What is Medicare? Medicare is a federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). Medicare typically covers the costs of emergency, preventative, and long-term healthcare .Medicare is funded by the federal government, but various related programs, like Medicare Supplements, have state oversight. The two main categories of Medicare coverage include Original Medicare (with optional Medicare Supplement and prescription drug insurance) and Medicare Advantage.

 

Who qualifies for Medicare? There are three groups who qualify to receive Medicare:

• People who are 65 and older.

• People under 65 years old who are disabled and who have been receiving Social Security Disability benefits for at least 24 months.

• Qualified people with End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis, also known as ALS or Lou Gehrig’s disease.

 

What does Medicare cover? A wide variety of healthcare services are covered by Medicare, depending on the type of policy you choose, including:

• Ambulance services 

• Anesthesia

• Artificial eyes & limbs

• Bariatric surgery

• Blood processing & handling

• Cardiac rehabilitation programs

• Cardiovascular disease screenings

• Cervical & vaginal cancer screenings

• Chemotherapy

• Depression screenings

• Diabetes prevention programs

• Diagnostic tests (laboratory and non-lab)

• Eye exams (routine)

• Eyeglasses & contact lenses

• Flu shots

• Foot care

• Hearing aids

• Hepatitis B and HIV screenings

• Inpatient hospital care

• Kidney transplants

• Lung cancer screenings

• Mammograms

• Mental health care (inpatient and outpatient)

• Occupational therapy

• Opioid use disorder treatment services

• Organ transplants

• Pain management

• Prescription drugs (outpatient)

• Preventive & screening services

• Radiation therapy

• Sexually transmitted infections screenings & counseling

• Sleep studies

• Surgery

• Urgently needed care

• X-rays

• Yearly "wellness" visits

 

Am I automatically enrolled in Medicare when I turn 65? Many people automatically get Original Medicare - also known as Part A and Part B - especially if they’re receiving Social Security retirement benefits when becoming eligible for Medicare coverage. Other people may need to sign up for Medicare.

 

If you're aging into Medicare, you have a seven-month Initial Enrollment Period (IEP) to apply for Medicare: three months before you turn 65, the month you turn 65, and three months after you turn 65. And you must sign up individually for the parts of the program - Parts A, B, C and/or D - that you want.

 

Do I need Medicare if I already have health insurance? It depends. You may need Medicare even if you already have other health insurance coverage, or if your current plan doesn’t meet the minimum coverage requirements.

 

Most plans that employers offer meet these standards. So if you have insurance through your job, you probably don't need Medicare. However, by staying on an employer plan, you can delay enrolling in Part B without a penalty and avoid paying Part B premiums.

 

What's the difference between Original Medicare, Medicare Advantage, and Medicare Supplement plans? Medicare is divided into two categories, with Medicare Part D as an additional option for prescription coverage. When signing up for Medicare, Part A is mandatory but Parts B, C, and D are optional. But keep in mind that you will incur a late penalty if you don't enroll in Parts B and D when you’re first eligible.

 

Here's a breakdown of the different Medicare parts and plans:

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Part A (Original Medicare Plan)

Covers inpatient care in a hospital, inpatient care in a skilled nursing facility (not custodial or long-term care), hospice care, skilled nursing home care, and other types of home health care.

Part B (Original Medicare Plan)

Covers medically necessary services, preventative care, clinical research, mental health care, inpatient and outpatient services, partial hospitalization, and more.

Part C (Medicare Advantage Plan)

Combines Parts A and B into bundled coverage through an approved private insurance company that uses the Medicare network.

Part D (Prescription Drug Coverage)

Pays for several tiers of name brand and generic medications, sometimes up to a limit.

Medicare Supplement Insurance

Extra coverage through an approved private insurance company that fills gaps or "supplements"

what Original Medicare doesn't cover. Also known as a Medigap plan.