- people age 65 or older who are U.S.citizens or legal residents for at least five years
- people under age 65 with certain disabilities
- people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant
Medicare is administered by the federal government since 1966, currently using about 30 private insurance companies across the U.S.
Part A Hospital Insurance – Most people don’t pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.
Employed individuals pay Medicare taxes through payroll deductions. You need to work and pay taxes for at least 10 years to qualify for premium-free Medicare Part A coverage when you turn 65. If you qualify, then your non-working spouse may qualify based on your work record when he/she turns 65, too.
Part B Medical Insurance – Most people pay a monthly premium for Part B. Medicare Part B helps cover doctors’ services and outpatient care. It also covers some other medical services that Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.
Part D Prescription Drug Coverage – Most people will pay a monthly premium for this coverage. Everyone with Medicare can get this coverage that may help lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is provided by private insurance companies. You must be entitled to Part A and/or enrolled in Part B to be eligible for Part D prescription drug benefits. Beneficiaries choose the drug plan and pay a monthly premium. If a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans. You must be entitled to Part A and/or enrolled in Part B to be eligible for Part D prescription drug benefits.
Medicare Part C : Medicare Advantage Plans – A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage. You must be entitled to Medicare Part A and enrolled in Part B in order to enroll in a Medicare Part C Medicare Advantage plan.
Medicare Supplement Plans (Medigap Plans) : A Medicare Supplement (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like co-payments, coinsurance, and deductibles. You must be enrolled in both Medicare Part A and Part B to be eligible to buy a Medicare Supplement Plan.
Some people get Part A & Part B automatically. If you’re automatically enrolled, you’ll get your red/white/blue Medicare card in the mail about 3 months before your 65th birthday or your 25th month of disability.
You need to sign up for Part A & Part B if you aren’t getting Social Security or the Railroad Retirement Board benefits, you qualify for Medicare because you have End-Stage Renal Disease, or you live in Puerto Rico and want to sign up for Part B. You must already have Part A to apply for Part B. You can sign up for Medicare Part A & Part B online at http://www.ssa.gov/medicare/apply.html.
However, online Medicare enrollment doesn’t work for people in some circumstances, including people who have had health coverage from their employer (or a spouse’s employer) since turning 65, those who qualify for Medicare on a spouse’s work record, and those who are not U.S. citizens. All these situations require you to show certain documents – such as evidence of employer insurance, a marriage certificate or green card – as proof of eligibility. Call Social Security’s main number, 800-772-1213, to make an appointment.
We can help you choose a Medicare Advantage Plan, a Medicare Prescription Drug plan, or a Medicare Supplement Plan if you are a resident of WA, OR or CA.