Intro to Medicare
Medicare coverage begins with the decision to be covered under Original Medicare (Medicare Part A and B) or Medicare Advantage (Medicare Part C).
To qualify for Medicare, you must be 65 or older, or have specific disabilities. Enrollment may vary based on your situation.
Medicare consists of Part A (Hospital Insurance) and Part B (Medical Insurance), each covering different aspects of healthcare.
Beneficiaries can choose Original Medicare or Medicare Advantage plans that include additional benefits.
Initial Enrollment occurs when you turn 65, with Annual Open Enrollment allowing changes to plans every fall. Open Enrollment Period allows changes once between January to end of March.
Medicare is a federal health insurance program in the U.S. designed for people aged 65 and older. It also extends to some individuals under 65 with certain disabilities and those with End-Stage Renal Disease (ESRD). Medicare is organized into four distinct parts, each covering various healthcare services:
Medicare Part A (Hospital Insurance): This part covers inpatient hospital care, skilled nursing facility services, hospice care, and some home health care. Most individuals do not pay a premium for Part A if they or their spouse contributed to Medicare through payroll taxes during their working years.
Medicare Part B (Medical Insurance): Part B helps with costs associated with outpatient services, such as doctor visits, preventive care (e.g., vaccinations), lab tests, mental health services, and durable medical equipment. There is a standard monthly premium for Part B.
Medicare Part C (Medicare Advantage): Medicare Advantage plans are offered by private insurance companies approved by Medicare and combine coverage from Parts A and B. Many of these plans include additional benefits such as vision, hearing, dental, and prescription drug coverage.
Medicare Part D (Prescription Drug Coverage): This optional coverage helps lower the cost of prescription medications. You can get Part D through a stand-alone plan or as part of a Medicare Advantage plan that includes drug coverage.
Medicare is primarily available to U.S. citizens or legal residents aged 65 and older. Additionally, individuals under 65 may qualify if they have certain disabilities or specific medical conditions, such as End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).
Yes. People under 65 may be eligible for Medicare if they have been receiving Social Security Disability Insurance (SSDI) benefits for at least 24 months or have been diagnosed with ALS or ESRD, requiring dialysis or a kidney transplant.
If you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters), you typically qualify for premium-free Medicare Part A. If you don’t meet this requirement, you may still qualify for Medicare, but you may need to pay a premium for Part A.
Non-U.S. citizens who are lawful permanent residents may qualify for Medicare if they have lived in the U.S. for at least five consecutive years and meet the age or disability requirements.
If you haven’t worked or didn’t earn enough credits to qualify for premium-free Medicare Part A, you may still enroll in Medicare by paying a monthly premium. Alternatively, if your spouse qualifies for Medicare, you may become eligible based on their work history.