Medicare Basics

The Medicare Program

The Medicare Program is the nation’s largest health insurance program. It is a federal health insurance program for those:

  • Age 65 and older
  • Under age 65 with certain disabilities
  • With ESRD (End Stage Renal Disease)

Age 65 and older

Those age 65 or older who are eligible for Social Security Administration (SSA) or Railroad Retirement Board (RRB) benefits are eligible for Medicare. U.S. residents can also buy Medicare.

Certain Disabilities

People over age 18 who had a disability prior to age 22 are eligible for Medicare.

People with disabilities under 65 are eligible for Medicare after getting disability benefits from SSA or RRB for 24 months.

The SSA and the RRB waive the 24 month waiting period for people with ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig’s disease). Additionally, people with ALS automatically get Medicare Part A the month their disability benefits begin.

ESRD (End Stage Renal Disease)

ESRD occurs when the kidneys are no longer able to work at a level needed for everyday life. It is a kidney failure involving maintenance dialysis and/or a kidney transplant.

People under the age of 20 with ESRD may qualify for Medicare coverage if they:

  • Need dialysis on a regular basis or require a kidney transplant.
  • Have at least 1 parent who receives or is eligible for Social Security retirement benefits. People over the age of 20 qualify for Medicare after receiving Social Security Disability Insurance (SSID) benefits for at least 24 months. (They may be able to receive SSDI even with no work history.)

The FOUR (4) Parts of Medicare

The 4 Parts of Medicare include:

  • Medicare Part A
  • Medicare Part B
  • Medicare Part C/Medicare Advantage plans
  • Medicare Part D (drug plan)

Medicare Part A

Medicare Part A is hospital insurance that helps cover inpatient care in hospitals and inpatient stays in a Skilled Nursing Facility (not custodial or long-term care), hospice care services, and home health care services.

Part A helps pay for:

  • Inpatient hospital care
  • Inpatient care in a Skilled Nursing Facility (SNF) after a covered hospital stay
  • Some home health care
  • Hospice care

Medicare Part B

Medicare Part B is medical insurance that helps to cover physician services, outpatient care, and other medical services that Part A doesn’t cover. Part B also covers some preventative services.

Part B helps to pay for medical services, including:

  • Physician services
  • Some preventive services
  • Home health for patients without Part A
  • Ambulance
  • Laboratory and diagnostic services
  • Surgical supplies
  • Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)
  • Hospital outpatient services

Medicare Part C

Medicare Part C refers to Medicare Advantage plans. Private insurance companies offer these plans. Medicare Advantage plans must cover all services that Medicare Part A and Medicare Part B cover, except hospice care.

Medicare Advantage plans may also offer other benefits that traditional Medicare doesn’t pay for.

Medicare Part D

Medicare Part D is the Medicare drug plan. Insurance plans or private companies provide these services. Plans vary in cost and what drugs they cover.

Drug plans give prescription drug coverage to people with Medicare that decide to enroll in the plan.