Medicare Insurance

What is Medicare?

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

What is Part A?

  • Part A is Hospital Insurance. It covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care

What is Part B?

  • Part B is Medical Insurance. It covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

Apply for Medicare

Automatic enrollment:

Some people get part A and B automatically if you are:

  • Already getting benefits from Social Security or the Railroad Retirement Board
  • Under 65 and received disability benefits from Social Security for 24 months
  • Have ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig

Submit Application:

Some people need to sign up for Medicare if you are:

  • Not getting Social Security or Railroad Retirement Board.
  • Qualify for Medicare because of End Stage Renal Disease (ESRD)

When to Apply?

When first eligible:

  • When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B.
  • In most cases, if you don’t sign up for Medicare Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll have to pay this penalty for as long as you have Part B and could have a gap in your health coverage.

Between January 1 – March 31 each year

You can sign up for Part A and/or B during the General Enrollment Period Between Jan 1 – March 31 each year if both of these apply:

  • You didn’t sign up when you were first eligible.
  • You aren’t eligible for a Special Enrollment Period (see below).
  • You must pay premiums for Part A and/or Part B. Your coverage will start July 1. You may have to pay a higher premium for late enrollment in Part A and/or a higher premium for late enrollment in Part B.

Special Circumstances:

Once your Initial Enrollment Period ends, you may have the chance to sign up for Medicare during a Special Enrollment Period (SEP). If you’re covered under a group health plan based on current employment, you have a SEP to sign up for Part A and/or Part B anytime as long as:

  • You or your spouse (or family member if you’re disabled) is working.
  • You’re covered by a group health plan through the employer or union based on that work.
  • You also have an 8-month SEP to sign up for Part A and/or Part B that starts at one of these times (whichever happens first):
  • The month after the employment ends
  • The month after group health plan insurance based on current employment ends
  • Usually, you don’t pay a late enrollment penalty if you sign up during a SEP.
 
 

What’s not covered?

  • Medicare doesn’t cover everything. If you need certain services Medicare doesn’t cover, you’ll have to pay for them yourself unless you have other insurance or you’re in a Medicare health plan that covers them.
  • Even if Medicare covers a service or item, you generally have to pay your deductible, coinsurance, and copayments.
  • Some of the items and services that Medicare doesn’t cover include:
    1. Long-term care (also called custodial care)
    2. Most dental care
    3. Eye examinations related to prescribing glasses
    4. Dentures
    5. Cosmetic surgery
    6. Acupuncture
    7. Hearing aids and exams for fitting them
    8. Routine foot care

What’s not covered?

  • Medicare doesn’t cover everything. If you need certain services Medicare doesn’t cover, you’ll have to pay for them yourself unless you have other insurance or you’re in a Medicare health plan that covers them.
  • Even if Medicare covers a service or item, you generally have to pay your deductible, coinsurance, and copayments.
  • Some of the items and services that Medicare doesn’t cover include:
  1. Long-term care (also called custodial care)
  2. Most dental care
  3. Eye examinations related to prescribing glasses
  4. Dentures
  5. Cosmetic surgery
  6. Acupuncture
  7. Hearing aids and exams for fitting them
  8. Routine foot care

Choose your Coverage

There are 2 main ways to get your Medicare coverage – Original Medicare or a Medicare Advantage Plan (like an HMO or PPO). Some people get additional coverage, like Medicare prescription drug coverage or Medicare Supplement Insurance (Medigap).

Choose your Coverage

There are 2 main ways to get your Medicare coverage – Original Medicare or a Medicare Advantage Plan (like an HMO or PPO). Some people get additional coverage, like Medicare prescription drug coverage or Medicare Supplement Insurance (Medigap).