Medicare
Health care, co-pays, deductibles, and drug costs can be very expensive and stressful. If you are over 65 years old or a person with a disability, the government has programs to help you pay for health care and medicine.
Medicare is a health insurance program from the federal government.
It is mainly for people aged 65 and older, but you can get it earlier if you have a disability.
The main parts of Medicare
Medicare has different “parts” that work together to give you the coverage you need. The main parts of Medicare include:
Part A:
Inpatient care at hospitals, skilled nursing facilities, hospice, and home health care.
Cost: No premium if you qualify for retirement or disability benefits, or if you get Medicare before you turn 65.
Part B:
Outpatient care from health care providers, home health care, medical equipment, and preventative care.
Cost: Monthly premium with an annual deductible based on income, coinsurance after deductible is met.
Part C:
An alternative to Part A & B called Medicare Advantage, run by private insurance companies. May include other benefits like vision, hearing, and dental care.
Cost: Plan B monthly premium amount plus possible additional monthly premiums.
Part D:
Prescription medications and some vaccinations.
Cost: Monthly premium, some may have an annual deductible.
Visit Medicare.gov to learn more about Medicare plans and the types of coverage you might need.
Eligibility
Most people can get Medicare when they turn 65, but some people can get it earlier because of their health.
For example, you can get Medicare (Part A and Part B) at any age if your kidneys do not work anymore, and you need regular dialysis or have had a kidney transplant.
You can get Medicare if:
- You have worked enough time under Social Security, the Railroad Retirement Board, or as a government employee.
- You are getting or can get benefits from Social Security or the Railroad Retirement Board.
- You are the spouse or dependent child of a person who has worked enough time to get Medicare, or who is getting benefits from Social Security (or Railroad Retirement Board).
You can use Medicare’s estimator tool to check if you are eligible or when you will be eligible.
Enrollment
Before you turn 65, the Secretary of the United States Department of Health and Human Services (HHS) will send you a notice when you become eligible for Medicare.
This notice will give you basic information about the benefits and how to enroll. It will also include the phone number 1-800-MEDICARE (800-633-4227) for questions or help.
Medicare usually starts when you turn 65. To enroll, you will need to sign up during your Initial Enrollment Period (IEP).
The IEP starts 3 months before your 65th birthday and lasts 3 months after. If you are already receiving Social Security retirement benefits, you are usually automatically enrolled in Medicare Part A and B.
If you do not enroll in Medicare when you turn 65, you could face late enrollment penalties for Part B. This penalty is usually a 10% increase to your monthly premium for each 12-month period you were eligible but did not enroll. There is also a penalty for Part D (prescription medication coverage) if you did not enroll when you first became eligible.
If you are still working when you turn 65 and do not plan to take retirement benefits, you can still sign up for Medicare. Or, if you like the health insurance from your job, you can wait until your coverage ends to sign up for Part B.
Once your private insurance coverage ends, you have an 8-month Special Enrollment Period (SEP) to sign up for Medicare.
Costs
For most people, Medicare health insurance is not free. The cost of Medicare is different for everyone and can include:
- Monthly premiums: the amount you pay for Medicare coverage, whether you get services or care or not.
- Annual deductibles: the amount you pay out of your own pocket each year for covered services and items before Medicare, or your plan starts to pay.
- Coinsurance: a percent of the costs you pay for covered medical services or items. For Part B, people usually pay 20% of the cost for each Medicare-covered service.
- Copayments: a fixed amount you pay for a Medicare-covered service, like $30 for a doctor’s office visit.
These costs may also be different for each Medicare Part. For example:
Part A: Hospital Insurance
Most people do not pay a Part A premium - if they or their spouse paid Medicare taxes long enough while working (about 10 years) or if they get Medicare before you turn 65. If you don’t qualify for $0 premiums on Part A – you might be able to buy it.
Premium: No
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Deductible: Yes
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Coinsurance: Yes
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Copay: Maybe
Part B: Medical Insurance
You must pay a premium for Part B coverage every month - even if you do not get any Part B-covered services. The monthly premium can change each year and may be higher based on your income. You probably will not get a bill from Medicare for the premium. Instead, Medicare automatically deducts the premium from your Social Security, Railroad Retirement Board, or Civil Service Retirement check. If you do not get any of these payments, you will get a bill for your Part B premium and can pay for Medicare directly.
Premium: Yes
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Deductible: Yes
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Coinsurance: Yes
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Copay: Maybe
Part C: Medicare Advantage
To get Medicare Part C, you must already have a Part A Plan and a Part B Plan. You must pay your Part B premium to stay in your Part C Plan. Monthly premiums for Part C coverage vary based on which plan you join. The premium amount can change each year.
Premium: Yes, plus Part B premium
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Deductible: Varies
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Coinsurance: Varies
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Copay: Varies
Part D: Prescription Drugs
Medicare Part D covers prescription drugs. How much you pay for Part D coverage will vary based on which Plan you join. The premium amount for Part D can change each year. You may also have to pay an extra amount each month based on your income.
Premium: Yes
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Deductible: Varies
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Coinsurance: Varies
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Copay: Varies
The Medicare page has more information about the cost breakdown for each Medicare Plan.
