Medicare Basics
Who is eligible?
Medicare is a national health insurance program administered by the Centers for Medicare & Medicaid Services (CMS).
Who is eligible?
- U.S. citizens and legal residents – Legal residents must live in the U.S. for five consecutive years just before applying for Medicare
Persons 65 or older
Persons under 65 with qualifying disability, receiving SSDI for 24 months
- Persons of any age with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS)
Understanding Parts of Medicare
Medicare Coverage
There are two main ways to get your Medicare coverage—Original Medicare or a Medicare Advantage Plan.
Original Medicare includes Medicare Part A and Part B. For drug coverage you can join a separate Medicare drug plan (Part D). You can use any doctor or hospital that takes Medicare, anywhere in the U.S. If you choose Original Medicare, you can also decide to add other insurance, a Medicare Supplement Insurance (Medigap), or employee or union coverage, to help pay your out-of-pocket costs.
If you don’t get Part B, Part D or Medigap when you’re first eligible (and do not have comparable health care coverage), you may have to pay more for this coverage later, including a penalty for Part B and/or Part D.
Part A: Hospital Insurance
Part A hospital insurance covers inpatient hospital care, skilled nursing facility care, hospice care, and home health care.
Most people don't pay a monthly premium for Medicare Part A coverage if you or your spouse paid Medicare taxes for a certain amount of time while working. If you don't qualify for premium-free Part A, you can pay a premium to receive coverage.
Part B: Medical Insurance
Part D: Prescription Drug Plans
- Medicare Prescription Drug Plans (PDPs) add drug to Original Medicare. You must have Part A and/or Part B to join one of these plans. PDPs have a monthly premium.
- Medicare Advantage Plans usually have prescription drug coverage (make certain before you join). You must have Part A and Part B to join. No additional premium is added. Advantage Plans may or may not have a premium.
Medicare Advantage Plans
(sometimes called Part C)
Medicare Advantage Plans are another way to get your Medicare Part A and Part B coverage. Advantage Plans are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D). In most cases you will need to use health care providers who participate in the plan’s network and service area for the lowest costs. These plans set a limit on what you’ll have to pay out-of-pocket each year for covered services, to help protect you from unexpected costs. Some plans offer out-of-network coverage, but usually at a higher cost.
Below are the most common types of Medicare Advantage Plans:
- Health Maintenance Organization (HMO) Plans
- Preferred Provider Organization (PPO) Plans
- Special Needs Plans (SNPs)
Please be careful and make sure that you understand Medicare policies and regulations before you make health care decisions.
You can reference the official government document (Medicare & You) published by CMS (Centers for Medicare & Medicaid Services) or call 1-800 MEDICARE (1-800-633-4227) for information.
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