Medicare is health insurance. When you work, some of the money you earn automatically comes out of your paycheck and goes into a Medicare fund with other people’s contributions. If you have to stop working because of a disability, Medicare will take money from this fund and use it to help you pay for your medical costs.You can also get Medicare health coverage if you are over 65 years old.

Like any insurance program, there are detailed rules about who can participate in Medicare and there are limits to what medical costs Medicare will help pay for.

The federal government is in charge of Medicare. Some parts of Medicare are now run by private companies, but those companies have to follow rules laid out by Medicare.

Medicare is actually a collection of related programs. Each program will help pay for a different aspect of your medical care. The programs are called “parts” and are named by letters. In general:

  • Medicare Part A helps pay for medical care you get while you’re in a hospital.
  • Medicare Part B helps pay for medical care you get outside of a hospital (when you go to the doctor’s office, for example).
  • Medicare Part C, also known as Medicare Advantage, is a way to get Part A, B, and sometimes Part D coverage through a private company.
  • Medicare Part D helps pay for prescription drugs.

Each Medicare part has different rules for how you sign up, how much it costs, which medical costs it helps with, and how much of the costs it will help pay for.

There are programs that can help you pay your Medicare costs if you have limited income. Programs that help pay the costs of Parts A or B are called Medicare Savings Programs. Programs that help pay the costs of Part D are called Low Income Subsidy.

Highlights

Closing the Donut Hole

In the past, Medicare Part D has had a gap in prescription drug coverage called the “donut hole.” Before the ACA, a person had to pay for 100% of their prescription drug costs while in the donut hole.

  • Since January 1, 2011, this has changed. Each year, people on Medicare who fall within the donut hole get a discount on their prescription drugs, to help cover their out-of-pocket costs while in the donut hole. The discount gets larger each year. In 2017 the discount is 60% for brand name prescriptions and 49% for generic drugs.
  • This discount will continue to grow until 2020, when the donut hole coverage gap is closed completely. At that point people with Medicare Part D will simply pay 25% of the cost of their prescription drugs.

Preventive Services

People on Medicare Part B are able to get a free wellness visit and personalized prevention plan each year. There are also no copayment, deductible, or coinsurance charges for recommended preventive services, like certain vaccines and cancer screening.

Medicare and MNsure

The Medicare Open Enrollment Period is from October 15 to December 7 of each year. This is the time when you can make changes to your Medicare Part D or Medicare Advantage plan. The Medicare Open Enrollment Period happens to overlap with MNsure's Open Enrollment. MNsure is a completely separate program.

  • If you have Medicare now, you can keep your coverage. You do not need to do anything with MNsure, which is the health insurance marketplace for Minnesota.
  • You cannot use MNsure to get information about or to sign up for Medicare, Medicare supplements (also called Medigap policies), or Medicare Advantage plans.