Coverage
To understand what health care, services, or supplies Medicare covers, you should check the official Medicare or the Centers for Medicare & Medicaid Services (CMS) website.
You can also contact Arizona’s State Health Insurance Assistance Program (SHIP) for free, personalized help by calling (800) 432-4040.
To find out if Medicare covers a specific service or supply:
- Talk to your doctor: Ask if Medicare will cover the service or item you need. If Medicare does not cover it, you can ask Medicare to review their decision. More information about appealing a Medicare decision can be found in the section below.
- Check coverage or call Medicare: You can check coverage online or call the Medicare helpline at (800) 633-4227 (800-MEDICARE).
Original Medicare does not cover everything.
If you need items or services Part A (Hospital Insurance) or Part B (Medical Insurance) do not cover, you may have to pay for them yourself unless:
- You have other health coverage. Other health coverage might help cover the costs. Learn about how other coverage works with Medicare.
- You are in a Medicare Advantage Plan (Part C), Medicare Cost Plan, or a Program of All-inclusive Care for the Elderly (PACE) Plan. These plans might cover extra benefits that Original Medicare does not, like certain vision, hearing, and dental services.
Denial and Appeals
If you disagree with a Medicare decision about coverage of services you need, you have rights. You can ask Medicare to reconsider if you disagree with any coverage or payment decision.
You can ask Medicare to reconsider if any of these are true:
- They do not cover a health care service, supply, item, or drug you think they should.
- They do not pay for a health care service, supply, item, or drug you have already received.
- They change the amount you have to pay for a health care service, supply, item, or medicine.
- They decide not to give you or pay for all or part of a health care service, supply, item, or medicine you think you still need.
- Your Plan’s drug management program says you are “at-risk” because you use too many medicines like opioids and benzodiazepines. This means your Plan limits your access to these medicines.
Before you start an appeal, you might want to ask your doctor or supplier for information about your coverage or payments. Knowing this information can make your appeal stronger.
The Plan must tell you, in writing, how to appeal. You should check your Plan materials or contact your Plan for details about your appeal rights. You can usually find your Plan’s contact information on your Plan membership card.
You can find more information on the appeals process for Part A and B, Part C, and Part D on the Medicare website. The appeals process can be different based on the kind of coverage you have.
Generally, there are 5 levels of appeals.
If you disagree with the decision at any level, you can usually go to the next level. At each level, you’ll get a decision letter with instructions on how to move to the next level of appeal.
You may have the right to ask for a fast appeal if you think services are ending too soon (or that you are being discharged too soon) from one of these providers:
- Hospital
- Skilled nursing facility (SNF)
- Home health agency (HHA)
- Comprehensive outpatient rehabilitation facility (CORF)
- Hospice care facility
Your provider must give you a notice telling you how to ask for a fast appeal. You should read this notice carefully. If you do not get this notice, ask your provider for it.
With a fast appeal, an independent reviewer, called a Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO), will decide if your covered services should continue. To find your BFCC-QIO, call 1-800 MEDICARE (1-800-633-4227).
Overpayments
Medicare overpayment is when you get more money than you should have under your plan. When Medicare finds an overpayment, you owe that money to the Federal government.
The Centers for Medicare & Medicaid Services (CMS) must get back all overpayments.
According to the law, you must report and return an overpayment to Medicare within:
- 60 days of finding out about the overpayment.
- 6 years from when you got the overpayment (this is called the “lookback period”).
- If needed, by the cost report due date.
When an overpayment is $25 or more, your Medicare Administrative Contractor (MAC) will start collecting the overpayment. The MAC will send you a letter asking you to pay back the extra money. This letter is called a “Demand Letter.”
It tells you that Medicare paid too much money and wants it back. If you get a demand letter from your Medicare Administrative Contractor (MAC), read it carefully.
The demand letter will include:
- Why you were overpaid.
- A warning that interest will start adding up if you don’t pay it all back within 30 days.
- Options for paying the money back over time (Extended Repayment Schedule or ERS).
- Your right to respond to or disagree with the letter (rebuttal).
- Your right to appeal the decision.
You can handle an overpayment in several ways. For example, you can:
Make an immediate payment. You can pay the full amount by following the instructions in the letter.
Request immediate recoupment. Instead of sending money, you can ask Medicare to take the amount from your future payments. You can choose if they take all or just part of it. Once you ask for this, it will apply to other debts too—unless you say otherwise.
Request standard recoupment. If you don’t ask for immediate recoupment or pay the amount, Medicare will automatically start taking money back based on their usual schedule. If you wait too long, interest might be added.
Ask for an ERS (Extended Repayment Schedule). If you cannot pay for it all right now, you can ask for more time by following the instructions in the letter.
Respond to the demand letter. If you received a demand letter, you can send a rebuttal to explain why you think the letter is wrong.
Appeal the decision. You can appeal the overpayment by asking for something called “redetermination”.
This topic can be complicated. You may want to talk to a legal professional for help.
This website shares general legal information. Some content may be simplified or may not reflect recent changes in law. If you need advice for your specific situation, you should talk to a legal professional.
This content was last updated on Oct 1, 2025.