Medicare Basics: An Introduction

What you need to know about Medicare, including coverage & appeals, eligibility & enrollment, and costs.

Contents

  1. What is Medicare?
  2. Eligibility & Enrollment
  3. Enrolling in Medicare
  4. The Story of Medicare: A Timeline

What is Medicare?

Medicare is the national health insurance program for older people and people with disabilities. Medicare is not a welfare program, and should not be confused with Medicaid. The income and assets of a Medicare beneficiary are not a consideration in determining eligibility or benefit payment. Medicare is a national program and procedures should not vary significantly from state to state.

Coverage under Medicare is similar to that provided by private insurance companies: it pays a portion of the cost of medical care. Often, deductibles and co-insurance (partial payment of initial and subsequent costs) are required of the beneficiary.

Medicare: Time to Renew, Not Retreat.

Read more about Medicare “Reform”

Eligibility & Enrollment

Individuals entitled to Social Security retirement insurance who are 65 years of age and older, and individuals entitled to Social Security disability benefits for not less than 24 months are eligible to participate in Medicare. Individuals entitled to Railroad Retirement benefits or Railroad Retirement disability benefits and individuals suffering from end stage renal disease or ALS are also eligible to participate. Certain federal, state and local government employees who are not eligible for Social Security retirement or disability benefits may be eligible for Medicare benefits if they worked and paid the Medicare Part A “hospital insurance” portion of their FICA taxes for a sufficient period of time.

Individuals who are not otherwise eligible for Medicare, but who are over age 65, may also purchase coverage by paying a monthly premium.

Enrolling in Medicare

An application for Social Security or Railroad Retirement benefits will trigger automatic enrollment in both Medicare Part A and Part B. However, since participation in Part B is voluntary and requires the payment of a monthly premium, individuals are offered an opportunity to decline enrollment in this part of the program – but be aware that failure to enroll may bring later financial penalties.

A person who is not entitled to Medicare by virtue of Social Security or Railroad Retirement benefits must make a separate application for Medicare and agree to pay monthly premiums.

A person may choose not to apply for Social Security or Railroad Retirement benefits at age 65 and still be entitled to Medicare coverage. In this case a separate application for Medicare benefits is required. Application for benefits can be made at any Social Security office. Railroad Retirement beneficiaries should contact the Railroad Retirement Board to enroll.

ENROLL ONLINE: As of 2010, you may also enroll online at www.socialsecurity.gov. Simply select the “Retirement/Medicare” link in the middle of the page. The application process can take less than 10 minutes.

The Story of Medicare: A Timeline