What is Medicare?
Medicare is the federal program specifically designed to provide healthcare coverage for specific sets of people here in the United States. It is run and administered by a branch of the Department of Health and Human Services called the Centers for Medicare and Medicaid Services or CMS.
Medicare & Medicaid are NOT the same
Medicare and Medicaid are often confused for one another because the names are so close, but, they are different programs.
Medicare is healthcare coverage for seniors, people who are disabled, and individuals with certain medical conditions.
Medicaid is coverage for those with low incomes, think – welfare.
It is possible to qualify for both at the same time.
Medicare & Social Security are NOT the same
Medicare and Social Security are different benefits. They often work closely together, but they are separate from each other and offer you different types of benefits.
There are four ways for an individual to qualify for Medicare benefits:
1. Turn 65 years old
Once you reach your 65th birthday, you qualify for Medicare benefits.
You must be a U.S. citizen or permanent legal resident who has lived in the U.S. for at least 5 years AND contributed to the Medicare system for at least 40+ quarters (10 years).
If you have been married for at least a year and your spouse is at least 62 years old, you may qualify with your spouse’s work history if he or she has 40+ quarters of work.
You can qualify before age 65 if you are disabled and receiving Social Security Disability Insurance (SSDI). Medicare will start after 24 months of disability.
Your Medicare card will automatically arrive in the mail about 3 months prior to the 25th month of Social Security Disability benefits.
You will have both Part A & Part B coverage.
3. End Stage Renal Disease (ESRD)
ESRD, also known as kidney failure, qualifies you for Medicare.
If your kidneys no longer function and you need dialysis, or you have already had a kidney transplant, you qualify for Medicare.
Coverage usually starts the 4th month of dialysis treatments, but may start immediately depending on your circumstances.
If you are on a group health insurance plan, the first 3 months of dialysis are covered by the group plan.
The next 30 days are referred to as the Coordination Period where your group plan is primary and Medicare is secondary.
After the Coordination Period, Medicare becomes primary and the group health plan is secondary.
4. Lou Gehrig’s Disease (ALS)
If you have ALS aka Lou Gehrig’s Disease you are automatically eligible for Medicare the month your Social Security Disability Insurance benefits begin.
With automatic enrollment, your Medicare card will arrive in the mail at the start of your SSDI benefits.
What they are, and what they cover.
Part A is your hospital coverage and covers:
$0 – if you worked for 40+ quarters throughout your life
$278 per month – if you worked for 30-39 quarters
$506 per month – if you worked less than 30 quarters
Deductible – $1,600 per benefit period (2023)
The Part A benefit period begins the day you are admitted as an inpatient in a hospital. The benefit period ends when you haven’t received any inpatient hospital care for 60 days in a row.
See other financial gaps not covered by Part A
(Link to one of the “extras” videos – 9 things Medicare does not cover these 9 things)
Part B is your medical coverage
$164.90 per month – (for most people)
Costs may be higher for those with higher incomes.
See the Income Limits here:
$226 per year
20% of the Medicare fee schedule
There is no limit or maximum to your 20% responsibility
PRIVATE INSURANCE COMPANIES
What is it?
Part C, most commonly known as Medicare Advantage plans, are a combination of benefits in one package. These plans are offered by private insurance companies and include:
These plans may also include:
Starting at $0
Premiums range from company to company as well as where you live because Medicare Advantage plans are built around specific zip codes. Several carriers and plans have $0 premiums in certain regions while others have a slightly higher monthly premium.
Expect between $0 – $100 per month.
You will have some cost sharing in the form of copays and coinsurance with your Medicare Advantage plans. These costs will vary based on the insurance company and plan you choose.
PRESCRIPTION DRUG PLANS
Part D covers prescription drugs and helps you save money on the medications you take to stay healthy
The national average is $31.50 per month
Premiums can vary from company to company depending on your medications and where you live. Medicare Part D plans are built around specific zip codes.
Premiums may also be adjusted for those with higher incomes.
Part D is notoriously complicated, which is why we have a whole page dedicated to Part D coverage details.