Understanding Medicare 

What is Medicare?
Medicare is the federal government’s health insurance plan, and is made up of two main parts, A and B.

  • Part A helps cover inpatient hospital or skilled nursing facility care.
  • Part B helps cover services like testing and visits to the doctor.

There are also other parts, C and D.

  • Part C offers ways to get managed health care, a combination of A and B, and may also include D.
  • Part D helps cover the cost of prescriptions.

In general, you pay a fee for parts B, C, and D.

Who can get Medicare?
Different situations can affect the coverage you qualify for. Here are some general qualifications.

  • Part A – If you are 65 or older, you can qualify if you are entitled to Social Security benefits or you or your spouse worked long enough for the government. People under age 65 may qualify if they have certain disabilities.
  • Part B – If you qualify for Part A, you can also get part B. The premium is based on income and changes year to year.
  • Part C – You must have part A and B to qualify.
  • Part D – You must have either A or B or both to qualify.

How do I get Medicare?
For Part A Medicare, you will automatically be enrolled if you get Social Security benefits. As soon as you turn 65, you are covered. In general, you should receive information about Medicare a few months before turning 65.

For Part B, which is optional, you are also automatically enrolled when you are enrolled for Part A, unless you turn it down. You will receive information about Part B when you receive your Part A packet.

Medicare Part C is considered the Medicare Advantage Plan, which is approved by Medicare but run by private companies. These plans combine part A and B and most include part D or may offer extra benefits. There are 5 basic types of plans under Part C, each with its own benefits and limitations.

Part D, the prescription drug coverage, is not a plan you are automatically enrolled in. Plans vary by area, so it’s best to compare coverage through www.medicare.gov.

Are there any restrictions when using Medicare Part A?
Yes. You must receive care from a participating facility or provider. Participating facilities are those who have been approved by Medicare. Before getting care, it is important to verify that your provider takes Medicare, or you might end up paying for any care you receive. In addition, the care must be deemed “reasonable and necessary,” which is the only type of care Medicare will pay for.

A Medicare Checklist:
Use this checklist as a guide to help you prepare for your Medicare coverage.

  • Contact Social Security about three months prior to turning 65 to discuss your situation and find out if you qualify.
  • Request information about Medicare by calling the Medicare hotline.
  • Keep a list of enrollment and other deadlines.
  • Compare your options and decide which plans would be best for you.
  • Discuss the options with your family or a professional who can help you decide.
  • Enroll in the plan of your choice.

To learn more, contact Medicare at www.medicare.gov or 1-800-633-4227. For Social Security questions, call 1-800-772-1213 or visit www.ssa.gov.