Medicare is a health insurance program for people age 65 or older. Some younger people are eligible for Medicare including people with disabilities, permanent kidney failure and amyotrophic lateral sclerosis (Lou Gehrig’s disease or ALS). Medicare helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care.

If you already get Social Security benefits, you do not need to sign up for Medicare. You will be automatically enrolled in Original Medicare (Part A and Part B) when you become eligible.  You will receive communications from the Social Security Administration a few months before you become eligible.

If you don’t get Social Security benefits and are not ready to apply for them yet, you should sign up for Medicare three months before your 65th birthday. You can apply online at https://www.ssa.gov/medicare/sign-up by calling at 1-800-772-1213 (TTY 1-800-325-0778), 8:00 a.m. – 7:00 p.m., Monday through Friday.

Medicare eligibility begins at age 65, and signing up on time can help you avoid premium surcharges. But if you’re still working at 65, and you have coverage under a group health plan through an employer with 20 employees or more, then you don’t have to enroll in Medicare right now. But if your employer has less than 20 employees, you need to take Medicare Parts A and B, because that will be your primary insurance

Medicare is federally sponsored health coverage for those 65 and over, and for younger people who are disabled

Medicaid, on the other hand, provides health coverage for low-income individuals who could not otherwise afford health insurance

Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, as well as skilled nursing facilities (not custodial or long-term care), hospice, and home health care.

Part B covers 2 types of services

• Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
• Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage when treatment is most likely to work best.

Part A premium: Most people don’t pay a premium for Part A coverage. This is sometimes called “premium-free Part A.” You won’t pay a Part A premium if you:

• Qualify to get (or are already getting) retirement or disability benefits from Social Security (or the Railroad Retirement Board).
• Get Medicare earlier than 65.
• Are 65 or older and you (or another qualifying person, like your current or former spouse) paid Medicare taxes while working for a certain amount of time (usually at least 10 years).

*If you don’t qualify for premium-free Part A, you might be able to buy it. 

Part B premium: You’ll pay a premium for Part B coverage every month, even if you don’t get any Part B-covered services. The monthly premium can change each year and may be higher depending on your income.

Part C premium: Monthly premiums for Part C coverage vary based on which plan you join. The premium amount can change each year.

Part D premium: Monthly premiums for Part D coverage vary based on which plan you join. The premium amount can change each year.

Medicare Advantage (MA) plans (also known as Part C plans) are offered by private companies and approved by Medicare. These plans generally help you pay the medical costs not covered by Original Medicare like some vision, hearing, dental, and fitness programs (like gym memberships or discounts). MA Plans can also choose to cover even more benefits. These plans include Medicare Part A and Medicare Part B, and usually Medicare drug coverage (Part D).

Original Medicare won’t pay for routine vision services like eye exams, prescription glasses, or contact lenses. But there’s an exception to this if you’ve just had cataract surgery; in that case, Medicare Part B will cover some of the cost of a single pair of glasses or set of contact lenses. On the other hand, Medicare Advantage generally covers standard vision testing, as well as glasses or contacts.

Although Medicare open enrollment concluded on December 7, 2022, beneficiaries enrolled in Medicare Advantage have an additional opportunity to change their 2023 coverage during different election periods. Contacts us to see if you qualify.