Getting Started with Medicare

Eligibility

Generally, you are eligible for Medicare if you or your spouse worked at least 10 years in Medicare-covered employment and you are 65 years or older and a citizen or permanent resident of the United States. If you are not yet 65, you may qualify for coverage if you have a disability or you have End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant).

You can get Medicare Part A at age 65 without having to pay premiums if:

  • You already get retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible to get Social Security or Railroad benefits but haven’t yet filed for them.
  • You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Medicare Part A without having to pay premiums if you have:

  • Received Social Security or Railroad Retirement Board disability benefits for 24 months.
  • End-Stage Renal Disease and meet certain requirements.

Medicare Part A (Hospital Insurance)

Most people do not have to pay a premium for Medicare Part A.

Part A helps pay for care in hospitals as an inpatient, critical access hospitals, skilled nursing facilities, hospice care, and some home health care.

If you get benefits from Social Security o r the RRB, you automatically get Part A starting the first day of the month you turn 65. If you are under age 65 and disabled, you automatically get Part A after you get disability benefits from Social Security or certain disability benefits from the RRB for 24 months. You will get your Medicare card in the mail 3 months before your 65th birthday or your 25th month of disability.

Medicare Part B (Medical Insurance)

Part B covers Medically-necessary services or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice. It also covers some preventative services that help prevent illness or detect illness at an early stage, when treatment is most likely to work best. For example, pap tests, flu shots, and prostate cancer exams.

Most people pay the Medicare Part B premium $96.40 per month in 2009. This amount will change January 1, 2010. In some cases, this amount may be higher if you didn’t choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you could have had Part B but did not sign up for it, except in special cases. You will have to pay this extra 10% as long as you have Medicare Part B.

Your Part B premium may be higher if your income is above a certain level.

Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7 month period that begins 3 months before you turn 65.

Medicare Part C (Medicare Advantage Plan)

Medicare Advantage Plans Include BOTH Medicare Part A (Hospital Insurance) and Part B (Medical Insurance), they are offered by Private Insurance companies approved by Medicare. In most plans, you need to use plan doctors, hospitals, and other providers or you pay more. You usually pay a monthly premium (in addition to your Part B premium) and a copayment for covered services. Costs, extra coverage, and rules vary by plan.

Medicare Part D (Prescription Drug Coverage)

You must choose and join a Medicare Prescription Drug Plan. These plans are run by private companies approved by Medicare. Most Medicare Advantage Plans include prescription drug coverage (Part D), usually for an extra cost.

Enrolling in Medicare

STEP 1. Decide if you want Original Medicare (Part A and Part B) or if you want a Medicare Health Plan / Medicare Advantage Plan (Part C).

STEP 2. Decide if you want Prescription Drug Coverage (Part D). If you selected a Medicare Advantage Plan then most likely this plan includes prescription drug coverage. If you selected Original Medicare, then you can choose the Prescription Drug Plan that best fits your needs.

STEP 3. Decide if you want Supplemental Coverage. If you selected Original Medicare, you may want to get private coverage that fills gaps in Original Medicare Coverage. You can choose to buy private supplement coverage, like a Medigap policy. Costs vary by policy and company. This does not include prescription coverage. You will need to enroll in a Prescription Drug Plan for prescription coverage.

You can enroll in Medicare Part A and Part B at your local Social Security Office, or call 1-800-772-1213, TTY users call 1-800-325-0778.

Enroll in a Medicare Advantage Plan

Enroll in a Prescription Drug Plan

Enroll in a Medicare Supplement Plan