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Medicare 101

Medicare and Your Health Insurance Coverage

Christian Worstell by Christian Worstell    |    Published Oct 03, 2019    |    Reviewed by John Krahnert

Medicare is a federal health insurance program administered by the Center for Medicare & Medicaid Services. Medicare offers coverage for Americans age 65 and older, as well as those who are under 65 and have certain disabilities. 

Medicare enrollment form

Original Medicare Part A and Part B

Original Medicare includes two parts:

  • Medicare Part A
    Medicare Part A is Original Medicare’s hospital insurance. It covers some of the costs for inpatient hospital stays, hospice care, skilled nursing facility care and certain home health services.

  • Medicare Part B.
    Part B is Original Medicare’s medical insurance. Medicare Part B covers some of the costs of doctor visits and services provided in outpatient settings. It also covers surgeries, ambulance services, medical equipment, mental health services.

Medicare Eligibility

If you’re age 65 or older and are a U.S. citizen or legal permanent resident, you are likely be eligible for Medicare. And if you’ve paid federal taxes for 10 years or more, you’ll likely qualify for Medicare Part A (hospital insurance) without having to pay a monthly premium.

Medicare is also available to Americans under 65 who have certain medical disabilities. To qualify, you must have received Social Security or Railroad Retirement Board disability benefits for 24 months or have end-stage renal disease or amyotrophic lateral sclerosis (also known as Lou Gehrig’s Disease), and meet certain additional eligibility requirements.

Medicare Enrollment 

If you’re approaching 65 years old and qualify for Medicare benefits, it is important to enroll during your initial enrollment period. Your initial enrollment period begins three months before you turn 65, includes your birthday month and extends three months after your 65th birthday. 

Failing to enroll in Medicare during your initial enrollment period could cause delays in coverage and may require you to pay a late penalty

Some people are automatically enrolled in Medicare Part A and Part B and others must sign up manually. If you’ve received benefits from Social Security (SS) or the Railroad Retirement Board (RRB) at least four months before you turn 65, you should be automatically enrolled in Part A and Part B. 

If you have not received SS or RBB benefits at least four months before you turn 65, you will have to enroll in Medicare yourself.

If you qualify for Medicare because of a disability, you will automatically be enrolled in Part A and Part B after your fourth month of receiving disability benefits from Social Security. 

Out-of-Pocket Costs

Original Medicare requires beneficiaries to share in a number of health insurance costs. These can include:

  • Coinsurance or copayments for inpatient care and for medical services such as visits to a physician
  • Medicare Part A deductible ($1,364 per benefit period in 2019)
  • Medicare Part B deductible ($185 per year in 2019)
  • Monthly Part B premiums
  • Part B excess charges

To get help covering some of these costs, Medicare beneficiaries can purchase a Medicare Supplement Insurance plan (also called Medigap). There are up to 10 standardized Medicare Supplement Insurance plans available in most states, and each offers a different combination of basic benefits.

Speak with a licensed agent at --ms-tfn-- or read through our guide, 10 Medicare Mistakes You Could Be Making to learn more.

 

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