The Federal Medicare Senior Health Care Program

Affordable Health Insurance for Americans 65 and Older

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Along with Social Security, Medicare stands as one of the top federal benefit programs providing an essential "safety net" for older Americans. Medicare is a health insurance program for people 65 years of age or older and some disabled people under 65, including people with End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant). Under Medicare, private health care providers are reimbursed by the federal government for services they provide to Medicare participants.

Medicare is funded by a portion of the payroll taxes paid by workers and their employers, and by monthly premiums deducted from Social Security benefit checks.

Medicare covered approximately 54 million beneficiaries in fiscal year 2014 at an estimated cost of $603 billion.

The program consists of four parts, Parts A through D. In general, Part A covers hospital and other inpatient stays, and Part B covers hospital outpatient and physician services, durable medical equipment, and other services. Together, Parts A and B are known as traditional Medicare or Medicare fee-for-service. Part C is Medicare Advantage, under which beneficiaries receive their Medicare health benefits through private health plans, and Part D is the Medicare outpatient prescription drug benefit, which is administered through private drug plans.

Medicare coverage is currently comprised of four parts:

Part A: Hospital Insurance
Part B: Medical Insurance
Part C: Medicare Advantage
Part D: Medicare Prescription Drug Coverage

While applications for Medicare are processed by the Social Security Administration, the Medicare program is administered by the Centers for Medicare & Medicaid Services (CMMS), a branch of the Cabinet-level U.S. Department of Health and Human Services.

Eligibility Criteria:

You must be 65 years of age or older and a citizen or permanent resident of the United States.

You might also qualify for coverage if you are a younger person with a disability or with End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant) or Lou Gehrig's Disease (ALS).

While Medicare helps pay the cost of health care, it does not cover all medical expenses or the cost of most long-term care services.

Medicare Part A: Hospital Insurance

Medicare Part A helps pay for inpatient care in hospitals or nursing facilities following a hospital stay. Part A also helps pay for some home health and hospice services.

Most people get Medicare Part A and Part B automatically starting the first day of the month they turn 65. Persons already getting Social Security retirement or disability benefits or railroad retirement benefits are automatically enrolled in Medicare Part A and Part B when they turn 65. However, since Part B requires the payment of a monthly premium, it may be declined.

Typically, Part A is free. You can get Part A at age 65 without having to pay premiums if:

  • You are already receiving retirement benefits from Social Security or the Railroad Retirement Board
  • You are eligible to receive Social Security or Railroad benefits but have not yet applied for them
    • You or your spouse had Medicare-covered government employment

    Medicare Part B: Medical Insurance

    Medicare Part B helps pay for services from doctors' and other health care providers, outpatient care, durable medical equipment, and home health care. Part B also helps pay for some preventive health services.

    Medicare Part B requires the payment of a standard monthly premium, which may adjusted annually. In 2012, for example, the Part B premium was $99.90 per month. Persons with higher incomes may have to pay higher Part B premiums.

    Persons getting monthly benefit payments from the Social Security Administration (SSA), the Railroad Retirement Board (RRB), or the Civil Service will have their Medicare Part B premium payments deducted from their monthly benefit payments. Persons not getting these benefits are billed directly for their Part B premiums.

    Medicare Part C: Medicare Advantage Plan

    The optional Medicare Advantage Plan (Part C) is similar to an HMO or PPO and is offered by private companies approved by Medicare.

    Medicare Advantage plans provide all coverage provided by Medicare Part A and B. Most also include Part D Medicare Prescription Drug Coverage. Other services, such as vision, hearing, dental, and/or health and wellness programs may also be covered by Medicare Advantage plans.

    There are several different types of Medicare Advantage Plans available and persons considering applying for one should review the Centers for Medicare & Medicaid Services' Medicare Advantage (Part C) information website.

    Medicare Part D: Medicare Prescription Drug Coverage

    Medicare prescription drug coverage is available to anyone who has Medicare. The coverage is provided by private insurance companies or other companies approved by Medicare. Most Medicare Advantage plans offered by private health care providers include Medicare prescription drug coverage. The out-of-pocket costs of Medicare prescription drug coverage vary from provider to provider.

    Program Contacts and Information:

    If you have additional questions about your eligibility for Medicare or if you want to apply for Medicare, please contact the Social Security Administration toll-free at: 800-772-1213. The TTY-TDD number for the hearing and speech impaired is: 800-325-0778.

    To check on Medicare eligibility and enrollment status, visit: Medicare Eligibility & Enrollment.