What is Medicare?

Medicare is a national health insurance program for people who are 65 or older, certain people under 65 with disabilities, and people with end-stage renal disease (permanent kidney failure). Medicare is basic protection, and does not cover all medical expenses or most long-term care. Medicare includes Part A Hospital Insurance, Part B Medical Insurance, Part C Medicare Advantage plans, and Part D Prescription Drug coverage.

Am I eligible?

Most people age 65 or older are eligible for Medicare. You may also be eligible if you or your spouse worked in Medicare-covered employment and you are under 65 and disabled, or you have end-stage renal disease (permanent kidney failure). Your income and assets do not affect your eligibility. For more information, call Medicare at 1-800-MEDICARE (TTY: 1-877-486-2048).

What benefits will I get?

Medicare is a basic health insurance program that pays only a portion of your health care costs. Part A Hospital Insurance includes inpatient hospital care, skilled nursing care, and home health care. Part B Medical Insurance includes doctors’ fees, medical tests, and outpatient care. Most people who are eligible for Medicare get Part A for free, and pay a monthly premium for Part B. You must also pay deductibles and coinsurance. People with Part A and B can enroll in a Medicare Advantage plan. People with Part A or B can enroll in a Prescription Drug Plan.

How do I apply?

People getting Social Security or Railroad Retirement benefits will automatically be enrolled in Medicare at age 65. People getting Social Security disability payments will automatically be enrolled after 24 months of disability (with some exceptions). Other people who are eligible for Medicare must apply by calling the Social Security Administration at 1-800-772-1213 (TTY: 1-800-325-0778).

How do I use my benefits?

Once you have been approved, Medicare will send you an enrollment package and your Medicare card. You must then decide if you want to keep Part B Medical Insurance, if you want to buy Medigap supplemental insurance, which Medicare health plan you want to use, and whether you want to enroll in a Prescription Drug Plan. You must show your Medicare card whenever you go for health services. If you are denied benefits or if Medicare pays less than you think they should, you may appeal. You will get a separate drug benefit card if you join a Medicare drug plan.

Medicare Health Plans

You must decide how you want to get your Medicare benefits. You may choose the Original Medicare Plan, which is a federal fee-for-service plan available nationwide, or you may join a Medicare Advantage plan offered by private companies under contract with Medicare. If you keep the Original Medicare Plan, you may buy supplemental Medigap insurance to cover some of the “gaps” in your Medicare benefits. If you choose a Medicare Advantage plan, you will usually have to pay an extra monthly fee, but will also get extra benefits. Your health plan choices will vary depending on where you live.

Medicare Prescription Drug Plans

Medicare Prescription Drug Plans, also called Medicare Part D, cover some of the costs of prescription drugs. All people with Medicare can get Medicare drug coverage if they choose. Prescription Drug Plans are offered by private insurers approved by Medicare. Different drug plans have different costs and benefits. Plan members must pay monthly premiums, an annual deductible, coinsurance/copayments, and coverage gap costs. Medicare recipients with limited incomes and resources can get help to pay their drug plan costs.