Medicare

Medicare is the federal health insurance program for people who are 65 or older, or with for younger people with certain disabilities or that have been on social security disability for 24 months, and people with End-Stage Renal Disease (ESRD). Medicare has different parts that help cover specific services. It is important to know which parts you are eligible and make sure you are getting all the services available to you.

Medicare Part A (Hospital Insurance)

Medicare Part A helps cover inpatient care in hospitals, skilled nursing facility, hospice, and home health care. Medicare provides this coverage directly.

Medicare Part B (Medical Insurance)

Medicare Part B covers doctors’ and other health care providers’ services, outpatient care, durable medical equipment, and home health care. It also covers some preventive services to help maintain your health and to keep certain illnesses from getting worse. You usually pay a monthly premium for Part B.

Medicare Part D (prescription drug coverage)

If you want this coverage, you must join a Medicare Prescription Drug Plan. You usually pay a monthly premium. These plans are run by private companies approved by Medicare.

If you choose not to get this coverage a Part D Late Enrollment Penalty may be added to your Part D premium if you did not have Medicare prescription drug coverage or “creditable” coverage when you first became eligible for Medicare.

What is the coverage gap on Part D or “donut hole”

Most Medicare Prescription Drug Plans have a coverage gap (also called the “donut hole”). This means there’s a temporary limit on what the drug plan will cover for drugs. Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. In 2015 – $2,960 on covered drugs (the combined amount plus your deductible), you’re in the coverage gap. In 2016, once you and your plan have spent $3,310 on covered drugs, you’re in the coverage gap. This amount may change each year.

How does Medicare Work?

Medicare is a federal health insurance program that provides benefits to individuals age 65 and older and individuals of any age who have a qualifying disability or illness. Most people are automatically enrolled into Original Medicare, Part A and Part B, when they become eligible at age 65. Medicare Part A and Part B cover costs associated with medically necessary hospital and medical services and supplies.

What is Original Medicare?

Original Medicare refers to Medicare Part A and Part B. It was the originally was the only part of Medicare for the first 32 years of the program. In the late 1990s Medicare Advantage or Medicare Part C was created.

How do I get Medicare?

Some people get Medicare Part A and Part B automatically if they meet certain criteria s. If you are receiving benefits from Social Security, or the RRB (Railroad Retirement Board). You are likely automatically getting Part A and Part B the first day of the month you turn 65.

If you are under 65 but have a qualifying disability you automatically get Part A Part B once you get disability benefits from Social Security for 24 months.