Hospital insurance (Part A)
Most people age 65 or older who are citizens or permanent residents of the United States are eligible for free Medicare hospital insurance (Part A).
You are eligible at age 65 if:
- You receive or are eligible to receive Social Security benefits; or
- You receive or are eligible to receive railroad retirement benefits; or
- Your spouse is eligible; or
- You or your spouse (living or deceased, including divorced spouses) worked long enough in a government job where Medicare taxes were paid; or
- You are the dependent parent of a fully insured deceased child.
If you do not meet these requirements, you may be able to get Medicare hospital insurance by paying a monthly premium. Usually, you can sign up for this hospital insurance only during designated enrollment periods.
NOTE:Even though the full retirement age is no longer 65, you should sign up for Medicare three months before your 65th birthday.
Before age 65, you are eligible for free Medicare hospital insurance if:
- You have been entitled to Social Security disability benefits for 24 months; or
- You receive a disability pension from the railroad retirement board and meet certain conditions; or
- If you receive Social Security disability benefits because you have Lou Gehrig’s disease (amyotrophic lateral sclerosis); or
- You worked long enough in a government job where Medicare taxes were paid and you meet the requirements of the Social Security disability program; or
- You are the child or widow(er) age 50 or older, including a divorced widow(er), of someone who has worked long enough in a government job where Medicare taxes were paid and you meet the requirements of the Social Security disability program.
- You have permanent kidney failure and you receive maintenance dialysis or a kidney transplant and:
- You are eligible for or receive monthly benefits under Social Security or the railroad retirement system; or
- You have worked long enough in a Medicare-covered government job; or
- You are the child or spouse (including a divorced spouse) of a worker (living or deceased) who has worked long enough under Social Security or in a Medicare-covered government job.
Medical insurance (Part B)
Anyone who is eligible for free Medicare hospital insurance (Part A) can enroll in Medicare medical insurance (Part B) by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. For more information, ask for Medicare Premiums: Rules For Higher-Income Beneficiaries (Publication No. 05-10536)or visit www.socialsecurity.gov/mediinfo.htm.
If you are not eligible for free hospital insurance, you can buy medical insurance, without having to buy hospital insurance, if you are age 65 or older and you are—
- A U.S. citizen; or
- A lawfully admitted noncitizen who has lived in the United States for at least five years.
Medicare Advantage plans (Part C)
If you have Medicare Parts A and B, you can join a Medicare Advantage plan. Medicare Advantage plans are offered by private companies and approved by Medicare. With one of these plans, you do not need a Medigap policy, because Medicare Advantage plans generally cover many of the same benefits that a Medigap policy would cover, such as extra days in the hospital after you have used the number of days that Medicare covers.
Medicare Advantage plans include:
- Medicare managed care plans;
- Medicare preferred provider organization (PPO) plans;
- Medicare private fee-for-service plans; and
- Medicare specialty plans.
If you decide to join a Medicare Advantage plan, you use the health card that you get from your Medicare Advantage plan provider for your health care. Also, you might have to pay a monthly premium for your Medicare Advantage plan because of the extra benefits it offers.
People who become newly entitled to Medicare should enroll during their initial enrollment period (as explained under Signing up for Medicareon page 10) or during the annual coordinated election period from October 15 – December 7 each year. The effective date for the enrollment is January 1 of the upcoming year. There also will be special enrollment periods for some situations.
Medicare prescription drug plans (Part D)
Anyone who has Medicare hospital insurance (Part A), medical insurance (Part B) or a Medicare Advantage plan (Part C) is eligible for prescription drug coverage (Part D). Joining a Medicare prescription drug plan is voluntary, and you pay an additional monthly premium for the coverage. Some beneficiaries with higher incomes will pay a higher monthly Part D premium. For more information, ask for Medicare Premiums: Rules For Higher-Income Beneficiaries (Publication No. 05-10536) or visit www.socialsecurity.gov/mediinfo.htm. You can wait to enroll in a Medicare Part D plan if you have other creditable prescription drug coverage, but, if you don’t have prescription coverage that is, on average, at least as good as Medicare prescription drug coverage, you will pay a penalty if you wait to join later. You will have to pay this penalty for as long as you have Medicare prescription drug coverage.
People who become newly entitled to Medicare should enroll during their initial enrollment period. After the initial enrollment period, the annual coordinated election period to enroll or make provider changes is October 15 –
December 7 each year. The effective date for the enrollment is January 1 of the upcoming year. There also will be special enrollment periods for some situations.
Help for some low-income people
If you cannot afford to pay your Medicare premiums and other medical costs, you may be able to get help from your state. States offer programs for people who are entitled to Medicare and have low income. The programs may pay some or all Medicare premiums and also may pay Medicare deductibles and coinsurance. To qualify, you must have Part A (hospital insurance) and have limited income and resources.
You can go online to get more information about these programs from the Centers for Medicare & Medicaid Services website. Visit www.medicare.gov/publications and request Get help with your Medicare costs (Publication No. CMS-10126).
Only your state can decide if you qualify for help under these programs. To find out, contact your state or local medical assistance (Medicaid) agency, social services or welfare office.
You also may be able to get extra help paying for the annual deductibles, monthly premiums and prescription co-payments related to the Medicare prescription drug program (Part D). You may qualify for extra help if you have limited income (tied to the federal poverty level) and limited resources. These income and resource limits usually change each year, and you can contact us for the current numbers.
You automatically qualify and do not need to apply for extra help if you have Medicare and meet one of the following conditions:
- Have Medicaid with prescription drug coverage;
- Have Supplemental Security Income (SSI); or
- Participate in a state program that pays your Medicare premiums.
For more information about getting help with your prescription drug costs, call Social Security’s toll-free number or visit our website. You also can apply online at Social Security’s website.