Understanding Medicare can cover many of your health care needs. Today’s Medicare is working with private companies approved by Medicare that provide different ways to get your health care and prescription drug coverage in the Medicare Program. The Medicare plan that you choose affects many things like cost, benefits, doctor choice, convenience, and quality.
- Age 65 or older,
- Under age 65 with certain disabilities, and
- Of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant)
What Services Does Medicare Cover?
Medicare covers certain medical services and supplies in hospitals, doctors’ offices, and other health care settings. Services are either covered under Medicare Part A (Hospital Insurance) or Medicare Part B (Medical Insurance).
Medicare Part A helps cover the following:
- Inpatient care in hospitals (such as critical access hospitals, inpatient rehabilitation facilities, and long‐term care hospitals).
- Inpatient care in a skilled nursing facility (not custodial or long‐term care)
- Hospice care services
- Home health care services
- Inpatient care in a Religious Nonmedical Health Care Institution. Please note that Medicare will only cover the non‐medical, non‐religious health care items and services in this type of facility for people who qualify for hospital or skilled nursing facility care but for whom medical care isn’t in agreement with their religious beliefs.
- You are age 65 or older, and you are entitled to (or enrolling in) Part B and meet the citizenship or residency requirements.
- You are under age 65, disabled, and your premium‐free Part A coverage ended because you returned to work.
- Most people pay a monthly premium for Part B.
- It helps cover doctors’ services and outpatient care.
- It also covers some other medical services that Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home health care.
- Part B helps pay for these covered services and supplies when they are medically necessary.
How You Get Part B:
- If you get benefits from Social Security or the Railroad Retirement Board (RRB), in most cases, you will automatically get Part B starting the first day of the month you turn age 65.
- If your birthday is on the first day of the month, your Part B will start the first day of the prior month.
- If you are under age 65 and disabled, you will automatically get Part B after you get disability benefits from Social Security or certain disability benefits from the RRB for 24 months. You will get your Medicare card in the mail about 3 months before your 65th birthday or your 25th month of disability.
- If you have ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig’s disease), you automatically get Part B the month your disability benefits begin.
Note: If you don’t want Part B, follow the instructions that come with the card, and send the card back. If you keep the card, you keep Part B and will pay Part B premiums.
Understanding Medicare can help you choose different ways to get the services covered. Depending on where you live, you may have different choices. You may want to consider a Medicare Prescription Drug Plan to add drug coverage. Or, you may want to consider a Medicare Advantage Plan (like an HMO or PPO) that provides all your Part A, Part B, and often Part D coverage.
Call Social Security at 1‐800‐772‐1213 for more information about your Medicare eligibility. TTY users should call 1‐800‐325‐0778. If you get RRB benefits, call the RRB at 1‐877‐772‐5772. For general information about enrolling, visit www.medicare.gov, and select “Find Out if You Are Eligible for Medicare and When You Can Enroll.” You can also get free, personalized health insurance counseling from your State Health Insurance Assistance Program (SHIP).
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- Medicare Plan Choices
- Medicare Prescription Drug Coverage
- Medicare Advantage Plans
- Understanding Medicaid
- How To Make Changes To Your Medicare Coverage
Source: U.S Department of Health and Human Services
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