Medicare Health Insurance. Medicare is our country’s health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare, too, including those who have disabilities, permanent kidney failure or amyotrophic lateral sclerosis (Lou Gehrig’s disease). The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care.
Medicare is financed by a portion of the payroll taxes paid by workers and their employers. It also is financed in part by monthly premiums deducted from Social Security checks.
The Centers for Medicare & Medicaid Services is the agency in charge of the Medicare program. But you apply for Medicare at Social Security, and we can give you general information about the Medicare program.
Medicare Has Four Parts
Hospital insurance (Part A) helps pay for inpatient care in a hospital or skilled nursing facility (following a hospital stay), some home health care and hospice care.
Medical insurance (Part B) helps pay for doctors’ services and many other medical services and supplies that are not covered by hospital insurance.
Medicare Advantage (Part C) plans are available in many areas. People with Medicare Parts A and B can choose to receive all of their health care services through one of these provider organizations under Part C.
Prescription drug coverage (Part D) helps pay for medications doctors prescribe for treatment.
You can get more detailed information about what Medicare covers from Medicare & You (Publication No. CMS-10050). To get a copy, call the Medicare toll-free number, 1-800-MEDICARE (1-800-633-4227), or go to www.medicare.gov. If you are deaf or hard of hearing, you may call TTY 1-877-486-2048.
A Word About Medicaid
You may think that Medicaid and Medicare are the same. Actually, they are two different programs. Medicaid is a state-run program that provides hospital and medical coverage for people with low income and little or no resources. Each state has its own rules about who is eligible and what is covered under Medicaid. Some people qualify for both Medicare and Medicaid. For more information about the Medicaid program, contact your local medical assistance agency, social services or welfare office.
Hospital Insurance (Part A)
Most people age 65 or older who are citizens or permanent residents of the United States are eligible for free Medicare hospital insurance (Part A). You are eligible at age 65 if:
You receive or are eligible to receive Social Security benefits; or
You receive or are eligible to receive railroad retirement benefits; or
Your spouse is eligible; or
You or your spouse (living or deceased, including divorced spouses) worked long enough in a government job where Medicare taxes were paid; or
You are the dependent parent of a fully insured deceased child.
If you do not meet these requirements, you may be able to get Medicare hospital insurance by paying a monthly premium. Usually, you can sign up for this hospital insurance only during designated enrollment periods.
NOTE: Even though the full retirement age is no longer 65, you should sign up for Medicare three months before your 65th birthday.
Before age 65, you are eligible for free Medicare hospital insurance if:
You have been entitled to Social Security disability benefits for 24 months; or
You receive a disability pension from the railroad retirement board and meet certain conditions; or
If you receive Social Security disability benefits because you have Lou Gehrig’s disease (amyotrophic lateral sclerosis); or
You worked long enough in a government job where Medicare taxes were paid and you meet the requirements of the Social Security disability program; or
You are the child or widow(er) age 50 or older, including a divorced widow(er), of someone who has worked long enough in a government job where Medicare taxes were paid and you meet the requirements of the Social Security disability program.
You have permanent kidney failure and you receive maintenance dialysis or a kidney transplant and:
You are eligible for or receive monthly benefits under Social Security or the railroad retirement system; or
You have worked long enough in a Medicare-covered government job; or
You are the child or spouse (including a divorced spouse) of a worker (living or deceased) who has worked long enough under Social Security or in a Medicare-covered government job.
Medical Insurance (Part B)
Anyone who is eligible for free Medicare hospital insurance (Part A) can enroll in Medicare medical insurance (Part B) by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. For more information, ask for Medicare Premiums: Rules For Higher-Income Beneficiaries (Publication No. 05-10536) or visit www.socialsecurity.gov/mediinfo.htm.
If you are not eligible for free hospital insurance, you can buy medical insurance, without having to buy hospital insurance, if you are age 65 or older and you are—
A U.S. citizen; or
A lawfully admitted noncitizen who has lived in the United States for at least five years.
Medicare Advantage Plans (Part C)
If you have Medicare Parts A and B, you can join a Medicare Advantage plan. Medicare Advantage plans are offered by private companies and approved by Medicare. With one of these plans, you do not need a Medigap policy, because Medicare Advantage plans generally cover many of the same benefits that a Medigap policy would cover, such as extra days in the hospital after you have used the number of days that Medicare covers.
Medicare Advantage plans include:
Medicare managed care plans;
Medicare preferred provider organization (PPO) plans;
Medicare private fee-for-service plans; and
Medicare specialty plans.
If you decide to join a Medicare Advantage plan, you use the health card that you get from your Medicare Advantage plan provider for your health care. Also, you might have to pay a monthly premium for your Medicare Advantage plan because of the extra benefits it offers.
People who become newly entitled to Medicare should enroll during their initial enrollment period (as explained under Signing up for Medicare) or during the annual coordinated election period from October 15 – December 7 each year. The effective date for the enrollment is January 1 of the upcoming year. There also will be special enrollment periods for some situations.
Medicare Prescription Drug Plans (Part D)
Anyone who has Medicare hospital insurance (Part A), medical insurance (Part B) or a Medicare Advantage plan (Part C) is eligible for prescription drug coverage (Part D). Joining a Medicare prescription drug plan is voluntary, and you pay an additional monthly premium for the coverage. Some beneficiaries with higher incomes will pay a higher monthly Part D premium. For more information, ask for Medicare Premiums: Rules For Higher-Income Beneficiaries(Publication No. 05-10536) or visit www.socialsecurity.gov/mediinfo.htm. You can wait to enroll in a Medicare Part D plan if you have other creditable prescription drug coverage but, if you don’t have prescription coverage that is, on average, at least as good as Medicare prescription drug coverage, you will pay a penalty if you wait to join later. You will have to pay this penalty for as long as you have Medicare prescription drug coverage.
People who become newly entitled to Medicare should enroll during their initial enrollment period (as explained under Signing up for Medicare). After the initial enrollment periods, the annual coordinated election period to enroll or make provider changes will be October 15 – December 7 each year. The effective date for the enrollment is January 1 of the upcoming year. There also will be special enrollment periods for some situations.
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