What is Medicare?
Medicare is the federal health insurance program for people who are 65 or older and certain younger people
with disabilities and a medical condition. To get Medicare, you must be a U.S. citizen or a legal resident for at least five years and meets one or more of these eligibility requirements:
- Age 65 or older
- Under age 65 with a qualifying disability
- Have End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant)
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 (hospital insurance) when you turn 65. If you qualify, then your non-working spouse may qualify based on your work record when he or she turns 65, too. In addition, you both would qualify for Medicare Part B coverage (medical insurance). Each covered individual pays a monthly Part B premium to Medicare.
How to sign up for Original Medicare (Medicare Part A and Part B):
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.
Medicare Part B : Medical Insurance
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 Part D : Prescription Drug Coverage – Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. 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 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.
I 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.