Medicare

Medicare, A Simple Explanation

October 24, 2019 • By

Last Updated: October 24, 2019

Social Security and Medicare are both programs that are household names, but do you know the true difference? Both programs help safeguard millions of Americans as well as improve the quality of life for their family and friends. While Social Security offers retirement, disability, and survivors benefits, Medicare provides health insurance.

Medicare is our country’s health insurance program for people age 65 or older and younger people receiving Social Security disability benefits. The program helps with the cost of health care, but it doesn’t cover all medical expenses or the cost of most long-term care.

When you first enroll in Medicare and during certain times of the year, you can choose how you get your Medicare coverage. There are 2 main ways to get Medicare:

Original Medicare

Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). If you want drug coverage, you can join a separate Part D plan. To help pay your out-of-pocket costs in Original Medicare (like your deductible and 20% coinsurance), you can also shop for and buy supplemental coverage. Examples include coverage from a Medicare Supplement Insurance (Medigap) policy, or from a former employer or union.

Medicare Advantage (also known as Part C)

Medicare Advantage is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.  Part C plans may have lower out-of-pocket costs than Original Medicare.  They also may offer extra benefits that Original Medicare doesn’t cover — like vision, hearing, dental, and more.

If you can’t afford to pay your Medicare premiums and other medical costs, you may be able to get help from your state. States offer programs for people eligible for or entitled to Medicare who have low income. Some programs may pay for Medicare premiums and some pay Medicare deductibles and coinsurance. To qualify, you must have limited income and resources.

You can learn more about Medicare, including how to apply for Medicare and get a replacement Medicare card on our website.


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About the Author

Darlynda Bogle, Assistant Deputy Commissioner

Darlynda Bogle, Assistant Deputy Commissioner

Comments

  1. Lyris J Prescod

    My medicare has stopped. I am not someone who came here illegally. I lost all of my documents and is having a hard time time getting them back. It is costing money I have no income coming in bearly have food. I would like to know if Social Security could begin paying me and give me a deadline to get my documents I don’t have money and this is costing quite a bit. Please help me

    • Ann C., Public Affairs Specialist

      Hi, Lyris. We are sorry to hear about your situation. For your security, we do not have access to private information in this venue. We ask that members in our Blog community work with our offices with specific questions. You can call us at 1-800-772-1213, Monday through Friday, between 7:00 a.m. and 7:00 p.m., for assistance. Generally, you will have a shorter wait if you call later in the day. You can also contact your local Social Security office. We hope this helps.

  2. Russell Fuller Jr

    Thank you for all you do for the communities.

  3. Anne Grainger

    I would like to qualify for medicare but i am living in the UK. I plan to return to the US where i am Financially responsible for my elderly parents. I started working and paying into the US system when I was 15 years old and i also represented the US in 4 olympic games including 2 silver medals. However i do not have enough social security payments to qualify for social security since my tax domicile is the UK. I am now 61 years old. What should I do ?

    • S T

      If you meet the stringent poverty requirements, and are over 65, you could apply for Supplemental Security Income, which was originally intended to supplement low monthly Social Security benefits but also stands alone as a program for impoverished disabled or elderly recipients. SSI recipients qualify for Medicaid, the medical insurance also with severe poverty requirements. If you are not that poor, then hope your UK benefits might transfer in some part to the US, just as Social Security can be paid to those living overseas.

    • Ann C., Public Affairs Specialist

      Hi, Anne. Since you are living outside of the U.S. you can contact your local Federal Benefits Unit for any assistance related to Social Security benefits. Also, our Office of International Operations home page provides more information to assist our customers living abroad. We hope this helps.

  4. Randy Bailey

    I do not turn 65 until May 26 2020, do I subscribe to Medicare now or wait until I turn 65? I keep hearing about Open Enrollment ending in December 2019 for 2020 and want to make sure I Gary it before December if I need it.

    • S T

      You would first be able to apply in February 2020, three months ahead.

    • Ann C., Public Affairs Specialist

      Thanks for your question, Randy. If you are already getting Social Security retirement benefits, you will be enrolled in Medicare Parts A and B automatically. However, because you must pay a premium for Part B coverage, you have the option of turning it down. If you are not already getting retirement benefits, you should contact us about three months before your 65th birthday to sign up for Medicare. You can sign up for Medicare even if you do not plan to retire at age 65. To learn more about Medicare, visit here. We hope this helps.

    • N. Berg

      Medicare ‘Open enrollment’ applies to those people already receiving Medicare benefits who want to change the plan(s) they are in.
      For new enrollies, those reaching Medicare eligibility (age 65) there is a seven-month enrollment period (3 months before you turn 65, the month you turn 65 and 3 months following the month you turn 65.). But, don’t wait for the last minute. Also, you are given the option of enrolling for only hospital coverage (PART A) or hospital (PART A) and medical (PART B) If you currently have group health insurance through your employer or union or some other source, you may want to decline Part B (MEDICAL) until that group coverage ends. Check with your insurance administrator. Some people may be automatically enrolled in Medicare if they are already receiving some form of Social Security benefits.

  5. Charles Serrano

    I have a coverage that became secondary to medicare part A from my job in NY City, also prescriptions and eye care from the union. The medical have a high deductible and never cover the 20% in full. Is there anything I can do without upsetting that secondary insurance, or the union prescription, eye and dental coverage which is like nothing anyway?

