New to Medicare?
Everything you need to know about Medicare to make an informed decision.
What is Medicare?
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD).
Medicare has different parts that help cover specific services. Understanding these parts will help you make the best decision for your healthcare needs.
Understanding Medicare Parts
Medicare Part A
Hospital Insurance
Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Medicare Part B
Medical Insurance
Covers certain doctors' services, outpatient care, medical supplies, and preventive services.
Medicare Part C (Medicare Advantage)
Medicare Advantage Plans
An alternative way to get your Medicare benefits through private insurance companies approved by Medicare. Often includes Part D prescription drug coverage.
Medicare Part D
Prescription Drug Coverage
Helps cover the cost of prescription drugs. Available as stand-alone plans or included in Medicare Advantage plans.
Medicare Eligibility
Original Medicare Eligibility Requirements
You may qualify for Original Medicare if you:
- Are age 65 or older
- Are a U.S. citizen or lawful permanent resident
- Have lived continuously in the United States for at least 5 years (for most permanent residents)
- Worked and paid Medicare taxes for at least 10 years (40 work credits) — or qualify through a spouse's work history
- Receive Social Security Disability Insurance (SSDI) benefits for 24 months
- Have qualifying conditions such as End-Stage Renal Disease (ESRD) or ALS
Citizenship & Residency Requirements
A person generally must be:
Either:
- U.S. citizen
OR
- Lawfully present permanent resident
AND
- Continuously reside in the U.S. for at least 5 years before Medicare application
Important Operational Medicare Concepts
Automatic Enrollment
Some people are automatically enrolled in Medicare if they:
- Already receive Social Security retirement benefits
OR
- Already receive SSDI (Social Security Disability Insurance)
Others must enroll manually.
Enrollment Periods
Initial Enrollment Period (IEP)
7-month period that includes the 3 months before you turn 65, your birth month, and the 3 months after.
Annual Enrollment Period (AEP)
October 15 - December 7 each year. You can make changes to your Medicare coverage, including switching to Medicare Advantage or back to Original Medicare.
Open Enrollment Period (OEP)
January 1 - March 31. If you're in a Medicare Advantage Plan, you can switch to another Medicare Advantage Plan or return to Original Medicare.
Special Enrollment Period (SEP)
Available in certain circumstances, such as moving to a new area, losing other health coverage, or qualifying for Extra Help.
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