Medicare, we've all heard of it but where do I start?

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Medicare is a National Health Insurance provided/subsidized by the US government, available to every qualified U.S. citizen beginning at 65 years of age and to those with qualifying disabilities and certain special medical conditions.


Americans are familiar with the term Medicare,but may not be aware of the crucial details.


Did you know? for example:

  • Medicare now offers choices, and is no longer a one size fits all plan. You must be aware of important deadlines when it comes to decision making when choosing your plan.
  • Medicare does not reimburse the cost of certain very expensive contingencies, such as long-term care or catastrophic illnesses, althought there are other programs available that can protect you.

These are just a few examples. This is where My eligibility resources can help you. We provide you with valuable tools and information to make sure you are up-to-date on the latest information so you can get all the benefits you are entitled to.


What follows is an introduction to the Medicare program that outlines the choices you must make, the deadlines you must meet, and where to get all the information that you need about the Medicare program for yourself and your family.


What is Medicare?

Medicare, like Social Security, is an "entitlement" program. As a U.S. citizen, if you meet certain eligibility requirements, you're entitled to Medicare coverage. Medicare is paid through taxes, other revenues of the government, and premiums paid during the years you work. With these funding sources, older Americans and those disabled receive their Medicare coverage at low or no cost.This applies to the entire program.


Traditional Medicare (Part A and B)


Part A (Hospital Insurance) reimburses:

  • The costs of your inpatient (hospital) care
  • Skilled Nursing Facility
  • Hospice care
  • Home health care

Part B (Medical Insurance)

  • Helps cover your outpatient care in a clinic or doctor's office
  • Home health care
  • Durable medical equipment
  • Preventative services
  • Ambulances
  • Mental Health Screening
  • Some prescription drugs

Additions to the traditional Medicare

  • Part D
  • Prescription drugs
  • Recommended shots and vaccines

Part C (Medicare Advantage)

  • Alternative coverage provided by a private company that is approved by Medicare.
  • Bundled Part A, B and part D plans
  • May have dental, hearing and vision benefits

Comparison between Medicare (provided by government) and Medicare Advantage (provided by Medicare approved private companies)



How to qualify for Medicare

Only older individuals and disabled persons are eligible for Medicare. Specifically, these are the three basic classifications of eligible people:

  • People older than 65 years of age.
  • People with disabilities.
  • People at any age with End Stage Renal Disease (ESRD).


To be eligible under one of these classifications, you must always be a U.S. citizen and have paid Medicare payroll taxes.Now, look more closely at eligibility classifications.

  • Those Americans 65 years of age or older.You are eligible for Part A, and pay no premium, if you are getting Social Security or Railroad Retirement Board benefits. You also qualify if you or your spouse has had a Medicare-covered government job..
  • Those Americans with disabilities.If you are younger than 65, but you have Social Security Disability Insurance (SSDI), you are eligible for Medicare. There is atwo-year ( 24-month) waiting period, though, so if you can claim SSDI you can get Medicare benefits two years after you get your first SSDI check.
  • Those Americans with ESRD:Kidney dialysis or kidney transplant patients can qualify for Medicare Part A, premium-free, if they need regular dialysis or have had a transplant. But to qualify, they must either be eligible for Social Security or Railroad Retirement Board benefits or have paid Medicare taxes for the required minimum of 10 years.


The child or spouse of someone who is Medicare-eligible can get Medicare if they need it.


When to apply

You can join, switch, or drop aMedicare Health Planor aMedicare Advantage Plan (Part C)with or without drug coverage during these times:

  • Initial Enrollment Period. When you first become eligible for Medicare, you can join a plan.
  • Open Enrollment Period. From October 15 – December 7 each year, you can join, switch, or drop a plan. Your coverage will begin on January 1 (as long as the plan gets your request by December 7).
  • Medicare Advantage Open Enrollment Period. From January 1 – March 31 each year, if you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time.


There is an initial eligibility period during which most people must apply to enroll in Medicare. That period begins when you or your spouse reaches 65 years old. There are exceptions: a person may be enrolled in Medicare automatically, without needing to apply. When does this occur?

  • You receive Social Security or Railroad Retirement Board benefits for at least 4 months before you reach 65 years of age.If so, you are automatically enrolled in Medicare Parts A and B when you become 65. The card will come in the mail about three months before your 65th birthday.
  • You have received SSDI for at least 24 months.As described above, after receiving SSDI for 24 months, you are automatically enrolled in Parts A and B the following month. The card will come in the mailabout three months before that.
  • You have received disability benefits from the Railroad Retirement Board for at least 24 months. The next month you are automatically enrolled, with the card coming in the mail three months before that.
  • You have Amyotrophic Lateral Sclerosis (Lou Gehrig's disease).You are automatically enrolled in Parts A and B, and get the card in the mail when your disability payments start.

Anyone not automatically enrolled in Medicare, but eligible to enroll, should know how to apply during the initial eligibility period. The seven-month initial eligibility period includes the three months before your 65th birthday month, your birthday month, and the three months after your 65th birthday month. If you miss enrolling, you may incur a Part B late penalty or health coverage may be delayed. Be aware that even if you are still receiving health insurance coverage from your employer, you can enroll in Medicare during your eligibility period.


How to apply

You can apply for Medicare enrollment online. You do so through the Social Security Administration (SSA) website. This step in applying is very quick and easy.You need no documentation and sign no form. SSA reviews this initial application and either enrolls you or asks for more information. If your application is approved and you are enrolled, your card will come in the mail.

You enroll in Medicare just once, not each year. On the other hand, you have an opportunity during each year's eligibility period to change your Medicare plan.


Medicare and Medicaid

Medicare and Medicaid are both federal health insurance programs enacted in 1965. Medicaid is intended to help very low income people and both its eligibility requirements and benefits are completely different from Medicare's. If you do not qualify for Medicare, you may be eligible for Medicaid. Some people are eligible for both programs and their benefits.


Some differences between Medicare and Medicaid:

  • Medicaid is a state as well as a federal program and all states and U.S. territories have a different version of Medicaid. That means that eligibility guidelines and how to apply will depend upon your state or territory.
  • The eligibility to enroll in Medicaid is based on your family income. Many special groups, including qualified pregnant women and newborns, qualify for Medicaid.
  • Medicaid benefits are of two types. One is services that the federal government requires all states to provide under Medicaid, including nursing home and home health care coverage, physician and laboratory services, and inpatient and outpatient services. The other is services each state government decides to provide under Medicaid.


Getting help with Medicare choices and questions

As you can see, there are many choices when it comes to Medicare and important deadlines. It is smartnot to waituntil you are approaching 65 to begin finding out about your Medicare options and deadlines. If you have time to become informed about these things, you will make better choices—and avoid mistakes.


For information and assistance with any questions about Medicare—or any problem at any stage of applying for enrollment in a program or getting your benefits—you canenter your informationhereand we will be in touch with you without delay.


You can turn to My Eligibility Resource for accurate, current information on programs to meet the needs of you and your family and how to apply successfully and overcome any unexpected problems.

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