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What is Medicare?

nurse and oldwoman in hospital bed - www.Social-Security.biz

Medicare is our country’s health insurance program for people age 65 or older.

Certain people younger than age 65 can qualify for Medicare, as well, including those who have disabilities, permanent kidney failure or amyotrophic lateral sclerosis (Lou Gehrig’s disease).

Medicare helps with the cost of health care.
It doesn't cover all medical expenses or the cost of most long-term care.

Medicare gets it's financing from part of the payroll taxes paid working Americans and their employers.

Some of it's financing comes from monthly premiums deducted from Social Security checks.

You can apply for Medicare at your local Social Security office and get general information about the Medicare program.

There are many ways to qualify for Medicare.
There are 4 parts to Medicare with separate requirements for each one.

The Social Security Administration tells us:

Hospital Insurance (Part A) If You Are 65 or Older

Most people 65 or older are eligible for Medicare hospital insurance (Part A) based on their own, or their spouse's employment. You are eligible at 65 if you: 

  • Receive Social Security or railroad retirement benefits;
  • Are not getting Social Security or railroad retirement benefits, but you have worked long enough to be eligible for them;
  • Would be entitled to Social Security benefits based on your spouse's (or divorced spouse's) work record, and that spouse is at least 62 (your spouse does not have to apply for benefits in order for you to be eligible based on your spouse's work), or 
  • Worked long enough in a federal, state, or local government job to be insured for Medicare. 

If You Are Under 65

Before age 65, you are eligible for Medicare hospital insurance if you:

  • Get Social Security disability benefits and have amyotrophic lateral sclerosis (Lou Gehrig's) disease; or
  • Have been a Social Security disability beneficiary for 24 months; or 
  • Have worked long enough in a federal, state, or local government job and you meet the requirements of the Social Security disability program.

If you receive a disability annuity from the Railroad Retirement Board, you will be eligible for hospital insurance after a waiting period. (Contact your railroad retirement office for details.) 

Eligibility For Family Members

Under certain conditions, your spouse, divorced spouse, widow or widower, or a dependent parent may be eligible for hospital insurance when your spouse turns 65, based on your work record.

Also, disabled widows and widowers under age 65, disabled divorced widows and widowers under 65, and disabled children may be eligible for Medicare, usually after a 24-month qualifying period. (For disabled widows/widowers, previous months of eligibility for Supplemental Security Income (SSI) based on disability may count toward the qualifying period.) 

If You Have Kidney Failure

Special rules apply to people with permanent kidney failure. Under these rules, you are eligible for hospital insurance at any age if you receive maintenance dialysis or a kidney transplant and: 

  • You are insured or getting monthly benefits under Social Security or the railroad retirement system, or
  • You have worked long enough in government to be insured for Medicare.

In addition, your spouse or child may be eligible, based on your work record if she or he receives continuing dialysis for permanent kidney failure or had a kidney transplant, even if no one else in the family is getting Medicare. 

If You Do Not Qualify Under These Rules

Certain aged people who do not qualify for Medicare hospital insurance under these rules may be able to get it by paying a monthly premium. They also must always enroll in medical insurance (Part B), to get this coverage. Certain disabled people who lost premium-free hospital insurance because they work can get Medicare hospital insurance again by paying a premium.

Medicare Medical Insurance
(also known as Part B)

Almost anyone who is 65 or older or who is under 65, but eligible for Medicare hospital insurance can enroll for Medicare medical insurance by paying a monthly premium. Anyone aged 65 or older does not need any Social Security or government work credits to enroll in this part of Medicare.

If you would like to file for Medicare Part A or Part B, please see How to Apply for Medicare

Medicare Advantage Plans
(Also known as Part C)

People with Medicare Parts A and B can choose to receive all of their health care services through an approved provider organization under Part C.  There might be additional premiums required for some plans.

Prescription Drug Coverage
(Also known as Part D)

Anyone who has Medicare hospital insurance (Part A), medical insurance (Part B) or Medicare Advantage plan (Part C) is eligible for prescription drug coverage (Part D).  Joining a Medicare prescription drug plan is voluntary, and you pay an additional monthly premium for the coverage.

For more information about Medicare Part C or Part D, please visit the Centers for Medicare and Medicaid Services website.

Read about the
1099-LTC Long Term Care Benefits Form
 
 
 
 
 
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