Medicare

Medicare is a federal health insurance program for people age 65 or older and younger people with disabilities. It offers affordable access to hospital services, outpatient care, preventive services, and prescription medications.

Medicare covers people regardless of income. That makes it different from Medicaid, which is based on income and household size, and it is why most families with children will use Medicaid, CHIP or a Marketplace plan instead.

Medicare is a federal program, but some rules can vary by state — especially for Medicare Advantage plans, Medigap coverage, and state assistance programs. Your plan options, costs, and enrollment rights may differ depending on where you live.

Who qualifies for Medicare?

Medicare is available to:

• People age 65 or older who are U.S. residents and either citizens or lawful permanent residents who have lived in the United States for 5 continuous years. ¹
• Younger people who have received Social Security or Railroad Retirement Board disability benefits for 24 months. You are enrolled automatically.
• People with ALS, who are entitled to Part A the first month they receive disability benefits, with no waiting period.
• People of any age with end-stage renal disease (permanent kidney failure) who need regular dialysis or have had a kidney transplant, and who meet work history requirements.

Medicare vs. Medicaid

What are the parts of Medicare?

There are 4 types of Medicare coverage, known as “parts.”

Medicare Part A – Hospital Care

Part A helps cover your hospital stays, skilled nursing care, hospice care, and some home health services. Most people don’t pay a premium for Part A because they or a spouse paid Medicare taxes while working, generally for at least 10 years. ²

Medicare Part B – Medical Care

Part B covers doctor visits, outpatient care, medical equipment, lab tests, and preventive services. There is a monthly premium for Part B depending on your income. According to the Medicare Cost Guide, ² you will have to pay $202.90 each month or higher for Medicare Part B.

Medicare Part C – Medicare Advantage

Part C is an all-in-one alternative to Original Medicare, offered by private insurance companies. These plans include Part A and Part B, often add Part D (drug coverage), and may include extras like dental, vision, or hearing benefits.

Medicare Part D – Prescription Drugs

Part D helps lower the cost of prescription medications. These plans are offered by Medicare-approved private insurers and can be added to your Medicare coverage.

How do I enroll in Medicare for the first time?

Your Initial Enrollment Period is the 7 months around your 65th birthday. It begins 3 months before the month you turn 65, includes your birthday month, and ends 3 months after. ³

If you’re 65 or older, you can sign up for Medicare in-person, by phone or online. You can enroll in both Part A and Part B, or choose Part A only.

When you apply, you’ll complete either the combined application for Retirement Benefits and Medicare or the Medicare-only application, depending on your situation.

1. Online: Visit the website of the Social Security Administration (SSA) and use their Medicare enrollment portal .
2. By phone: Call SSA at 1-800-772-1213 (TTY 1-800-325-0778).
3. In person: Visit your local SSA office if you prefer paper forms or need assistance.

If you’re still covered under an employer group health plan, you may choose to delay Part B to avoid paying the monthly premium until you need it. You can sign up later during a Special Enrollment Period without a penalty, but COBRA does not count as current employment coverage, and waiting could mean a lifelong late enrollment penalty. ³