Frequently Asked Questions
In the United States, Medicare is a national insurance program, administered by the U.S. Federal Government, that guarantees access to health insurance for Americans aged 65 and older, younger people with disabilities as well as people of all ages with end stage renal disease.
- Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, hospice care, skilled nursing facility care and home health care.
- Medicare Part B (Medical Insurance) helps cover outpatient hospital care, services from other physicians and health care providers, home health care, durable medical equipment and some preventive services.
- Medicare Part C (Medicare Advantage Plan) includes all services covered under Part A and Part B. Medicare-approved private insurance companies administer it. Usually includes Medicare Prescription Drug coverage (Part D). If you join a Medicare Advantage Plan you can’t use a Medicare Supplement policy.
- Medicare Part D (Prescription Drug Plan) helps cover the cost of prescription drugs. They are run by Medicare-approved private insurance companies. A Part D plan may help lower your prescription drug costs.
You are eligible for Medicare at the age of 65 if you are a U.S. citizen or legal resident and you or your spouse has worked in the U.S. for at least 10 years. You are also eligible for Medicare if you are under the age of 65 with certain disabilities or have End Stage Renal Disease (ESRD).
Original Medicare pays for many health care services, but not all. Medicare Supplement plans are also called Medigap policies. Medicare Supplement insurance policies can help pay some of the costs that Original Medicare does not cover. These are standardized policies sold by private insurance companies and designed to fill in the gaps in Original Medicare.
A Medicare Supplement policy can help cover copayments, coinsurance and deductibles. Medicare will pay for its share of the Medicare-approved amount for covered health care costs, and then your Medicare Supplement policy will pay its share. If you join a Medicare Advantage Plan you can’t use a Medicare Supplement policy. You must have Part A and Part B Medicare for a Medicare Supplement plan.
You will be automatically enrolled in Medicare Part A and Part B if you are already getting benefits from Social Security or the Railroad Retirement Board (RRB) starting the first day of the month you turn 65. If you’re under the age of 65 and disabled, you’ll automatically get Part A and Part B after you get disability benefits from Social Security. If you’re automatically enrolled, you’ll receive your Medicare card in the mail 3 months before your 65th birthday or 25th month of disability benefits. If you elect to wait to get Part B, follow the instructions on the card and send it back. If you have End Stage Renal Disease (ESRD), you’ll have to contact Social Security to find out when and how to sign up for Medicare.
If you are turning 65, you can sign up for Part A and Part B during your Initial Enrollment Period (IEP), a 7 month period that begins 3 months before the month you turn 65, the 3 months after you turn 65 and the month you turn 65. If you didn’t sign up for Part A and Part B during the IEP, you can sign up between January 1 – March 31 each and your coverage will begin July 1st of that year. You may have to pay higher premiums for late enrollment.
You can apply to Medicare at the U.S. Social Security Administration by clicking here.
Medicare covers health services and supplies that would be considered medically necessary to treat a condition or disease, such as lab tests, surgeries and doctor visits. If you’re in a Medicare Advantage plan, you may have different rules, but you must have at least the same coverage as Original Medicare.
In general, Part A covers hospital care, skilled nursing care, hospice and home health services. Part B general covers outpatient hospital care, services from other physicians and health care providers, home health care, durable medical equipment and some preventative services.
Medicare Supplement plans add additional coverage to fill in the “gaps” of Original Medicare.
The Annual Enrollment Period (AEP), sometimes referred to as the Open Election Period (OEP), is is from October 15th through December 7th each year. Any changes you make during this time will go into effect on January 1st of the next year. Your Medicare plan benefits and your needs can change on an annual basis, so use the AEP to compare your options or make changes to your Medicare Advantage or Prescription D plans.
During this time, you may switch from Original Medicare Part A and Part B to a Medicare Advantage plan. Or change back from a Medicare Advantage plan back to Original Medicare. You may also switch from one Medicare Advantage plan to another. You may also switch to a plan that offers drug coverage (MAPD) from a Medicare Advantage Plan. This is also a time to join a Prescription Drug Plan (PDP) or switch from one PDP to another.
Once the AEP is over, you can’t make changes to your Medicare plan until the next year. There are also Special Enrollment Periods (SEPs) when you can also make changes to your Medicare Advantage and Prescription Drug plan. These SEPs happen when certain events happen in your life, like if you move or you lose other insurance coverage.
Note: Medicare Supplement Insurance plans are an exception. You can join or change from one plan to another at any time during the year, not just during AEP.
The words “Medicare” and “Medicaid” are so similar it’s easy to be confused. They are both government programs and both help people pay for health care. But they are two completely different programs. The main difference is that Medicare is generally for people over the age of 65 or those with disabilities.
Medicaid is for people with limited income and resources. The Federal government governs Medicare and State governments govern Medicaid. You can call your State Medical Assistance office to see if you qualify for Medicaid.
Links and Resources
Medicare Documents and Information
- Medicare & You In English 2020
- Medicare & You in Spanish 2020
- Enrolling in Medicare Part A & Part B
- A Quick Look at Medicare
- Enrolling in Medicare Parts C & D
- Guide to Prescription Drug Plans
- Understanding Medicare Advantage Plans
- Federal Medicare website
- Social Security Administration
- Apply for Medicare online
- Federal Medicare contact information