Department of Health and Human Services
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, Maryland 21244-1850Important decisions about your new
Medicare coverage
Welcome to Medicare! Because you’re getting Social Security or Railroad Retirement Board benefits,
you’re automatically enrolled in Medicare Part A. Your enclosed Medicare card shows what
coverage you have and when it starts.
Medicare Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing
facility care, hospice care, and some home health care. You don’t need to pay a premium for
Part A.
Medicare Part B (Medical Insurance): Helps cover services from doctors and other health care
providers, outpatient care, durable medical equipment, and many preventive services. Part B
is optional, and you pay a monthly premium for it.
Make these 2 important decisions now:
Decision 1: Do I want to sign up for Part B?
If you want Part B, you have 7 months from the date on this letter to sign up.
• Medicare will automatically deduct the premium from your monthly Social Security benefits
(or Railroad Retirement Board or federal retiree benefits). If you don’t get benefits or don’t get
enough to cover your premium, you’ll get a bill for your Part B premium every 3 months. Visit
Medicare.gov/basics/costs/pay-premiums to learn about ways you can pay your bill.
• You need both Part A (Hospital Insurance) and Part B (Medical Insurance) to join a Medicare
Advantage Plan or (in most cases) to buy a Medigap policy.
• If you don’t want Part B, you don’t need to do anything. Part B is optional. However, if you decide to
sign up for Part B later, and you don’t qualify for a Special Enrollment Period, you may have to wait
for your coverage to start and pay a monthly penalty (that’s added to your premium) for as long
as you have Part B.
Important! Read pages 4-8 in the booklet to find out if you should sign up for Part B (based on
your situation).
Decision 2: How do I want to get my Medicare health coverage if I sign up for Part B?
You have 2 main ways to get your Medicare coverage:
• Original Medicare—includes Part A and Part B. You can use supplemental coverage (like Medigap)
to help pay your out-of-pocket costs. You can also add Medicare drug coverage (Part D).
• Medicare Advantage—a Medicare-approved plan from a private company that bundles your
Part A, Part B, and usually Part D together. Medicare Advantage Plans may offer some extra
benefits that Original Medicare doesn’t cover.
How do I sign up for Part B?
You can sign up for Part B by:
• Downloading Form CMS-40B (Application for Enrollment in Medicare Part B) at Medicare.gov/
basics/forms-publications-mailings/forms/enrollment. Complete the application and sign it.
Return the completed application to your local Social Security office.
• Going to SSA.gov/medicare/sign-up or contacting your local Social Security office. Visit SSA.gov/
locator to find your local office.
Important! Read pages 10-15 in the booklet for additional and important information to make
your decision. Turn this page over for your options at-a-glance.
Soon, we’ll mail your official “Medicare & You” handbook with more information. You can also visit
us at Medicare.gov/basics/get-started-with-medicare.
Enclosures
CMS Product No. 11989
January 2025
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 use or 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 plans bundle your
Part A, Part B, and usually Part D together.
• 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 different out-of-pocket costs
than Original Medicare or supplemental
coverage like Medigap. You may also have an
additional premium.
• Plans may offer extra benefits that Original
Medicare doesn’t cover.
There are 2 main ways to get your Medicare coverage:
You have the right to get Medicare information in an accessible format, like large print, braille or
audio. You also have the right to file a complaint if you feel you’ve been discriminated against.
Visit Medicare.gov/about-us/accessibility-nondiscrimination-notice, or call
1-800-MEDICARE (1-800-633-4227) for more information. TTY users can call 1-877-486-2048.
Your options
Part A
Part B
You can add:
Part D
You can also add:
Supplemental coverage
This includes Medicare Supplement
Insurance (Medigap). Or you can use
coverage from a current or former
employer or union, or Medicaid (if
you have it).
Part A
Part B
Most plans include:
Part D
Some extra benefits
2025
Important decisions about
your Medicare coverage
Welcome to
You have the right to get Medicare information
in an accessible format, like large print, braille,
or audio. You also have the right to file a
complaint if you feel you’ve been discriminated
against.
Visit Medicare.gov/about-us/accessibility-
nondiscrimination-notice, or call
1-800-MEDICARE (1-800-633-4227) for more
information. TTY users can call 1-877-486-2048.
Health Insurance Marketplace® is a registered
service mark of the U.S. Department of Health
and Human Services.
This product was produced at U.S. taxpayer
expense.
Now’s the time to make some
important decisions about your
Medicare coverage.
