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Home Knowledge CenterWhat is Medicare?

What is Medicare?

Learn the basics of Medicare, including what is the purpose of Medicare, how much does Medicare cost, what it covers, and more.

Medicare Overview

Medicare is a federal health plan. It was started in 1965 and first made available to people age 65 and over. It was then expanded to include people with certain disabilities and End-Stage Renal Disease/kidney failure. Medicare is broken up into parts that cover various types of care and services:

  • Part A (Original Medicare) covers hospital care and services.
  • Part B (Original Medicare) covers medical care and services, including preventive care.
  • Part D provides coverage for prescription drugs.
  • Part C is also called Medicare Advantage. These plans combine Part A and B (and often Part D prescription drug coverage) into a single convenient plan.
  • Medicare Supplement insurance policies (also known as Medigap) helps cover some of the costs that Original Medicare doesn’t.

Video: How Does Medicare Work

This 5-minute video explains the Medicare coverage options available, and the differences between them. (Length: 00:05:25)

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Video: How Does Medicare Work

What is the purpose of Medicare and who qualifies?

Medicare’s purpose is to provide national health coverage to the following:

  • Older adults, age 65 and over. This has been a traditional retirement age, when health insurance coverage through an employer might typically end. Medicare provides health coverage at a time of life when health care and prescription costs often increase.
  • People with certain disabilities, or End Stage Renal Disease. The purpose is to provide health coverage to those unable to work due to disability or kidney failure and therefore unable to get health coverage through an employer. Medicare ensures affordable access to care and services that could otherwise be costly.

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What are the main types of Medicare coverage?

In understanding the basics of Medicare, it’s important to learn the different types of Medicare coverage and what they generally offer:

  • Original Medicare is a fee-for-service health plan that has 2 parts: Part A (Hospital Insurance) and Part B (Medical Insurance). You can go to any doctor, supplier, hospital, or other facility that accepts Medicare, and is accepting new Medicare patients.
  • Medicare Advantage, also known as Part C, is a type of Medicare plan offered by a private company, like Cigna. These plans provide you with all your Medicare Part A and Part B benefits and may include plan extras not offered by Original Medicare.
  • Medicare Part D Prescription Drug Coverage provides optional prescription drug coverage to anyone with Medicare. Private companies, like Cigna, offer this as a standalone Part D plan or with select Medicare Advantage Plans.
  • Medicare Supplement (also known as Medigap) insurance includes plans offered by private companies like Cigna.1 Plans help cover costs that Original Medicare doesn’t, including deductibles, copays, and coinsurance.

What are the basics of Medicare?

Here’s a quick overview of what each part of Medicare covers and how they work together:

Part A and Part B (Original Medicare) is the federal government’s Medicare program:

  • Part A covers you for hospital care and services. This includes inpatient hospital stays, surgeries, and more.
  • Part B covers two types of services: medically necessary services (services or supplies needed to diagnose or treat a medical condition), and preventive services (health care to prevent illness or detect it in an early state, including doctors’ visits, preventive care, ambulance, and durable medical equipment).
  • Original Medicare works with:
    • Medicare Supplement Plans
    • Standalone Part D Prescription drug plans
    • Or, use it alone with no additional coverage

Learn more about Part A and B (Original Medicare)

Medicare Advantage Part C is part of the government’s Medicare program, but is offered and managed through private insurers like Cigna.

  • Includes Part A hospital and Part B medical coverage.
  • Part D prescription drug coverage is usually included.
  • Other coverage may include some basic dental, vision, and hearing depending on the plan and insurer you choose.
  • Part C works with:
    • Standalone Part D Prescription drug plans (if they are not already included as part of the Part C plan or cannot be included due to certain types of plan designs).

Learn more about Part C

Medicare Part D Prescription Drug Coverage is part of the government’s Medicare program, but is offered and managed through private insurers like Cigna.

  • Part D plans cover costs for various types of prescription drugs, depending on the plan you choose.
  • Part D works with:
    • Original Medicare (Part A and B)
    • Medicare Supplement policies
    • Many Medicare Advantage plans come with some prescription coverage already included

Learn more about Part D

What are the basics of Medicare Supplement Insurance (Medigap)?

Medicare Supplement Insurance is not part of the federal government’s Medicare program. These policies are sold through private insurers like Cigna and designed to help cover some expenses not covered by Original Medicare:

  • Helps pay Part A and sometimes Part B annual deductibles.2
  • Helps pay copays, coinsurance and other out-of-pocket costs you may owe for services.
  • Medicare Supplement works with:
    • Original Medicare, alone
    • Original Medicare plus Part D Prescription Drug plan

Learn more about Medicare Supplement

How does Medicare work?

Signing up for Medicare: When you turn 65 you must choose either to sign up for Original Medicare (Parts A and B) or a Medicare Advantage Plan through a private insurer.3

  • You are eligible to sign up during the 3 months before the month in which you turn 65, during your birthday month, and through the 3 months that follow your birthday month. So you have 7 months in which to sign up for Medicare.

If you have End Stage Renal Disease or a chronic condition or disability for which you receive Social Security benefits, you would be eligible for Medicare, regardless of age.

Medicare annual open enrollment: Medicare Open Enrollment usually runs from October 15 to December 7, each year. During that time you can decide if you want to make any changes to your current Medicare coverage.

For example, if you signed up for Original Medicare when you turned 65, you may decide you want to try a Medicare Advantage plan instead, or vice versa.

Signing up* for a Medicare Supplement Insurance policy (Medigap): If you are 65 or older and have signed up for Original Medicare then you may be eligible for a Medicare Supplement insurance plan. These plans are not part of the federal government’s Medicare program and are sold exclusively through private insurers.