    • Marc

      If you have insurance through a job or union membership, Medicare is secondary to that insurance, not the other way around. Medicare will pay part of what the job/union insurance doesn’t but not all of it. Once you retire or no longer have insurance through your job, Medicare will become primary and a supplemental policy (Part G or Medigap) would cover much of the rest, or you could switch to a Part C plan like your union plan.

    • Ann C., Public Affairs Specialist

      Hi, Charles. For your security, we do not have access to private information in this venue. We ask that members in our Blog community work with our offices with specific questions. You can call us at 1-800-772-1213, Monday through Friday, between 7:00 a.m. and 7:00 p.m., for assistance. Generally, you will have a shorter wait if you call later in the day. You can also contact your local Social Security office. You may also wish to contact your local Medicare SHIP (State Health Insurance Program Coordinator) to discuss your options. We hope this helps.

  6. Robert Jacob

    Are you talking the A;B;C coverage within Medicare or are you talking of a supplement?

    If so are you allowed to direct me to the best additional insurance provider

  7. LAWRENCE BARBERI

    Why does my Medicare card say
    HOSPITAL (PART A)
    BENEFITS ONLY?

    • BETTY GORDON

      call medicare promptly!! glad you discovered that.

      it should show BOTH A & B !! it’s important that it does.

      best wishes on getting this straightened out NOW!

      betty gordon, iowa

    • S T

      You may have other insurance that covers the same things Part B covers so that you were not required to take (and pay for) Part B.

    • Ann C., Public Affairs Specialist

      Hi, Lawrence. For your security, we do not have access to private information in this venue. We ask that members in our Blog community work with our offices with specific questions. You can call us at 1-800-772-1213, Monday through Friday, between 7:00 a.m. and 7:00 p.m., for assistance. Generally, you will have a shorter wait if you call later in the day. You can also contact your local Social Security office. We hope this helps.

    • Christine Hess

      If you don’t have Part D, and do not have any drug coverage equal to the Medicare Part D drug plan, you will be charged a penalty by Social Security for each month after your credible coverage expires. There is a time limit after your creditable coverage ends. This penalty will be charged in addition to any premium for Part D or Part C Medicare Advantage.

  8. Lesly Francois

    Survivor retired disability i don’t know that does mean please i need to understand more!!!!

    • S T

      Survivor – gets benefits based on another family member’s work history
      Retired – gets benefits based on worker’s own work history – reduced benefits begin at age 62, full benefits at Full Retirement Age (now 66 or later, depending on date of birth – look it up)
      Disabled – gets benefits before retirement age based on symptoms of a disabling medical condition that is expected to last more than one year

    • Ann C., Public Affairs Specialist

      Hi, Lesly. For your security, we do not have access to private information in this venue. We ask that members in our Blog community work with our offices with specific questions. You can call us at 1-800-772-1213, Monday through Friday, between 7:00 a.m. and 7:00 p.m., for assistance. Generally, you will have a shorter wait if you call later in the day. You can also contact your local Social Security office. We hope this helps.

  9. Diane Riley

    This article is very informative; I enjoyed reading it.

  10. lloyd

    I have Part A & B now how much does Part C cost

    • Joanne Wells

      How much does part cost

      • nburg

        Part C is not provided by the government – it is provided by private insurance companies and the monthly premiums vary – depending on your location and the prescription drug plan you choose. Not all plans are offered in all states. Choose a plan that covers your prescriptions. Not all plans cover the same prescriptions. You can request a copy of the ‘formulary’ which is the list of drugs covered by the particular insurance company. Don’t choose a plan based only on the cost of the premium.

        • Marc

          If you have Part A and Part B you don’t need Part C. You either choose traditional Medicare (Part B) where you can go to any doctor you want, or you choose Part C, which is a private ch company plan that has network doctors you have to use in order for it to pay for your medical services. Part D is the stand alone drug plan for people who don’t have prescription coverage. I have traditional Medicare with a great Part D drug plan through the A AARP with no deductible.

          • BETTY GORDON

            good, comprehensive answer above.

            for those on limited income, look into HUMANA PPO…it’s a combination of medicare & supplement as ONE plan!

            monthly cost goes up to $51/month next year.

            it has tiers 1, 2, & 3; majority of my prescription meds for 3 months are FREE.

            as person stated above, check it all out.

            i’m even thinking of making an appt. with SHIP rep to explain programs for 1st time.

            best wishes to everyone thinking of which to chose or which to switch to!!

            betty gordon, iowa

          • Elena Faurescu

            You don’t need Medicare part C?
            If I want to change to Advantage part C they asked me to pay late fee enrollment.
            If it is not mandatory
            why to be charge late fee?

      • Ann C., Public Affairs Specialist

        Hi, Joanne. For more information about Medicare costs, visit here. Thanks!

    • Tina langford

      can anyone tell me how long before the first does social security send out the verification letters

    • Ann C., Public Affairs Specialist

      Hi, Lloyd. If you have Medicare Parts A and B, you can join a Medicare Advantage plan (Part C). Medicare Advantage plans are offered by private companies that Medicare approves. For more information about Medicare Advantage Plans and the costs, visit here. Thanks!

Comments are closed.