Medicare

Medicare, A Simple Explanation

October 24, 2019 • By

Last Updated: July 16, 2021

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

Comments

  1. Roxane

    How is it as of the first of the year you will no longer let us have our pain medication? I live in pain 24/7 and my pain pills take a little edge off the pain. But now they say we won’t be able to get them or if we do it will only be a few a week and have to travel 70miles a week to get the prescription. That just seem like it goes against our constitutional rights. Please rethink this new plan. I feel it will raise the crime rate out of this world. There will be more brake in, more shotting and killing. The people that used these medications for the wrong reasons will get them one way or the other.

  2. Stephan O. Whitaker

    I was wondering if I will ever get my full SSA since the company I was working for cut our hours back I was forced to apply for my Social security early on top of that I got injured too.

  3. Gerald P Turpin

    I have Tricare for life, Retired military. I also am a disabled Veteran. I always use local VA for any medical services I require. Why do I have to pay for Medicare Part B, when I never use it?

    • Luis A., Public Affairs Specialist

      Hi Gerald. If you have coverage under a program from the Department of Defense, your health benefits may change or end when you become eligible for Medicare. You should contact the Department of Defense or a military health benefits advisor for information before you decide whether to terminate Medicare medical insurance. For more information on how other health insurance plans work with Medicare, call the Medicare toll-free number, 1-800-MEDICARE (1-800-633-4227), and ask for Medicare and Other Health Benefits: Your Guide to Who Pays First (Publication No. CMS-02179) or visit http://www.medicare.gov/publications. You may also wish to contact your local Medicare SHIP (State Health Insurance Program Coordinator) to discuss your options. We hope this helps.

  4. Lucinda Fishman

    I have a medical policy with Kaiser at my work at present time also I am 66 years old…so my question is do i have to wait until next year to make change to Medi-care and supplemental insurance or can I do it mid year in July when we pick you insurance? Thanks for any help Lucinda

    • Luis A., Public Affairs Specialist

      Hi Lucinda. Unfortunately, your question is a bit more complex than we can handle in this forum. To get additional information on Medicare benefits, click here. You may also wish to contact your local Medicare SHIP (State Health Insurance Program Coordinator) to discuss your options. We hope this helps.

  5. Mona Zaky

    Thank you. Are we getting a cola for 2020?

    • Laurie B.

      I believe that they said it would be about 1.6% for 2020.

    • Luis A., Public Affairs Specialist

      Hi Mona. There will be a 1.6% cost-of-living adjustment (COLA) in 2020 for all beneficiaries. This new increase will take effect for Supplemental Security Income (SSI) payments on December 31, 2019, and for Social Security payments in January 2020. You can find out more information on the new COLA here. Hope you find this information helpful.

  6. Amador Salgado

    Would be very helpful if you could get benefits why’ll your application is being summited it’s been almost four months and I myself have been going through a lot of problems with bills and other things the bad thing is that if you don’t get approved what are you going to do that’s my appenian thank you and God bless.

  7. Elvira Baerman

    Is there a part of D or C that covers transportation to dialysis an back home again. It is costing me $18.00 each way for LYFT. That is $ 36.00 x 3, I go that many times a week which =$108.00 a week. Thats comes to
    $432.00 a month. I have tried to seek others way of transporation. But I am out of their bounty for a mile an a half. Thats a bummer. I have heard a few of the insurance company’s offering transporation, don’t know which ones.
    Can you check this out for me. I would be truly happy if you did did.
    Thanks,
    Elvira Baerman
    Email address: baermanelvira@gmail.com

    • Ann C., Public Affairs Specialist

      Hi, Elvira. Unfortunately, your question is a bit more complex than we can handle in this forum. For your security, we do not have access to information about your account in this venue. To get additional information on Medicare benefits, check out http://www.medicare.gov/. You may also wish to contact your local Medicare SHIP (State Health Insurance Program Coordinator) to discuss your options. We hope this helps.

  8. Lucas Yvonne Annette

    The program is flawed I can barely get my prescriptions as well as the numerous copays for the different doctors. I was originally in the Affordable Healthcare program and then I turned 65. I preferred the Affordable Health Care is it coming back.

  9. Ellie Schwartz

    If I retire at 62, do I qualify for social security at 62?

    • BETTY GORDON

      yes, but you get much LESS MONEY by getting it now vs. waiting until official retirement age depending on when you were born!

    • Ann C., Public Affairs Specialist

      Hi, Ellie. You can create a my Social Security account to review estimates of your retirement, disability, and survivors benefits, your earnings record, and the estimated Social Security and Medicare taxes you’ve paid. To get started, visit here. Thanks!

  10. Alan Goatham

    The only thing I do know is that we paid in to both programs. They were not meant to be handed out to just anyone. Medicare for all would ruin it for our seniors. Social security was not meant to live on but a tax we and our employers paid into to give us a little extra cash in our old age. It was not meant to be handed out to how the government feels they need to help. Thanks for asking and use our money wisely.

    • Victress Jenkins

      I agree with Alan. Those who have paid into Part A during their working years and who become eligible to enroll are eligible.
      The trust fund should be protected from those who want to take the money we contributed.

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