2024
Medicare
& You
The official U.S. government
Medicare handbook
What’s new &
important?
Medicare strives to improve access to affordable treatments to keep you healthy.
Check out what’s new this year to help you manage your health.
Saving money on your prescription drugs
Starting January 1, 2024, if you have Medicare drug coverage (Part D) and your drug
costs are high enough to reach the catastrophic coverage phase, you don’t have to pay
a copayment or coinsurance. Extra Help—a program that helps cover your Part D drug
costs—will expand to cover more drug costs for certain people with limited resources
and income. Go to pages 83 and 92.
Coinsurance amounts for some Part B-covered drugs may be less if a prescription
drug’s price increased higher than the rate of inflation. Go to page 40.
Lower costs for insulin and vaccines
Your Medicare drug plan can't charge you more than $35 for a one-month supply of
each insulin product Part D covers, and you don’t have to pay a deductible for it. Go to
page 88.
If you take insulin through a traditional pump that’s covered under Medicare’s durable
medical equipment benefit, that insulin is covered under Medicare Part B. You won’t
pay more than $35 for a month’s supply and the Medicare deductible no longer
applies. Go to pages 39 and 88.
Recommended adult vaccines are also now available at no cost to you. Go to page 50.
Changes to telehealth coverage
You can still get telehealth services at any location in the U.S., including your home,
until the end of 2024. After that, you must be in an office or medical facility located in
a rural area to get most telehealth services. There are some exceptions, like for mental
health services. Go to page 51.
Managing and treating chronic pain
Medicare now covers monthly services to treat chronic pain if you’ve been living with it
for more than 3 months. Go to page 34.
Better mental health care
Starting January 1, 2024, Medicare will cover intensive outpatient program services
provided by hospitals, community mental health centers, and other locations if you
need mental health care. Go to pages 46–47.
More times to sign up for Medicare
If you recently lost (or will soon lose) Medicaid, you may be able to sign up for
Medicare or change your current Medicare coverage. There are other special situations
that allow you to sign up for Medicare. Go to page 18.
COVID-19 care
Medicare continues to cover the COVID-19 vaccine, and several tests and treatments to
keep you and others safe. Go to page 37.
Contents
What’s new & important? .........................................................................................................2
Index of topics .............................................................................................................................. 4
What are the parts of Medicare? ...........................................................................................9
Your Medicare options .............................................................................................................10
At a glance: Original Medicare vs. Medicare Advantage ...........................................11
Get started with Medicare ......................................................................................................13
Get help finding the right coverage for you ...................................................................14
Section 1: Signing up for Medicare .....................................................................................15
Section 2: Find out what Medicare covers .....................................................................25
Section 3: Original Medicare ................................................................................................ 57
Section 4: Medicare Advantage Plans & other options .............................................61
Section 5: Medicare Supplement Insurance (Medigap) ........................................... 75
Section 6: Medicare drug coverage (Part D) .................................................................79
Section 7: Get help paying your health & drug costs ................................................91
Section 8: Your Medicare rights & protections ............................................................97
Section 9: Get more information .....................................................................................107
Section 10: Definitions ..........................................................................................................119
Need information in an accessible format or another language?
Go to pages 123 and 125–126.
Symbol key
Look for these symbols to help you understand your Medicare coverage.
Compare: Shows
comparisons between
Original Medicare and
Medicare Advantage Plans.
Cost & coverage: Gives you
information about costs
and coverage for services.
Preventive service:
Gives you details about
preventive services.
Important!
Important: Highlights
information that’s important to
review.
New!
New: Highlights what’s new in
this year’s “Medicare & You.”
Helps you find important
information on Medicare.gov.
Index of topics
Note: The bold page numbers have the most details.
