemental coverage.

• Can use any doctor or hospital that takes 

Medicare, anywhere in the U.S.

Part A

Part B

 You can add:

Part D

 You can also add:

Supplemental 

coverage

This includes a Medicare

Supplement Insurance

(Medigap) policy. Or, you can use 

coverage from a former employer 

or union, or Medicaid.

Medicare Advantage

(also known as Part C)

• Medicare Advantage is an “all in one” 

alternative to Original Medicare. These 

“bundled” plans include Part A, Part B, 

and usually Part D.

• Plans may have lower out-of-pocket costs 

than Original Medicare.

• In most cases, you’ll need to use doctors 

who are in the plan’s network.

• Most plans offer extra benefits that 

Original Medicare doesn’t cover—like 

vision, hearing, dental, and more.

Part A

Part B

 Most plans include:

Part D

Extra benefits

 Some plans also include:

Lower out-of-pocket-costs
Important decisions about 

your Medicare coverage

2 0 2 1

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 is covered. 

It’s 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 enroll in 

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 2021, the standard Part B premium is 

$148.50. You’ll pay more if you have a higher 

income. The premium amount can change 

each year. (See page 9 for more on costs.)

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. (See page 14.)

Decision 1: Should I sign up for 

Part B if I haven’t already?

If you 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’ll have to wait until the 

General Enrollment Period (January 1– 

March 31 each year) to sign up, and your 

coverage won’t start until July 1 of that 

year. 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. (See page 8 for the 

cost of the penalty.)

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’m covered 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 see if they require you 

to enroll in Part B. If your employer 

has 20 or more employees, 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’re covered by an employer or 

union group health plan based on 

that current employment.

– You’re under 65 and disabled, you 

or a family member is currently 

working, and you’re covered 

by an employer or union group 

health plan 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’re covered by the 

employer or union group health plan 

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 

your medical costs once you’re eligible 

for Medicare.

• You’re also not eligible for this Special 

Enrollment Period when this coverage 

ends. This means:

– You’ll have to wait until the General 

Enrollment Period (January 1–

March 31 each year) to sign up for 

Part B, and your coverage would 

start July 1 of that year.

– In most cases, you’ll pay a late 

enrollment penalty added to your 

monthly premium for as long as you 

have Part B coverage.
6

I have coverage through the Health 

Insurance Marketplace for individuals 

or families:

You should consider signing up for Part B 

and stopping 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 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 enroll in Part B under a Special 

Enrollment Period without a penalty. 

(See 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 enroll in Part B later, 

you won’t 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 coverage:

You must have Part B to keep your 

coverage. However, if you’re an active-duty 

service member or the spouse or dependent 

child of an active-duty service member, you 

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. (See 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. (See page 3.)

How much is the penalty if I 

enroll 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 $203 in 2021.

With Original Medicare, you:

• Can go to any doctor or hospital that 

takes Medicare, anywhere in the U.S.

• You 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).

• Can join a Medicare Drug Plan (Part D) 

to get drug coverage. (See page 11.)

• Can get supplemental coverage (like 

a Medigap policy) to help pay your 

remaining out-of-pocket costs (like your 

20% coinsurance). (See page 13.)

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

Original Medicare unless you enroll in a 

Medicare Advantage Plan.
10

Medicare Advantage (also 

known as Part C)

Medicare Advantage is an “all-in-one” 

alternative to Original Medicare. These 

“bundled” plans include Part A, Part B, and 

usually Part D (drug coverage). 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. (See page 12 for other 

times you can join.)

With Medicare Advantage, you:

• Can get extra benefits that Original 

Medicare doesn’t cover—like vision, 

hearing, dental, and more.

• Need to use providers who are in the 

plan’s network (for non-emergency or 

non-urgent care).

• 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 

prescription 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 enrolling in a Part D plan. Your 

plan must tell you each year if your drug 

coverage is creditable coverage. 

If you need prescription drug coverage, 

you have to sign up for it. You can get 

drug coverage by joining 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 join a 

Part D plan.

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, 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 prescription 

drug coverage. And, the penalty goes up the 

longer you wait to enroll.
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 leave 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 

make one 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: In certain 

situations, you may be able to join, switch, 

or drop Medicare Advantage or Medicare 

drug plans when certain events happen in 

your life. 

Your enrollment generally lasts for a 

calendar year.
13

Do I need a Medicare 

Supplement Insurance 

(Medigap) policy?

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 a Medigap policy?

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 enrolled in 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 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 

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 drug costs. To apply 

for this program, visit socialsecurity.

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 

Medical Assistance (Medicaid) office to 

learn more.

Get answers to your Medicare 

questions:

For questions about enrolling in Medicare, 

visit socialsecurity.gov, or call Social 

Security at 1-800-772-1213. 

For information about Medicare in general, 

and Medicare health and prescription

drug plans choices in your area, visit 

Medicare.gov, or call 1-800-MEDICARE.
CMS Product No. 12020 

December 2020

Paid for by the U.S. Department of 

Health and Human Services.

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.