Open Enrollment is a 6-month period when you can buy any Medicare Supplement policy sold in your state, even if you have pre-existing health conditions. This period automatically starts on the first day of the month that you meet both of the following 2 criteria:

  • You're 65 (or older) and
  • You’re enrolled in Medicare Part B (Medical Insurance)

*You can apply for a Medicare Supplement policy any time during the year, however during your Open Enrollment period, you are guaranteed Medicare Supplement coverage. When applying outside of your Open Enrollment period, you may be subject to restrictions based on your previous health history or current medical conditions, and you could also be denied acceptance.

How much does Medicare cost?

Medicare is not free. The different types of Medicare each have certain out-of-pocket costs:

  • Original Medicare Part A and Part B come with monthly premiums that vary from year to year, depending on your income level. Part A and Part B each has its own annual deductible, as well as copays and coinsurance for care and services. Learn more about Original Medicare
  • Part C, or Medicare Advantage plans, often come with low or no monthly premiums, depending on the plan. You will pay copays for specialist doctor visits, some of the cost for other various services and care, as well as copays for prescriptions if included in the plan. Costs and coverage can vary.
  • Part D prescription plans have a monthly premium, as well, and may also have a prescription deductible depending on the types of prescription drugs you need.
  • Medicare Supplement plans have monthly premiums, which help pay some of the health care costs that Original Medicare doesn’t cover.

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View State Disclosures, Exclusions, and Limitations

1 Insured by Cigna Health and Life Insurance Company, American Retirement Life Insurance Company, Loyal American Life Insurance Company or Cigna National Health Insurance Company. In Kansas, insured by Cigna National Life Insurance Company, Cigna Health and Life Insurance Company and Loyal American Life Insurance Company. American Retirement Life Insurance Company is not available to residents of Kansas. In Pennsylvania, Maryland North Carolina and Utah, insured by Cigna National Health Insurance Company domiciled in Ohio. In New Mexico, Idaho and Ohio, insured by Cigna Health and Life Insurance Company.

2 Plans F and High Deductible F include the Part B Deductible and are only available if you first become eligible for Medicare before January 1, 2020 (which means your 65th birthday occurred before January 1, 2020). Or you have qualified for Medicare due to disability before January 1, 2020.

3 You can sign up later if you have group plan coverage.

View Kansas disclosures, exclusions, and limitations

Notice for persons eligible for Medicare because of disability:

In the following states, all Medicare Supplement plans are available to persons eligible for Medicare because of disability: California, Colorado, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Kansas, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Missouri, Montana, New Hampshire, Oregon, Pennsylvania, South Dakota, Tennessee, Vermont, and Wisconsin.

Tennessee Medicare Supplement Policy Forms

Plan A: CNHIC-MS-AA-A-TN; Plan F: CNHIC-MS-AA-F-TN; Plan G: CNHIC-MS-AA-G-TN; Plan N: CNHIC-MS-AA-N-TN.

MS-SITE-AllMedicare2022

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Medicare Advantage and Medicare Part D Policy Disclaimers

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna contracts with Medicare to offer Medicare Advantage HMO and PPO plans and Part D Prescription Drug Plans (PDP) in select states, and with select State Medicaid programs. Enrollment in Cigna depends on contract renewal.

Medicare Supplement Policy Disclaimers

Medicare Supplement website content not approved for use in: Oregon.

AN OUTLINE OF COVERAGE IS AVAILABLE UPON REQUEST. We'll provide an outline of coverage to all persons at the time the application is presented.

Our company and agents are not connected with or endorsed by the U.S. Government or the federal Medicare program. This is a solicitation for insurance. An insurance agent may contact you. Premium and benefits vary by plan selected. Plan availability varies by state. Medicare Supplement policies are underwritten by Cigna National Health Insurance Company, Cigna Health and Life Insurance Company, American Retirement Life Insurance Company or Loyal American Life Insurance Company. Each insurer has sole responsibility for its own products.

The following Medicare Supplement Plans are available to persons eligible for Medicare due to disability: Plan A in Arkansas, Connecticut, Indiana, Maryland, Oklahoma, Texas, and Virginia; Plans A, F, and G in North Carolina; and Plans C and D in New Jersey for individuals aged 50-64. Medicare Supplement policies contain exclusions, limitations, and terms under which the policies may be continued in force or discontinued. For costs and complete details of coverage, contact the company.

This website is designed as a marketing aid and is not to be construed as a contract for insurance. It provides a brief description of the important features of the policy. Please refer to the policy for the full terms and conditions of coverage.

American Retirement Life Insurance Company, Cigna National Health Insurance Company and Loyal American Life Insurance Company do not issue policies in New Mexico.

Kansas Disclosures, Exclusions and Limitations

Medicare Supplement Policy Forms: Plan A: CNHIC-MS-AA-A-KS, CNHIC-MS-AO-A-KS; Plan F: CNHIC-MS-AA-F-KS, CNHIC-MS-AO-F-KS; Plan G: CNHIC-MS-AA-G-KS, CNHIC-MS-AO-G-KS; Plan N: CNHIC-MS-AA-N-KS, CNHIC-MS-AO-N-KS

Exclusions and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare Eligible Expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible;

(2) any expense which You are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if You were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare Eligible Expense except as provided previously in this policy;

(6) any deductible, Coinsurance or Co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy; or

(7) Preexisting Conditions: We will not pay for any expenses incurred for care or treatment of a Preexisting Condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if You applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy You had at least six (6) months of prior Creditable Coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If You had less than six (6) months prior Creditable Coverage, the Preexisting Conditions limitation will be reduced by the aggregate amount of Creditable Coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied.

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Y0036_23_788405_M | Page last updated 10/01/2022.