Read this booklet carefully
before you make any decisions.
Medicare Overview
Medicare is health insurance for people 65 or
older, certain people under 65 with disabilities,
and people of any age with End-Stage Renal
Disease (permanent kidney failure requiring
dialysis or a kidney transplant).
Medicare Part A
(Hospital Insurance)
helps cover inpatient care in
hospitals, skilled nursing facility
care, hospice care, and some
home health care.
Medicare Part B
(Medical Insurance)
helps cover services from
doctors and other health care
providers, outpatient care,
durable medical equipment (like
wheelchairs, walkers, hospital
beds, and other equipment), and
many preventive services (like
screenings, shots or vaccines,
and yearly “Wellness” visits).
Note: If you’re not lawfully present in the U.S.,
Medicare won’t pay for your Part A and Part B
claims, and you can’t join a Medicare Advantage
Plan (Part C) or a Medicare drug plan (Part D).
What does Part B cost?
You’ll pay a monthly premium for Part B. In
2025, the standard Part B premium is $185.
You’ll pay more if you have a higher income.
The premium amount can change each year.
If you have limited income and resources, you
may be able to get help with costs if you meet
certain conditions. (Go to page 15.)
To learn more about what
Medicare Part A and Part B cover, visit:
Medicare.gov/coverage
or call:
1-800-MEDICARE (1-800-633-4227)
TTY users can call 1-877-486-2048
Decision 1:
Do I want to sign up
for Part B?
If you don’t sign up for Part B and you
don’t have other coverage based on current
employment, there are some risks:
• You’ll likely have to pay all of the costs for
doctors’ services, outpatient care, medical
supplies, and preventive services.
• If you change your mind and want to
get Part B later, you may have to wait
until the General Enrollment Period
(January 1– March 31 each year) to sign
up. This may cause a gap in your health
coverage.
• In most cases, if you decide you want
Part B later, you may have to pay a late
enrollment penalty for as long as you
have Part B coverage. The penalty amount
is added to your monthly Part B premium,
and it goes up the longer you go without
Part B coverage. (Go to page 8.)
The best time to sign up for Part B depends
on your situation. The next few pages cover
common situations that may apply to you.
Common Situations
I’m still working and have coverage
through my employer. Or, my spouse (or
my family member, if I’m disabled) is still
working and I have coverage through his
or her employer:
• You may need to sign up for Part B right
away if your employer has fewer than
20 employees. Check with your benefits
administrator to find out if they require
you to sign up for Part B. If you don’t
sign up for Part B and continue coverage
with your employer, you may be able
to sign up for Part B during a Special
Enrollment Period without a late
enrollment period, if:
– You’re 65 or older, you or your spouse
is currently working, and you have
employer or union group health
coverage from that job.
– You’re under 65 and disabled, you (or a
family member) are currently working,
and you have employer or union group
health coverage from that job. (If the
group health plan coverage is based
on the current employment of a family
member, the employer must have 100
or more employees.)
If you’re eligible for a Special Enrollment
Period, you can sign up for Part B:
• Anytime while you have employer or
union group health coverage from a job.
• For up to 8 months after the group health
coverage or the job ends, whichever
happens first.
I’m retired and have coverage through a
former employer, or I have COBRA or VA
coverage:
• You may need both Part A and Part B
to get full benefits from this coverage,
and your current coverage might not
pay (or only pay a small portion of) your
medical costs once you’re eligible for
Medicare, even if you haven’t signed up
for Medicare yet.
• Contact your State Health Assistance
Program (SHIP) at shiphelp.org for free,
personalized help deciding whether to
sign up for Medicare.
• You aren’t automatically eligible for a
Special Enrollment Period when this
coverage ends. That means:
– You may have to wait until the General
Enrollment Period (January 1–March 31
each year) to sign up for Part B.
– In most cases, you’ll pay a late
enrollment penalty that’s added to
your monthly premium for as long as
you have Part B coverage.
I have coverage through a private
insurance plan (not through the
Marketplace or an employer):
If you get Part B, Medicare will pay its part
of the costs for any health care services you
get, and then any amount Medicare doesn’t
cover is submitted to your private plan.
If you choose to sign up for Part B later, you
may not be eligible for a Special Enrollment
Period. This means you’ll have to wait for
the General Enrollment Period (January 1–
March 31 each year) to sign up, and you may
have to pay a late enrollment penalty for as
long as you have Part B coverage. (Go to
page 9.)
