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What Is Medicare?

Medicare is a Health Insurance Program for:

• People age 65 or older.
  
  
• People under age 65 with certain disabilities.
  
  
• People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

Medicare has Two Parts:

• Part A (Hospital Insurance)

  Most people don't have to pay for Part A.
  

• Part B (Medical Insurance)

  Most people pay monthly for Part B.

You can choose different ways to get the services covered by Medicare. Depending on where you live, you may have different choices. In most cases, when you first get Medicare, you are in Original Medicare. You may want to consider a Medicare Prescription Drug Plan to add drug coverage. Or, you may want to consider a Medicare Advantage Plan (like an HMO or PPO) that provides all your Part A, Part B, and often Part D coverage. You make a choice when you are first eligible for Medicare. Each year you can review your health and prescription needs and switch to a different plan in the fall.

As long as you have both Part A and Part B, items covered by Part A and Part B are covered whether you have Original Medicare, or you belong to a Medicare Advantage Plan (like an HMO or PPO). For more information see the Your Medicare Coverage database.

Part A (Hospital Insurance)

Helps Pay For:

Care in hospitals as an inpatient, critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas), skilled nursing facilities (not custodial or long-term care), hospice care, and some home health care. Information about your coverage under Medicare Part A can be found in the Your Medicare Coverage database.

If you aren’t sure if you have Part A, look on your red, white, and blue Medicare card. If you have Part A, “HOSPITAL (PART A)” is printed on your card.

Cost:

Most people get Part A automatically when they turn age 65. They don't have to pay a monthly payment called a premium for Part A because they or a spouse paid Medicare taxes while they were working.

If you don’t automatically get premium-free Part A, you may be able to buy it if

• You (or your spouse) aren’t entitled to Social Security because you didn’t work or didn’t pay enough Medicare taxes while you worked and you are age 65 or older, or
• You are disabled but no longer get premium-free Part A because you returned to work.

If you have limited income and resources, your state may help you pay for Part A and/or Part B. For more information, visit www.socialsecurity.gov on the web or call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-877-772-5772.

Part B (Medical Insurance)

Helps Pay For:

Doctors' services, outpatient hospital care, and some other medical services that Part A doesn't cover, such as the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. Information about your coverage under Medicare Part B can be found in the Your Medicare Coverage database.

Cost:

The standard Medicare Part B monthly premium will be $99.90 in 2012, a $15.50 decrease over the 2011 premium of $115.40. However, most Medicare beneficiaries were held harmless in 2011 and paid $96.40 per month. The 2012 premium represents a $3.50 increase for them. For additional details, see our FAQ titled: Medicare premiums and coinsurance rates for 2012.

If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $99.90 per month. For additional details, see our FAQ titled: 2012 Part B Premium Amounts for Persons with Higher Income Levels.

In some cases this amount may be higher if you didn't choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you could have had Part B but did not sign up for it, except in special cases. You will have to pay this extra 10% as long as you have Medicare Part B.

Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Please call Social Security at 1-800-772-1213 or visit or call your local Social Security office to sign up. If you choose to have Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you don’t get any of the above payments, Medicare sends you a bill for your Part B premium every 3 months. You should get your Medicare premium bill by the 10th of the month. If you don’t get your bill by the 10th, call Social Security at 1-800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-877-772-5772.

For More Information About Medicare Part B Coverage:

Visit the Your Medicare Coverage database.

Who is Eligible for Medicare?

Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years or older and a citizen or permanent resident of the United States. If you aren’t yet 65, you might also qualify for coverage if you have a disability or with End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant).

Here are some simple guidelines. You can get Part A at age 65 without having to pay premiums if:

• You already get retirement benefits from Social Security or the Railroad Retirement Board.
  
  
• You are eligible to get Social Security or Railroad benefits but haven't yet filed for them.
  
  
• You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A without having to pay premiums if you have:

• Received Social Security or Railroad Retirement Board disability benefits for 24 months.
  
  
• End-Stage Renal Disease and meet certain requirements.

While you don’t have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it. The Part B monthly premium in 2012 is $99.90. For additional details, see our FAQ titled: Medicare premiums and coinsurance rates for 2012. It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t get any of the above payments, Medicare sends you a bill for your Part B premium every 3 months.

Note: You will be eligible for Medicare when you turn 65 even if you are not eligible for Social Security retirement benefits.

If you have questions about your eligibility for Medicare Part A or Part B, or if you want to apply for Medicare, please call Social Security at 1-800-772-1213 or visit or call your local Social Security office. TTY users should call 1-800-325-0778. You can also get information about buying Part A as well as Part B if you don’t qualify for premium-free Part A.

Enrolling in Medicare

Medicare has two parts:

• Medicare Part A (Hospital Insurance), which helps pay for care in a hospital and skilled nursing facility, home health care, and hospice care; and
  
  
• Medicare Part B (Medical Insurance), which helps pay for doctors, outpatient hospital care, and other medical services.

Most people don't have to pay for Medicare Part A. Most people pay for Medicare Part B.

To find out how you enroll in Medicare Part A & B, please go to My Medicare Enrollment General Enrollment Period

If you didn’t sign up for Medicare Part B when you first became eligible, you may be able to sign up during the General Enrollment Period. This period runs from January 1 through March 31 of each year. During this time, you can sign up for Medicare Part B at your local Social Security office. If you get benefits from the Railroad Retirement Board (RRB), call your local RRB office or 1-877-772-5772. Your Medicare Part B coverage will start on July 1 of the year you sign up.

Important: The cost of Medicare Part B will go up 10% for each full 12-month period that you could have had Medicare Part B but didn’t take it, except in special cases. You will have to pay this penalty as long as you have Medicare Part B.

If you already have Medicare Part A and need Part B you can sign up for Part B at your local Social Security office or by calling 1-800-772-1213 (TTY users should call 1-800-325-0778).

For more information on delaying enrollment in Medicare Part B if you or your spouse is still working, see our FAQ: Can I delay my Medicare Part B enrollment without paying higher premiums? If you can delay your enrollment because you or your spouse are still working, the General Enrollment Period will not affect you until after you (or your spouse) stop working.

If you are a military retiree or the spouse or dependent child of either a military retiree or an active duty sponsor, see our FAQ: How does the Medicare Prescription Drug Improvement and Modernization Act impact enrollment in Medicare Part B for military retirees or the spouse or dependent child of either a military retiree or an active duty sponsor?

If your income is above a certain amount, then you may have to pay a higher Part B premium. For more information, see our FAQ: Medicare premiums and coinsurance rates for 2012.

Page Last Updated: August 3, 2012