MEDICARE

Medicare is the 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, sometimes called ESRD). 

You qualify at age 65 or older if:

1. You are a U.S. citizen or a permanent legal resident; and

2. You or your spouse has worked long enough to be eligible for Social Security or railroad retirement benefits — usually having earned 40 credits from about 10 years of work — even if you are not yet receiving these benefits; or
3. You or your spouse is a government employee or retiree who has not paid into Social Security but has paid Medicare payroll taxes while working.

Note: You can qualify for Medicare on your spouse's work record if he or she is at least age 62 and you are at least age 65. You also may qualify on the work record of a divorced or deceased spouse.

Following the Supreme Court's ruling on the Defense of Marriage Act in June 2013, people in same-sex marriages may qualify on their spouse's work record if they live in the state where they were wed or in another state that recognizes same-sex marriage, or if they are civilian or military employees of the federal government. It's currently unclear whether same-sex couples outside of these categories have the same rights — but if you're in this position, you should apply anyway.

You qualify UNDER age 65 if: 

• You have been entitled to Social Security disability benefits for at least 24 months (which need not be consecutive); or
• You receive a disability pension from the Railroad Retirement Board and meet certain conditions; or
• You have Lou Gehrig's disease (amyotrophic lateral sclerosis), which qualifies you immediately; or
• a. You have permanent kidney failure requiring regular dialysis or a kidney transplant — and you or your spouse has paid Social Security taxes for a certain length of time, depending on your age.

Anyone who is a U.S. citizen or legal resident and is turning 65 is entitled to an initial enrollment period that lasts seven months — from three months before the month of their 65th birthday to three months after that month. For example, if you turn 65 in June, your enrollment period is March 1 to Sept. 30.

Use this enrollment period to sign up for Medicare Part A and Part B at age 65 if:

• you are retired or not working; or
• you do not have health insurance from an employer for whom you or your spouse is still working; or
• you live outside the United States and its territories and are not working.

The different parts of Medicare help cover specific services:

Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance)
Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.

Medicare Part C (Medicare Advantage Plans)
A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren't paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.

Medicare Part D (prescription drug coverage)
Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans. 

Generally, how much you pay for Medicare depends on: which Medicare plan you choose; how often you go to the doctor or hospital; whether you have other health insurance; and whether you qualify for help with Medicare costs.

Medicare does not cover all of your health care costs. Depending on which plan you choose, you might have to share in the cost of your care by paying premiums, deductibles, copayments and coinsurance. 

A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits.

Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans.

If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren't paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage. 

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