I have TRICARE or CHAMPVA coverage:
You generally need Part A and Part B to
keep TRICARE. However, if you’re an active
duty service member or the spouse or
dependent child of an active duty service
member, you don’t need to sign up for Part
B to keep TRICARE. If you have CHAMPVA,
you must sign up for Part A and Part B to
keep it.
I have Medicaid:
You should sign up for Part B. Medicare will
pay first, and Medicaid will pay second. You
may be able to get help with costs.
(Go to page 15.)
I don’t have other medical insurance:
You should consider signing up for Part B,
so you have coverage for things like doctors’
services and preventive services. Be aware of
the risks for not signing up for Part B.
(Go to page 4.)
Exceptional situations:
You may be eligible for a Special Enrollment
Period without a late enrollment penalty
if you miss an enrollment period because
of certain exceptional circumstances, like
being impacted by a natural disaster or an
emergency, incarceration, employer or health
plan error, or losing Medicaid coverage. For
more information, visit Medicare.gov, or call
1-800-MEDICARE (1-800-633-4227).
TTY users can call 1-877-486-2048.
How much is the penalty if I
sign up later?
If you sign up for Part B later and you aren’t
eligible for a Special Enrollment Period,
you’ll pay 10% more for each full 12-month
period you could’ve had Part B but didn’t
take it. In most cases, you’ll have to pay this
late enrollment penalty each time you pay
your premiums, for as long as you have
Part B. The penalty increases the longer you
go without Part B coverage.
Visit Medicare.gov/basics/costs/medicare-
costs/avoid-penalties to learn more.
Decision 2:
Choose how you
get Medicare health
coverage.
If you signed up for Part B, you have 2 main
ways to get your Medicare coverage:
• Original Medicare
• Medicare Advantage
Original Medicare
Original Medicare includes Part A and
Part B. You generally pay a set amount for
your health care (deductible) before Medicare
begins to pay its share. Once Medicare pays its
share, you typically pay 20% of the cost of the
Medicare-approved service under Part B.
The deductible for Part B is $257 in 2025.
Visit Medicare.gov/basics/costs/medicare-costs
for Part A and other Medicare costs.
With Original Medicare, you:
• Can go to any doctor or hospital that takes
Medicare, anywhere in the U.S.
• Don’t need a referral to see a specialist, in
most cases.
• Generally pay a portion of the cost for each
covered service. There’s no yearly limit on
what you pay out of pocket, unless you have
supplemental coverage (like a Medigap
policy, Medicaid, or employer or union
coverage).
• May be able to get supplemental coverage
(like a Medigap policy) to help pay your
remaining out-of-pocket costs (like your 20%
coinsurance). (Go to page 14.)
• Can join a separate Medicare drug plan
(Part D). (Go to page 12.)
When you sign up for Part B, you’ll have
Original Medicare unless you join a Medicare
Advantage Plan.
Medicare Advantage (also known
as Part C)
You must have both Part A and Part B to join
a Medicare Advantage Plan.
Medicare Advantage bundles your Part A, Part
B, and usually Part D coverage together. Plans
may offer some extra benefits that Original
Medicare doesn’t.
Medicare Advantage Plans are offered by
Medicare-approved private companies that
follow rules set by Medicare. Each plan can
have different rules for how you get services,
like needing referrals to see a specialist. Costs
for monthly premiums and services you get
vary depending on which plan you join.
Plans must cover all emergency and urgent
care, and almost all medically necessary
services Original Medicare covers. Some plans
offer additional benefits for specific conditions
With Medicare Advantage, you:
• Generally need to use providers who are in
the plan’s network (for non-emergency or
non-urgent care).
• May pay a premium for the plan in addition to
the monthly Part B premium. Plans may have
a $0 premium or may help pay all or part of
your Part B premiums.
• Can’t buy or use Medicare Supplement
Insurance (Medigap). (Go to page 14.)
Do I need Medicare
drug coverage (Part D)?
If you don’t have prescription drug
coverage, or the coverage you have isn’t at
least as good as Medicare drug coverage
(called creditable coverage), you should
consider joining Medicare drug coverage
(Part D). If you have other drug coverage,
your plan must tell you each year if it counts
as creditable drug coverage.
Creditable prescription drug coverage could
include drug coverage from a current or
former employer or union, TRICARE, Indian
Health Service, the Department of Veterans
Affairs, or individual health insurance
coverage.
