Medicare for You: What You Need to Know
Reading Time: 2 MinutesLast Updated: April 6, 2023
We invited the Administrator to share helpful information on Medicare coverage. This is part 1 in the two-part series.
Your health is important and needs to be protected. If you are 65 or older, or have certain disabilities, or End-Stage Renal Disease, you can get health care coverage through the Medicare program. You’ll get access to health care services you need to achieve and maintain good health.
It’s important to review your Medicare coverage options and find an affordable option that meets your health care needs.
Medicare coverage options
There are two types of Medicare coverage:
- Traditional or Original Medicare.
- Medicare Advantage.
Original Medicare helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. It also covers:
- Services from doctors and other health care providers.
- Outpatient care.
- Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment).
- Preventive services (like screenings, certain vaccines, and annual wellness visits).
Original Medicare is often referred to as Part A and Part B. You can go to any doctor or hospital, anywhere in the United States, that accepts Medicare. If you have Original Medicare, you can also buy a Medicare Supplement Insurance (Medigap) policy from a private insurance company. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medigap policy can help pay some of the remaining health care costs, such as copayments, coinsurance, and deductibles.
Medicare Advantage bundles your Original Medicare – and usually Medicare prescription drug coverage – into one health insurance plan. If you select Medicare Advantage coverage, you join a plan offered by Medicare-approved private companies.
Each plan can have different rules for how you get services – like referrals to see a specialist. All plans must cover emergency and urgent care, as well as all medically necessary services covered by Original Medicare.
In many cases, you can only use doctors and other providers who are in your plan’s network and service area. Costs for monthly premiums and services vary depending on which plan you join. Some plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.
Whether you choose Original Medicare or Medicare Advantage, be sure you have prescription drug coverage. You can join a Medicare Prescription Drug Plan (called a PDP) in addition to Original Medicare. You can also get it by joining a Medicare Advantage plan with Medicare prescription drug coverage.
Please visit Medicare.gov to learn more about the difference between Original Medicare and Medicare Advantage. With the Medicare Plan Finder, you can see comparisons of costs and coverage for Original Medicare, Medicare Advantage, and Medicare drug plans.
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David R.
I am the father of a disabled adult daughter who is unemployed and who is receiving SSI. I have been trying so hard to have her receive insurance benefits. I went to our local Social Security office (SSA) and was told my daughter is eligible to receive insurance benefits being that she is on SSI. The social security office official gave me a piece of paper (DO1) to take to the local social service department (Tulare Works) I submitted the paperwork to Tulare Works and later received a State of California Benefits Identification Card (BIC). I produced the card to medical facilities who accept Medi-Cal/Medicaid. I was told that the card was inactive. I went to the local SSA and Tulare Works (3) times. Both agencies told me that it was the other agencies’ responsibility to activate the BIC card. Who is the proper person/agency to contact to activate the BIC card?
A.C.
Hi, David. We are sorry to hear about your experience. We encourage you to continue to work with your state medical assistance office. To get the local phone number, call the Centers for Medicare & Medicaid Services at 1-800-633-4227 (TTY, 1-877-486-2048). We hope this is resolved soon.
what d.
I love this post. The thing I like in your posts is that everything is in a detailed and learning manner.
what d.
One of the best posts I have ever come across. Not only did I learn a lot of hidden things. Keep uploading and encouraging us.
Paul R.
My question combines Social Security and Medicare.
I’m told that many people have Medicare costs taken out of their Social Security payments. I’m 70 and about to enroll in both Medicare and Social Security for the first time after being covered by employer-based medical coverage.
First, if I follow that route of Medicare taken out of Social Security, is there any downside to it? Second, should I enroll in one before the other, or does it matter?
I have the completed Employer Portion of the Enrollment Form (CMS-L564) to verify my employer-based coverage.
Thanks.
A.C.
Hi, Paul. Thanks for visiting our blog. When you apply for retirement benefits, you can also apply for Medicare. You can learn more about benefits and how to appy by visiting our Benefits Planner. To discuss your specific situation, you can call us at 1-800-772-1213, Monday through Friday, between 8:00 a.m. and 7:00 p.m., for assistance. You can also contact your local Social Security office. We hope this helps.
Susan G.
I will turn 65 next and still working. I’m currently on my employer’s plan, which is a high deductible health plan with an HSA. So far I’m in good health. Do I have to apply for medicare at 65? I hope to defer until I’m ready to retire. How would I do this? Who do I notify?
A.C.
Hi. Susan. Thanks for your questions. Under certain conditions, you may qualify for a Special Enrollment Period, which would allow you to sign up for Medicare Part B if you are past your Initial Enrollment Period. If you are still working and covered under a group health plan based on that employment, you may not need to file for Medicare part B until you stop working or drop your health care coverage. You should speak to your personnel office, health benefits advisor, or health plan to see what’s best for you. For further specific questions, you can call us at 1-800-772-1213, Monday through Friday, between 8:00 a.m. and 7:00 p.m., for assistance. You can also contact your local Social Security office. We hope this helps.
Elle J.
When you said that each plan may have various guidelines for how to obtain services, including as referrals to visit a specialist, I thought it was fascinating. All plans are required to cover all Original Medicare-covered medically essential services, including emergency and urgent care. Next year, my parents want to sign up for a Medicare Advantage plan for themselves. I’ll share this with them because they said that they want their prescription medications covered when they purchase an insurance to protect their future. http://carieyounginsurance.com/insurance-services
Becky H.
I signed up and got confirmation that I was enrolled in Medicare A.
I am now trying to enroll in Medicare B as part of the “Special Enrollment Period”
The application asks for my Medicare number. I have not yet received my Medicare card – is the number on the approval letter for Medicare A?
Do I really have to take the application in person to my local SS office ( it is a hot mess!)
Nancy R.
Hi Becky, I did not get my Part B originally as I was employed full time and did not need it. When I retired and lost medical benefits, I printed out a form, took it to my SS office and it took (after waiting time in office) 5 minutes for the worker to take my form and change it in computer. I got new Medicare Card in mail in a few weeks and my Part B had started the first of the following month. It was very easy. It was effective day I went to office. Good luck.
A.C.
Hi, Becky. Thanks for visiting our blog. If you are covered under a group health plan based on your current employment, you may qualify for a Special Enrollment Period (SEP) that will let you sign up for Medicare Part B. You have an 8-month SEP to sign up for Part A and/or Part B that starts at one of these times (whichever happens first):
• The month after the employment ends
• The month after group health plan insurance based on current employment ends. Usually, you don’t pay a late enrollment penalty if you sign up during a SEP.
You should always check with your health benefits advisor, or health plan representative to see what’s best for you. For more information and instructions on how to apply, check out our Medicare publication. For specific questions, please call us at 1-800-772-1213, Monday through Friday, between 8:00 a.m. and 7:00 p.m., for assistance. You can also contact your local Social Security office. We hope this helps.