How Medicare Works

More than 60 million Americans get their health care coverage through this federal insurance program for older Americans.

At 65, you become eligible for the program — which means you will need to set aside time around that milestone birthday to sift through many options so you can sign up for the coverage that meets your health needs and budget.

It’s up to you to get ready. No letter will arrive in the mail announcing it’s time to start making these decisions. What’s more, the timetable is specific — and important. You can start signing up three months before you turn 65, and you’ll have until three months after your birthday month to enroll. If you miss that deadline, you may end up paying higher premiums. If you are still working and have employer-sponsored health coverage, you can probably wait to sign up — but more about that later.

Original Medicare is health coverage managed by the federal government. Generally, there is a cost for each service. In most cases, you can go to any doctor, other health care provider, hospital, or another facility that is enrolled in Medicare and is accepting new Medicare patients. With a few exceptions, most prescriptions are not covered in Original Medicare. However, you can add drug coverage by joining a Medicare Prescription Drug Plan (Part D). With Original Medicare, you do not need to choose a primary care doctor. In most cases, with Original Medicare, you don’t need a referral to see a specialist, but the specialist must be enrolled in Medicare. You may already have employer or union coverage that may pay costs that Original Medicare does not. If not, you may want to buy a Medicare Supplement Insurance (Medigap) policy. Alternatively, you may wish to get a Medicare Part C, or, Medicare Advantage Plan.