Cardiac rehabilitation 33
Catastrophic coverage 81, 83
Cervical and vaginal cancer screenings 33
Chemotherapy 34, 65
Chiropractic services 34
Chronic care management services 34
Chronic pain management and treatment
services 34
Claims 25, 58–59, 99–100, 102–105, 109
Clinical research studies 27, 34, 61
COBRA 18–19, 89
Cognitive assessment 35, 55
Colonoscopies 35–36
Continuous Positive Airway Pressure (CPAP)
devices, accessories, & therapy 36
Coronavirus disease 2019 (COVID-19) 37,
49, 50
Cosmetic surgery 55
Cost Plan. Go to Medicare Cost Plans.
Costs (copayments, coinsurance,
deductibles, and premiums)
Extra Help paying for Part D 92–94
Medicare Advantage Plans 64–65
Original Medicare 58–59
Part A and Part B 22–24, 25–56
Part D late enrollment penalty 83–85
Counseling to prevent tobacco use &
tobacco-caused disease 36
Coverage determination (Part D) 99–100
Covered services (Part A and Part B) 25–56
Creditable prescription drug coverage 64,
79, 81, 83–85, 89, 94, 119
Abdominal aortic aneurysm 30
Accessible Communications 123
Accountable Care Organization (ACO) 29,
51, 74, 103, 110–111, 119
Acupuncture 30, 87
Advance Beneficiary Notice of
Non-coverage 101
Advance care planning 30–31, 35, 54
Alcohol misuse screenings & counseling 31
Ambulance services 31, 53
Ambulatory surgical centers 31–32
Amyotrophic lateral sclerosis (ALS) 15
Appeal 28, 59, 65, 87, 97–101, 108, 113
Artificial limbs 49
Assignment 29–43, 45, 47–48, 50, 54–55,
58, 59–60, 65, 119
Balance exam 42
Barium enema 35
Behavioral health integration services 32,
87
Beneficiary and Family Centered
Care-Quality Improvement
Organizations 100, 113
Benefit period 27, 29, 119
Benefits coordination 22, 89, 90, 113
Bills 23–24, 59, 82, 89, 99, 105
Blood 26, 32–33, 35–36, 38–39, 43, 45, 76
Blood-based biomarker test 36
Blue Button® 59, 105, 109
Blue Button 2.0® 59, 109
Braces (arm, leg, back, neck) 49
Index of topics
Index of topics
Note: The bold page numbers have the most details.
End-Stage Renal Disease (ESRD) 16–17, 21,
31, 42, 44, 51–52, 64, 70, 74, 98
Enroll
Medicare Advantage Plans (Part C) 63–64
Medicare drug coverage (Part D) 80–81
Extra Help (help paying Medicare drug
costs) 79, 81, 83, 88, 92–94, 96, 113, 120
Eyeglasses 41, 55, 75
Fecal occult blood tests 35–36
Federal Employee Health Benefits (FEHB)
Program 89
Federally Qualified Health Center
services 41, 46
Flexible sigmoidoscopies 35–36
Flu shot 41, 50, 54
Foot care 42
Formulary 81, 85–86, 88, 99, 120
Fraud 86, 103, 105–106
General Enrollment Period 18, 23, 71, 80
Glaucoma screening 42
Health Insurance Marketplace® 18, 19, 20
Health Maintenance Organization (HMO)
Plan 61, 64, 66
Health risk assessment 54
Health Savings Accounts (HSAs) 20
Hearing aids 42, 55, 75
Hepatitis B shot 42, 50
Hepatitis C screening 43
HIV screenings 43
Home health care/services 9, 25–26, 29, 44,
100, 108
Home infusion therapy services &
supplies 40, 44
Hospice care 9, 25, 26–27, 61, 76, 87, 100,
108
HSA. Go to Health Savings Accounts
(HSAs).
Defibrillators 38
Dementia 35, 55, 70
Demonstrations/pilot programs 74, 120, 121
Dental care and dentures 10, 12, 55, 56, 62,
67, 75, 95
Department of Defense 113
Department of Health & Human Services.
