Medicare is the United States' health insurance program for people age 65 or older. (Certain people younger than age 65, particularly those who have disabilities, can also qualify for Medicare, but they must meet other specific criteria.)
You will be eligible for Medicare when you turn 65 even if you are not eligible for Social Security retirement benefits. However, this program does not cover all medical expenses or the cost of most long-term care. Medicare looks vastly different than it did just a few years ago. It now consists of four main parts, which are detailed below.
Medicare Part A covers hospice care, home health care, skilled nursing facilities, and inpatient hospital stays.
Most people age 65 or older who are citizens or permanent residents of the United States are eligible for "free" Medicare Part A. You can get Part A at age 65 without having to pay premiums if:
- You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
- You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.
- You or your spouse had Medicare-covered government employment.
Although you don't pay a premium, there are some co-payments and a yearly deductible.
Medicare Part B covers doctors' bills, outpatient hospital care, home-based physical therapy, lab tests and X-rays, chiropractic care, durable medical equipment, ambulance services, and a limited number of prescription drugs. Part B helps cover some preventive services to help maintain a person's health and to keep certain illnesses from getting worse. It generally pays 80 percent of the Medicare-approved amount for covered services.
Part B is optional and there is a monthly premium and an annual deductible. However, it is highly recommended that you take this benefit (if you are not otherwise covered for doctor's services) because late enrollment carries a substantial penalty.
Your Part B monthly premium depends on the cost of living and when you enrolled. It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don't get any of the above payments, Medicare sends you a bill for your Part B premium every three months.
If you didn't sign up for Medicare Part B when you first became eligible, you may be able to sign up during the General Enrollment Period (please note that you may be subject to a financial penalty). This period runs the first 45 days of every year. During this time, you can sign up for Medicare Part B at your local Social Security office. Visit Social Security online to find the office closest to you.
Medicare Advantage is often called "Medicare Part C," because people with Medicare Parts A and B can choose to receive all of their health care services through a private insurance company under Part C. You must purchase these benefits through private companies approved by and under contract with Medicare.
Anyone enrolled in a Medicare Advantage plan can switch to Original Medicare during the first 45 days of the new year.
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Medicare Part D is optional prescription drug coverage that is available to all people who are eligible for Medicare. Plans are offered through insurance companies and other private companies. There is a monthly premium, a yearly deductible, and a co-payment.
Medicare Supplemental Insurance
Also known as Medigap policies, these supplemental plans are sold by private companies and may help pay certain fees, such as copayments and deductibles, as well as the portion of doctor bills that Original Medicare does not cover. Only one person may be covered under a Medigap policy, so spouses will need separate policies. Medigap plans also do not work in conjunction with Part C (Medicare Advantage Plans).
The official Medicare website has a useful a tool that helps you determine whether or not you or your loved one is eligible to receive Medicare benefits.
You will be asked to answer a series of questions and the tool will determine if you might be able to receive Medicare. Click here to go to the Medicare Eligibility Tool.