Run by the Centers for Medicare and Medicaid Services (CMS)
Benefit decisions controlled by the U.S Congress
Social Security Administration (SSA) handles enrollment and eligibility
Who is Eligible For Medicare?
Age and work history
Age 65+ and eligible for benefits under either Social Security, Rail Road Retirement,
Federal, State or local employee
40+ quarters of Social Security covered employment is eligible for Social Security
AND Medicare Part
Married may receive benefits under spouse's work record
Married at least 10 years to receive benefits under former spouse
Persons with disabilities
Receiving disability benefits under Social Security or Rail Road Retirement for
24 months or more
Any age
Receiving regular kidney dialysis or a kidney transplant
Amyotrophic Later Sclerosis (ALS)- Lou Gehrig’s disease
The Different Parts of Medicare
Medicare Part A (also known as Hospital Insurance)
Helps cover inpatient care in hospitals, skilled nursing facilities, hospice, and
home health care.
Most people do not have to pay a premium for Medicare Part A because they or a spouse
paid Medicare taxes while working in the United States. If you do not automatically
get premium-free Part A, you may still be able to enroll, and pay a premium.
Medicare Part B (also known as Medical Insurance)
Helps cover doctors’ and other health care providers’ services, outpatient care,
durable medical equipment, and home health care.
Helps cover some preventive services.
Most people pay up to the standard monthly Medicare Part B premium.
Note: You may want to get coverage that fills gaps in Original Medicare coverage.
You can choose to buy a Medicare Supplement Insurance (Medigap) policy from a private
company.
Medicare Part C (also known as Medicare Advantage)
Offers health plan options run by Medicare-approved private insurance companies.
Medicare Advantage Plans are a way to get the benefits and services covered under
Part A and Part B. Most Medicare Advantage Plans cover Medicare prescription drug
coverage (Part D).
Some Medicare Advantage Plans may include extra benefits for an extra cost.
Medicare Part D (also known as Medicare Prescription Drug Coverage)
Helps cover the cost of prescription drugs
May help lower your prescription drug costs and help protect against higher costs.
Run by Medicare-approved private insurance companies
Costs and benefits vary by plan
You May Purchase Medical Coverage If:
Age 65, but not enough qualified work history
May purchase coverage
30-39 quarters-$441.00 per month for Part A
29 quarters or less-$451 per month for Part A
Must be age 65+ and a permanent U.S. resident
U.S. Citizen or permanent legal resident living in the U.S. for 5 continuous years
Medicaid is health coverage available to certain people and families who have limited
income and resources.
When May You Enroll?
Initial enrollment
7 months (3-1-3)
3 months before, month of, and 3 months after 65th birthday or 25th month of Social
Security Administration disability
Special Enrollment Period (SEP)-age 65+
May delay enrollment of still working or covered by working spouse
Part B-must enroll within 8 months after work terminates
General Enrollment Period – if you don’t enroll when you are first eligible) or
miss SEP
January 1-March 31st of each year
Coverage begins July 1st
Penalties may apply (10% for each year missed)
Even if you are not sure whether you qualify, if your income is limited, and if
you or someone in your family needs health care, you should apply for Medicaid and
have a qualified caseworker in your state look at your situation.
If you have questions about Medicaid, you can call your State Medicaid office for
more information.
Visit www.medicare.gov/contacts
or call 1-800-MEDICARE (1-800-633-4227) to get the telephone number. TTY users
should call 1-877-486-2048.
Five Things Emeritus To Remember About Medicare
1. It Makes Prescription Drugs More Affordable.
If you enter the coverage gap known as the “donut hole,” you will receive a 50%
discount when buying Part D-covered brand-name prescription drugs. This discount
will be automatically applied at the counter of your pharmacy; you do not have to
do anything to get it. In addition, over the next ten years, you will get additional
savings until the coverage gap is completely closed in 2020. 2. It Gives You Preventive Care Services For Free.
If you have Medicare, you can get free preventive screenings and services like colorectal
cancer screening and mammograms. You can also get a free yearly wellness visit to
develop and update your personal prevention plan based on current health needs.
Again, these services are free: no co-pays or cost sharing for you.
3. It Provides Incentives For Your Doctors To Work Together For You.
The law makes it easier for your doctors to work together by offering them support
and resources for patient-centered care. If you’re hospitalized, the new law also
helps you return home successfully—and avoid going back—by helping to coordinate
your care and connecting you to services and support in your community.
4. It Strengthens Medicare Advantage.
If you have Medicare Advantage, you will be protected from large increases to your
premiums or decreases in your benefits. Medicare reviews changes to your plan before
they happen to stop the ones that are unreasonable. Beginning in 2012, Medicare
Advantage plans will have even more reason to improve the quality of care you receive.
Plans that have a rating of three stars or more on the quality rating system will
receive a bonus, part of the national effort to improve quality.
5. It Helps Ensure Your Access to Care. You can still choose your doctor.
The law increases the number of primary care doctors, nurses, and physician assistants
to provide better access to care through expanded training opportunities, student
loan forgiveness, and bonus payments. Support for community health centers will
increase, allowing them to serve some 20 million new patients.