Go to Office for Civil Rights.
Department of Veterans Affairs 84, 90, 114
Depression 32, 35, 38, 46, 55
Diabetes 34, 38–39, 42, 46, 70
Dialysis (kidney/renal dialysis) 16, 31, 44–45,
51, 65, 66, 98, 108
Disability 15–19, 21, 30, 54–56, 91, 96, 103,
124
Drug coverage (Part D) 79–90
Appeals 97–101
Coverage under Part A 26–29
Coverage under Part B 39–40
Join, switch, or drop 80–81
Medicare Advantage Plans 61–65
Drug plan
Costs 81–85
Enrollment 80–81
Types of plans 79
What's covered 85–88
Drugs (outpatient) 39–40
Dual eligibles (Medicare-Medicaid
plans) 70, 95
Durable medical equipment 9, 26, 29, 39,
40, 44
EKG/ECG 41, 51
Electronic handbook 14, 63
Electronic Health Records 111
Electronic Medicare Summary Notices
(eMSN) 59, 109
Electronic prescribing 112
Emergency department services 41
Employer group health plan coverage
Costs for Part A may be different 26
Drug coverage 80, 84, 88
How it works with Medicare 21
Medigap Open Enrollment 77
Index of topics
Note: The bold page numbers have the most details.
Medicare
Part A (Hospital Insurance) 25–29
Part B (Medical Insurance) 29–56
Part C (Medicare Advantage Plans) 61–74
Part D (Medicare drug coverage) 79–90
Medicare account 14, 24, 59, 91, 105, 107,
109, 111, 112
Medicare Administrative Contractor 99, 103
Medicare Advantage Open Enrollment
Period 13, 71–72, 80
Medicare Advantage Plan 121
How they work with other coverage 64
Plan types 66–70
Medicare Beneficiary Ombudsman 106
Medicare card 15, 24–25, 37, 61, 107, 109,
113–114
Medicare Cost Plans 55, 72, 79, 82, 121
Medicare drug plan 79–80
Medicare-Medicaid Plans 95
Medicare Savings Programs (MSPs) 91–92
Medicare Summary Notice (MSN) 59, 91,
99, 101, 103, 105, 109
Medicare Supplement Insurance
(Medigap) 10–12, 26, 29, 56–58, 64, 73,
75–78, 89, 98, 121
Medication Therapy Management
program 88
Medigap. Go to Medicare Supplement
Insurance.
Mental health care 46–47
MSN. Go to Medicare Summary Notice.
Notices 28, 59, 62–63, 69, 81, 86, 91, 97,
99–101, 103–105, 109, 111, 124
Annual Notice of Change 63, 69, 81
Medicare Outpatient Observation Notice
(also called “MOON”) 28
Medicare Summary Notice (MSN) 59, 91,
99, 101, 103, 105, 109
Nondiscrimination Notice 124
Notice of Privacy Practices 103–104
Nurse practitioner 39, 41, 44, 46, 48, 53
Nursing home 26, 56, 70, 74–75, 93, 95, 108,
110
Nutrition therapy services. Go to Medical
nutrition therapy.
Immunosuppressive drug coverage 52–53,
64, 92
Income Related Monthly Adjustment
Amount (IRMAA) 23–24, 82
Indian Health Service 84, 90, 119
Initial Enrollment Period 17, 18, 20, 71, 80
Inpatient hospital care 27–28
Institution 70, 93
Insulin 39, 88
Join
Medicare drug plan 79–80
Medicare health plan 63–64
Kidney disease education 45
Kidney (renal) dialysis. Go to dialysis.
Kidney transplant 16, 45, 46, 52–53, 64, 98
Laboratory tests 37, 44, 45
Late enrollment penalty. Go to Penalty.
Lifetime reserve days 27, 120
Long-term care 55–56, 75
Lost Medicare card. Go to Replacement
Medicare card.
