Medicare & SSA
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 and those who have 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.
Medicare has four parts
Hospital insurance (Part A) that 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) that 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) that helps
pay for medications doctors prescribe for treatment.
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
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 someone who worked long enough in a government job
where Medicare taxes were paid. 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
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. 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 U.S. 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. 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 November 15 – December 31 each
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. You can wait to enroll in a Medicare
Part D plan if you have other 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 November 15 – December 31 each year. There also will be special enrollment
periods for some situations.