If you don’t get drug coverage when you’re
first eligible for Medicare, and you don’t
have other creditable drug coverage, you
may have to pay a Part D late enrollment
penalty if you get Medicare drug coverage
later. Generally, you’ll pay this penalty for as
long as you have Medicare drug coverage.
And, the penalty goes up the longer you
wait to get coverage.
If you want Medicare drug coverage, you
can join a separate Medicare drug plan
or a Medicare Advantage Plan with drug
coverage.
Choosing and joining a plan
Learn more about your coverage options
at Medicare.gov/basics/get-started-with-
medicare/get-more-coverage. You can also
find and compare plans by visiting Medicare.
gov/plan-compare.
If you didn’t join a Medicare Advantage Plan
or a Medicare drug plan when you were first
eligible, you’ll have at least one chance each
year to make changes to your Medicare
coverage:
October 15–December 7: You can join,
switch, or drop a Medicare Advantage
Plan or a Medicare drug plan during this
period each year. Your new coverage will
begin on January 1 of the next year.
January 1–March 31:
If you’re in a Medicare Advantage Plan,
you can change to a different Medicare
Advantage Plan or switch back to
Original Medicare (and join a stand-alone
Medicare drug plan) once during this
time. Any changes you make go into
effect the month after the plan gets your
request.
Special Enrollment Periods: You may be
able to join, switch, or drop Medicare
Advantage or Medicare drug plans when
certain events happen in your life (like if
you move, lose other insurance coverage,
and other situations).
For more information about when you can join a
plan, visit Medicare.gov/basics/get-started-with-
medicare/get-more-coverage/joining-a-plan.
Do I need Medicare Supplement
Insurance (Medigap)?
Original Medicare pays for much, but not
all, of the cost for covered health care
services and supplies. If you choose Original
Medicare, you might be able to buy a
Medicare Supplement Insurance (Medigap)
policy from a private company to help
pay your out-of-pocket costs in Original
Medicare (like your 20% coinsurance). In
most cases, you need both Part A and Part
B to buy a Medigap policy.
Medigap policies:
• Can cover costs like coinsurance,
copayments, and deductibles.
• May offer coverage for services that
Original Medicare doesn’t cover, like
medical care when you travel outside
the U.S.
• Generally don’t cover long-term care (like
care in a nursing home), vision, dental,
hearing aids, private-duty nursing, or
prescription drugs.
Medicare and the Health Insurance
Marketplace®
Medicare isn’t part of the Marketplace. Since
you live in Puerto Rico, you aren’t eligible
to use the Marketplace to enroll in health
coverage. If you move to the continental
U.S., you generally don’t need to enroll
in a plan through the Marketplace for
individuals or families, and may not be able
to do so. If you’re able to enroll through the
Marketplace for individuals or families, you
won’t be eligible for financial help paying
your premiums.
When can I get Medigap?
The best time to buy a Medigap policy is
during your Medigap Open Enrollment
Period. This 6-month period begins on
the first day of the month in which you’re
65 or older and have Part B. (Some states
have additional Open Enrollment Periods.)
During this time, you can buy any Medigap
policy sold in your state and the insurance
company can’t deny you because of pre-
existing health problems. After the Medigap
Open Enrollment Period, you might not
be able to buy a Medigap policy, or it may
cost more.
If you’re under 65, you might not be able
to buy the Medigap policy you want, or any
Medigap policy, until you turn 65.
If you’re able to buy one when you’re under
65, it may cost more.
Visit Medicare.gov/health-drug-plans/
medigap to learn about Medigap.
You can also visit Medicare.gov/medigap-
supplemental-insurance-plans/ to compare
the types of Medigap policies in your area,
or call 1-800-MEDICARE (1-800-633-4227).
TTY users can call 1-877-486-2048.
Help with Costs
Puerto Rico has programs available to
help people with limited income and
resources to pay for Medicare costs. For
more information, visit Puerto Rico’s
Department of Health Medicaid Program at
Medicaid.pr.gov or call 787-641-4224.
TTY users can call 787-625-6955.
For more
information
About signing up for Medicare:
Visit SSA.gov/medicare/sign-up.
About Medicare:
Visit Medicare.gov, or call
1-800-MEDICARE (1-800-633-4227).
TTY users can call 1-877-486-2048.
For free, personalized health insurance
counseling, visit shiphelp.org to contact
your State Health Insurance Assistance
Program (SHIP).
CMS Product No. 11989
January 2025
Make the most of your
Medicare by visiting us at
Medicare.gov