Lung cancer screenings 45
Lymphedema compression treatment
items 45
Mammogram 45, 66, 70, 122
Marketplace. Go to Health Insurance
Marketplace®.
Medicaid 10, 11, 18, 19, 21, 26, 29, 34, 52,
55–59, 65, 70, 74, 88, 91–96, 103, 120
Medical identity theft 105
Medical nutrition therapy 38, 46
Medical Savings Account (MSA) Plan 20, 61,
64–65, 67, 79, 121
Index of topics
Note: The bold page numbers have the most details.
Puerto Rico 15, 16, 53, 92, 93, 96
Pulmonary rehabilitation programs 49
Quality of care 108, 110–113
Railroad Retirement Board (RRB) 15–16, 20,
23–24, 59, 82, 114
Referral
Definition 122
Medicare Advantage Plans 11, 62, 66–70
Original Medicare 11, 57, 63
Part B-covered services 30–56
Religious non-medical health care
institution 28
Replacement Medicare card 107, 113
Respite care 27
Retiree health insurance (coverage) 18, 19,
21–22, 26, 29, 57–58, 64, 88, 90
RRB. Go to Railroad Retirement Board.
Rural emergency hospital 31
Rural Health Clinic 46, 49
Screenings. Go to Preventive services.
Senior Medicare Patrol Program 105
Service area 11, 63, 74, 79, 81, 122
Sexually transmitted infection screenings
and counseling 50
SHIP. Go to State Health Insurance
Assistance Program.
Shots (vaccinations) 9, 14, 37, 41–43, 48, 50,
54, 108, 122
Sigmoidoscopy 35–36
Skilled nursing facility (SNF) care 9, 25, 28,
65, 74, 76, 100, 101, 111, 122
SNF. Go to Skilled nursing facility (SNF)
care.
SNP. Go to Special Needs Plan.
Observation 28
Occupational therapy services 44, 47
Office for Civil Rights 104, 124
Office of Personnel Management 24, 89, 114
Open Enrollment 13, 71–72, 77–78, 80, 84
Opioid use disorder treatment 27, 40, 47,
54, 87
OPM. Go to Office of Personnel
Management.
Opt-out (doctors) 56, 60
Original Medicare 57–60
Orthotic items 49
Outpatient hospital services 48
Oxygen 40
PACE. Go to Program of All-inclusive Care
for the Elderly.
Payment options (premium) 23–24
Pelvic exam 33
Penalty (late enrollment)
Part A (Hospital Insurance) 17, 18, 22
Part B (Medical Insurance) 15–16, 17, 18, 23
Part D (Medicare drug coverage) 64, 79,
81, 82, 83–85, 89, 93–94
Pharmaceutical Assistance Programs 95
Physical therapy services 48
Physician assistant 39, 41, 46, 48, 53
Pilot/demonstration programs 74, 95, 120,
121
Pneumococcal shots 48, 50, 54
Preventive services 9, 14, 29–33, 35–39,
41–43, 45–50, 54–55, 90, 108–109, 122
Primary care doctor 31, 33, 43, 47, 50, 57,
66–70, 111, 122
Principal care management services 49
Privacy notice 103–104
Private Fee-for-Service (PFFS) Plan 61, 64,
69, 121
Program of All-inclusive Care for the Elderly
(PACE) 74, 95, 121
Prostate cancer screenings (PSA test) 49
Prosthetic/orthotic items 49
Index of topics
Note: The bold page numbers have the most details.
Tax forms 22–23
Telehealth 51, 111
Tests (Non-laboratory) 51
Tiers (drug formulary) 81–83, 85, 100
Transitional care management services 52
Transplant services 16, 33, 45, 46, 52–53,
56, 64, 98
Travel 12, 53, 75–76
TRICARE 19, 21, 52, 84, 90, 113, 119
Union
Costs for Part A may be different 26
Drug coverage 79–80, 84, 88, 94
Medicare Advantage Plan 64
Signing up for Part B 19
Urgently needed care 12, 53, 60
VA. Go to Veterans' benefits.
