Understanding Medicare

Medicare is a 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).

Who is Eligible for Medicare?

• Age: You are eligible for Medicare if you are 65 years old or older and have lived in the United States for at least five years.
• Disability: You are eligible for Medicare if you have been receiving Social Security disability benefits for at least two years.
• End-Stage Renal Disease: You are eligible for Medicare if you have been diagnosed with End-Stage Renal Disease and are receiving dialysis or a kidney transplant.

Parts of Medicare

• Part A: Hospital Insurance
  • Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
  • You may pay a premium for Part A, but most people do not because they or a spouse paid Medicare taxes while working.
• Part B: Medical Insurance
  • Covers doctor visits, outpatient care, medical supplies, and preventive services.
  • You pay a monthly premium for Part B.
• Part C: Medicare Advantage Plans
  • Are private health insurance plans that offer all of the benefits of Part A and Part B, plus some additional benefits.
  • You may pay a monthly premium for Part C, but it may be lower than your Part A and Part B premiums.
• Part D: Prescription Drug Coverage
  • Covers prescription drugs.
  • You pay a monthly premium for Part D.

Medicare Donut Hole

• The Medicare Donut Hole is a coverage gap in Part D prescription drug plans.
• Once you and your plan have spent a certain amount on prescription drugs in a year, you will pay more for your medications until you reach another spending threshold.
• There are ways to avoid the Donut Hole, such as enrolling in a plan with a low-cost prescription drug formulary or using generic drugs.

Getting Started with Medicare

If you are eligible for Medicare, you will need to choose a plan. You can choose Original Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C). You can also choose to add a Part D prescription drug plan.

You can start the enrollment process by calling the Social Security Administration at 1-800-772-1213. You can also get help from a Medicare-approved insurance agent.

Medicare is a complex program, so it is important to get help when making decisions about your coverage.