Medicare is a federal health insurance program that helps cover hospital and medical costs, such as hospital stays, surgeries and visits to a doctor’s office. In general, to receive Medicare benefits, you must be 65 older. Some younger people with certain disabilities or End-Stage Renal Disease (ESRD) may also qualify.
Determining Your Medicare Health Insurance Eligibility
Medicare eligibility can be confusing, so we’ve broken it down into two parts:
- If you’re age 65 or older
You qualify for Medicare Part A and Part B health insurance benefits if you are a U.S. citizen or permanent legal resident and you or your spouse are eligible for Social Security or Railroad Retirement Board (RRB) benefits. You may also qualify if you or your spouse is a government employee or retiree who has not paid into Social Security but has paid into Medicare while working.
- If you’re younger than 65
You may qualify for Medicare if you have been entitled to Social Security benefits for at least 24 months, receive a disability pension from the RRB, you have Lou Gehrig’s disease or you have End-Stage Renal Disease (ESRD).
What Medicare Covers
Medicare is broken down into four parts, Part A, Part B, Part C and Part D.
Part A is also known as Medicare “hospital insurance” and covers things such as hospital stays, surgeries and hospice care.
Part B is also known as Medicare “medical insurance” and covers things such as doctors’ services, outpatient care and some medical supplies.
Part C, also known as Medicare Advantage, includes plans sold through private insurance companies that are approved by Medicare. These plans provide you with all of your Part A and Part B benefits and may include various additional benefits. It’s an alternative to Medicare Part A and Part B (Original Medicare).
Part D, also known as prescription drug coverage, adds prescription drug benefits to Original Medicare and certain other types of Medicare plans. Like Part C, Medicare Part D is offered through private insurance companies and approved by Medicare.
Medicare Doesn’t Cover Everything
While Medicare covers a lot of medical expenses, it doesn’t cover everything. That’s where Medicare Supplement Insurance plans come in. Medicare Supplement Insurance plans (also referred to as Medigap) are designed to help cover many of the costs that Original Medicare (Part A and Part B) does not.