Vaccinations. Go to Shots.
Veterans' benefits (VA) 84, 90, 114
Vision (eye care) 41, 55
Walkers 9, 28, 40, 44
“Welcome to Medicare” preventive visit 41,
54–55
Wellness visit 9, 14, 30–31, 35, 54–55, 108
Wheelchairs 9, 40, 44
X-ray 28, 48, 51
Social Security
Change address on MSN 59
Extra Help paying Part D costs 94
Other helpful contacts 113
Part A and Part B premiums 22–24
Part D premium 82
Sign up for Part A and Part B 15–19
Supplemental Security Income (SSI)
benefits 93, 96
SPAP. Go to State Pharmacy Assistance
Program.
Special Enrollment Period
Part A and Part B 17–18, 23
Part C (Medicare Advantage plans) 71–73
Part D (Medicare drug plans) 80, 89
Special Needs Plan (SNP) 61, 70
Speech-language pathology 39, 41, 44, 50
SSI. Go to Supplemental Security Income.
State Health Insurance Assistance Program
(SHIP) 14, 16, 56, 60, 73, 77, 78, 80, 83, 89,
94, 95, 100, 105, 108, 110, 115–118
State Medical Assistance (Medicaid)
office 19, 56, 57, 70, 92, 94–96, 123
State Pharmaceutical Assistance
Programs 95
Substance use disorder treatments 40, 47,
51, 54, 55, 86–87
Supplemental insurance (Medigap)
Drug coverage 89
Open Enrollment 77
Original Medicare 57
Supplemental Security Income (SSI) 93, 96
Supplies (medical) 27, 28, 36, 39–41, 44, 48,
49, 50, 58, 59, 75, 88, 90, 120
Surgical dressing services 50
What are the parts of
Medicare?
Part A (Hospital Insurance)
Helps cover:
• Inpatient care in hospitals
• Skilled nursing facility care
• Hospice care
• Home health care
Go to pages 25–29.
Part B (Medical Insurance)
Helps cover:
• Services from doctors and other health care providers
• Outpatient care
• Home health care
• Durable medical equipment (like wheelchairs, walkers,
hospital beds, and other equipment)
• Many preventive services (like screenings, shots or vaccines,
and yearly “Wellness” visits)
Go to pages 29–55.
Part D (Drug coverage)
Helps cover the cost of prescription drugs (including many
recommended shots or vaccines).
Plans that offer Medicare drug coverage (Part D) are run by
private insurance companies that follow rules set by Medicare.
Go to pages 79–90.
10
Your Medicare options
When you first sign up for Medicare, and during certain times of the year, you can
choose how you get your Medicare coverage. There are 2 main ways to get Medicare:
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.
Medicare Advantage
(also known as Part C)
• Medicare Advantage is a
Medicare-approved 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 many cases, you can only use
doctors who are in the plan’s network.
• In many cases, you may need to get
approval from your plan before it
covers certain drugs or services.
• Plans may have lower or higher
out-of-pocket costs than Original
Medicare. You may also have an
additional premium.
• Plans may offer some extra benefits
that Original Medicare doesn’t cover—
like certain vision, hearing, and dental
services.
Part A
Part B
You can add:
Part D
You can also add:
Supplemental
coverage
This includes Medicare
Supplement Insurance
(Medigap). Go to Section 5
(starting on page 75) to learn
more about Medigap. Or, you
can use coverage from a current
or former employer or union, or
Medicaid.
Part A
Part B
Most plans include:
Part D
Some extra benefits
Some plans also include:
Lower out-of-pocket
costs
Go to Section 3 (starting on
page 57) to learn more about
Original Medicare.
Go to Section 4 (starting on
page 61) to learn more about
Medicare Advantage.