What is Medicare?

Overview

Medicare is a federally funded health insurance program for people age 65 or older. Certain people younger than age 65 can also qualify, including those who have disabilities and those who have permanent kidney failure or amyotrophic lateral sclerosis (Lou Gehrig’s disease). This 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 not a welfare program, and should not be confused with Medicaid (called Medi-Cal in California). The income and assets of a Medicare beneficiary are not a consideration in determining eligibility or benefit payment. Medicare is a national program and procedures should not vary significantly from state to state.

Part A

Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits. Most people won’t pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working.

Part B

Medicare Part B (Medical Insurance) helps cover doctors’ services and outpatient care. It also covers some other medical services that Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. Most people pay a monthly premium for Part B.

Part C

Medicare Part C (Medicare Advantage) formerly known as Medicare + Choice plans are available in may areas. People with Medicare Parts A & B can choose to receive all of their health care services through one of these provider organizations under Part C.

Part D

Part D is prescription drug coverage that helps pay for medications doctors prescribe for treatment. On January 1, 2006, this coverage became available to everyone with Medicare. Medicare Part D may help lower prescription drug costs and help protect against higher costs in the future. Joining a Medicare prescription drug plan is voluntary, and you pay an additional monthly premium for the coverage. You can wait to enroll in a Medicare Part D plan if you have other prescription drug coverage but if you don’t have 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.

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). If you are deaf or hard of hearing, you may call TTY 1-877-486-2048.

Signing Up For Medicare

If you are already receiving Social Security Retirement or Disability Benefits or Railroad Retirement checks, you will be contacted a few months before you become eligible for Medicare and given the information you need. You will be enrolled in Medicare Parts A & B automatically. However, because you must pay a premium for Part B coverage, you have the option of turning it down.

If you are not already getting retirement benefits, you should contact the Social Security Office about three months before your 65th birthday to sign up for Medicare. You can sign up for Medicare even if you do not plan to retire at age 65.

For more information about Medicare click here or visit your local Social Security office or call 1-800-772-1213.