- If you are 65 years old and a U.S. citizen--or if you have been a permanent legal resident for five continuous years--you are eligible for Medicare. You can elect to join Original Medicare (fee for service), or one of Medicare's Part C "private" plans, called Medicare Advantage.
-
If you are on Social Security before you turn 65, the Social Security Administration (SSA) will automatically enroll you in Medicare Parts A and B to take effect on the first day of the month you turn 65. The SSA will not enroll you in Part D (prescription drugs). To get Part D, you must enroll in a standalone drug plan or a Medicare Advantage plan (see below) that provides the Part D benefit.
If you are not on Social Security when you turn 65, you must apply for it. You can do that at any Social Security office at any time between three months before or three months after your 65th birthday. If you want Medicare drug coverage, you can arrange to join Part D at the same time. -
Medicare has four separate parts, A, B, C and D.
Medicare Part A covers charges for hospital inpatient care and--if you meet specific requirements--some time-limited nursing home, home health and hospice care. Part A carries no monthly premium, but you are required to pay your share of the costs.
Part B covers 80 percent of the medical expenses you incur outside the hospital, including visits to your doctor, outpatient treatment and such. Part B has a monthly premium. You must pay an annual deductible and the 20 percent co-pay.
Medicare introduced Part D, prescription drug insurance, in 2006. There are monthly premiums that vary greatly among plans, as do their formularies (drugs covered) and drug cost. - Medicare Advantage (Part C) contains within it Parts A and B and may include Part D (drug coverage). Private health insurers offer the Medicare Advantage programs (HMOs, PPOs and such). Plans vary in cost and benefits, depending on the insurance company involved. You must live within a plan area to join one.
-
Medicare's coverage contains coverage "gaps." For example, the insurance does not cover eye exams, glasses, hearing aids, care provided outside the United States and long-term continuing care.
As a result, the federal government, the military and private industry provides supplementary (secondary) health care insurance for Medicare recipients, either as a continuation of previously in-place health insurance or through the purchase of a "Medigap" policy (see References).
