Jane Dotson
Medicare is the federal health insurance program for people aged 65 and over in the United States. If you are under 65, you may still be eligible for Medicare if you have a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's Disease). There are four types of Medicare coverage, known as parts, which cover hospital and medical costs, prescription medications, and more. If you already have health insurance through your employer, you may be able to keep it and apply for Medicare only. However, if you are looking to transition to Medicare, there are a few steps you need to take, including signing up during one of the three enrollment periods to avoid penalties or gaps in coverage.
| Characteristics | Values |
|---|---|
| Who is eligible for Medicare? | People aged 65 or older |
| People under 65 with a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig’s Disease) | |
| How to get Medicare? | Some people get Medicare automatically when they turn 65 |
| Others have to sign up if they start receiving retirement or disability benefits from Social Security before turning 65 | |
| Enrollment periods | 3 enrollment periods |
| Sign up as soon as possible to avoid penalties or gaps in coverage | |
| Medicare Parts | Part A: Hospital Insurance |
| Part B: Medical Insurance | |
| Part C: Medicare Advantage Plans (private insurance option) | |
| Costs | Most people get Part A for free |
| Some people have to pay a premium for Part A | |
| Medicare plans include a $2,000 cap on what you pay out-of-pocket for Part D drugs | |
| Medicare Savings Programs | Income and asset limits determine eligibility |
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What You'll Learn
Medicare Part A and Part B
Medicare is the federal health insurance program for people aged 65 and over. If you are under 65, you may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's Disease).
Medicare Part B is medical insurance. Most people pay a monthly premium for Part B, and the exact premium depends on your income level. If you receive Social Security disability benefits, you will automatically begin receiving Medicare Parts A and B after 24 months. If you have Lou Gehrig's Disease (ALS), you will receive Medicare Parts A and B immediately when you enrol in Social Security disability benefits.
You can also choose to add on to your Original Medicare plan by enrolling in Medicare Part D, which helps cover prescription drug costs. Private insurance companies run Part D plans, and you must be enrolled in Part A or Part B before signing up for Part D.
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Medicare Advantage Plans
Medicare is the federal health insurance program for people aged 65 and over in the US. If you are under 65, you may still be eligible if you have a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's Disease).
There are four types of Medicare coverage, known as "parts". Medicare Advantage Plans, also known as Part C, are a type of Medicare health plan that is offered by Medicare-approved private companies. These companies must follow rules set by Medicare.
Before joining a Medicare Advantage Plan, it is important to talk to your employer, union, or other benefits administrator about their rules. Joining a Medicare Advantage Plan might cause you to lose your existing coverage, and that of your spouse and dependents.
A Medicare Advantage Plan can disenroll you for several reasons, including if you move outside the plan's service area, lose Medicare or Medicaid eligibility, or if the plan's contract with Medicare ends.
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Medicare Part D
Under the program, drug benefits are provided by private insurance plans that receive premiums from both enrollees and the government. Part D plans typically pay most of the cost for prescriptions filled by their enrollees. However, plans are later reimbursed for much of this cost through rebates paid by manufacturers and pharmacies. Part D enrollees cover a portion of their own drug expenses by paying cost-sharing. The amount of cost-sharing an enrollee pays depends on the retail cost of the filled drug, the rules of their plan, and whether they are eligible for additional Federal income-based subsidies.
To enroll in Part D, Medicare beneficiaries must also be enrolled in either Part A or Part B. Beneficiaries can participate in Part D through a stand-alone prescription drug plan or through a Medicare Advantage plan that includes prescription drug benefits. In 2020, the average monthly Part D premium across all plans was $27. The number of offered plans varies geographically, but a typical enrollee will have dozens of options to choose from.
The Extra Help program helps people with limited income and resources lower or cut Part D costs. The level of help provided depends on the income and resources of the enrollee.
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Medicare and other insurance
Medicare is the federal health insurance program for people aged 65 and over in the US. If you are under 65, you may still be eligible for Medicare if you have a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's Disease). There are four types of Medicare coverage, known as "parts".
Medicare Part A covers hospitalization, home or skilled nursing, and hospice. If you receive Social Security disability benefits, you will automatically begin receiving Medicare Part A after 24 months. If you have Lou Gehrig's Disease (ALS), you will receive Medicare Part A immediately when you enrol in Social Security disability benefits.
Medicare Part B is medical insurance. If your group health plan or retiree coverage is the secondary payer, you may need to sign up for Medicare Part B before they pay.
Medicare Part C (Medicare Advantage Plans) is a private insurance option that covers hospital and medical costs. Medicare Advantage plans provide Part A and Part B benefits to people with Medicare.
Medicare Part D covers prescription medications.
If you have Medicare and other health insurance, each type of coverage is called a "payer". The "primary payer" pays up to the limits of its coverage and then sends the rest of the balance to the "secondary payer". If the "secondary payer" doesn't cover the remaining balance, you may be responsible for the remaining costs. This order of payment is called "coordination of benefits". If the insurance company doesn't pay the claim promptly (usually within 120 days), your doctor or other providers may bill Medicare.
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Medicare enrolment
Medicare is a federal health insurance program for people aged 65 and over. If you are under 65, you may still be eligible for Medicare if you have a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's Disease).
Enrolling in Medicare
To enrol in Medicare, you must meet certain criteria and provide proof of identity and residency. If you are an Australian citizen, you must have a permanent resident visa or have applied for one. You can enrol in Medicare by signing in to your myGov account and providing the necessary details and documents. If your application is approved, you will receive your Medicare card in the mail. You can also enrol your baby in Medicare using the Newborn Child Declaration, which you will receive from the hospital.
If you do not have a myGov account, you will need to create one to enrol in Medicare. Alternatively, you can complete a Medicare enrolment form and submit it by mail or email to Medicare Enrolment Services. If you are enrolling as a family, you will need to nominate a contact person for the family Medicare card.
Medicare Coverage
There are four types of Medicare coverage, known as "parts". Medicare Part A covers hospitalization, home or skilled nursing, and hospice, while Part B covers medical insurance. Part C, also known as Medicare Advantage Plans, is a private insurance option that covers hospital and medical costs. Part D covers prescription medications.
Enrollment Periods
There are three enrollment periods for Medicare, and it is important to sign up as soon as possible to avoid penalties or gaps in coverage. If you are not yet ready to receive Social Security benefits at 65 because you are still working, you can apply online for Medicare only. If you receive Social Security disability benefits, you will automatically begin receiving Medicare Parts A and B after 24 months.
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Frequently asked questions
Medicare is a federal health insurance program for people aged 65 and over.
If you are receiving Social Security benefits, you will automatically begin receiving Medicare Parts A and B when you turn 65. If you are not receiving Social Security benefits, you will need to apply for Medicare by contacting the Social Security Administration.
There are four types of Medicare coverage, known as "parts":
- Part A (Hospital Insurance) covers hospitalization, home or skilled nursing, and hospice care. Most people get Part A for free.
- Part B (Medical Insurance) covers doctor visits and other outpatient services.
- Part C (Medicare Advantage Plans) is a private insurance option that covers hospital and medical costs.
- Part D covers prescription medications.
Yes, you can have Medicare and other health insurance, such as employer-provided coverage or a Marketplace plan. If you have Medicare, you don't need to make any changes to your coverage when enrolling in the Health Insurance Marketplace.
There are three enrollment periods for Medicare: when you turn 65, when you retire, and during a special enrollment period if you are still working at 65. It's important to sign up as soon as you are eligible to avoid penalties or gaps in coverage.
