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Medicare Basics

Medicare is a federal health insurance program for those who are age 65 or older. Certain younger people with disabilities or End-Stage Renal Disease are also covered. Medicare provides hospital and medical coverage.


Eligibility

To receive Medicare, you must meet specific criteria and enroll. For specific information and how to enroll, see the Official U.S. Government Site for Medicare. In general, you are eligible for Medicare if:

  • You are 65 years of age or older*
  • You or your spouse have worked for at least 10 years in Medicare-covered employment (employment that pays into the Medicare system)
  • You are a citizen or permanent resident of the United States
  • Certain younger people with disabilities or End-Stage Renal Disease may also be eligible.

Medicare Benefits

There are several different parts to Medicare coverage, with different benefits and costs. You need to decide what you need.

  • Part A. Medicare Part A covers hospitalization. Basically, it pays for inpatient care, and some home healthcare, skilled nursing home care and nursing home care. It also pays for hospice care. Most people do not have to pay premiums for Part A.
  • Part B. Part B covers medical services such as doctor’s visits and outpatient treatments, as well as medical services and supplies not covered under Part A. Most people pay premiums for Part B.
  • Part C. Part C is more commonly called Medicare Advantage. It is provided by private insurance companies and combines Parts A and B. Part D may be included. Because Medicare Advantage is offered by private companies, the costs and benefits may vary from plan to plan. At a minimum, you must continue to pay your Part B premiums. There may be other costs. There also may be other benefits.
  • Part D. Part D covers prescription drug costs and is available to individuals who have Part A, B or C. Just like in a traditional insurance plan, the amount of coverage for each drug is determined by the type of drug and how it is classified on a Formulary. Most people pay premiums for Part D. If you don’t enroll in a Part D plan when you become eligible for Medicare Part A and B or if you drop your Part D coverage for more than 63 days, you may have to pay a late enrollment penalty if you decide to enroll in Part D at a later time.

Medicare is administered by the Centers for Medicare and Medicaid Services. Assistance may be available to low-income individuals to help with the costs of Medicare through Extra Help, also called Low-Income Subsidy (LIS).If you are eligible, this lowers your plan premium and drug copays, as well as eliminates the coverage gap (the donut hole). You must be on a plan that includes prescription drug coverage to qualify. Note: Levels are reviewed annually by the Social Security Administration and may change each year.

 

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Last Updated: 09/30/2017