Introduction To Medicare - Medicare Basics

Medicare is a federal health insurance program that gives you access to specific coverage and benefits. Medicare is different from health insurance you may have had before. It offers you a variety of coverage options - and it has key enrollment dates and guidelines you need to follow. We're here to help you make sense of it all.

You may be surprised at the differences between Medicare and other types of health insurance. If you’ve had health coverage through your employer, your plan likely included medical and prescription drug coverage, along with other benefits. It also may have covered both you and your spouse.

Medicare only covers one person at a time. This means you and your spouse must enroll separately. In addition, Medicare gives you options that can make it possible to receive your benefits in a variety of different ways.

You can:

• Choose hospital and medical coverage delivered through the federal government.

• Add prescription drug coverage delivered through a private company.

• Purchase a supplemental insurance policy from a private insurer that can help cover some of the costs.

• Choose coverage from a private insurer that combines hospital, medical and often prescription drug coverage into one plan.

In short, with Medicare you can choose coverage that fits your needs, budget and lifestyle. We can help you take full advantage of that freedom.

Medicare eligibility primarily revolves around age, specific disabilities, and certain health conditions. Here are the general criteria for Medicare eligibility:

• Age: Individuals who are 65 years of age or older are eligible for Medicare. You can enroll in Medicare even if you are still working and not yet receiving Social Security benefits.

• Disability: People under 65 years old who have been receiving Social Security Disability Insurance (SSDI) benefits for 24 months are eligible for Medicare. This also applies to individuals with Amyotrophic Lateral Sclerosis (ALS), who are eligible for Medicare as soon as they begin receiving SSDI benefits.

• End-Stage Renal Disease (ESRD): Individuals of any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant) are eligible for Medicare.

• Lou Gehrig’s Disease (ALS): As mentioned, individuals diagnosed with Amyotrophic Lateral Sclerosis (ALS) are eligible for Medicare as soon as they begin receiving SSDI benefits.

If you’re like most people, you’ll enroll in Medicare around the time you turn 65. Your Initial Enrollment Period begins three months before your 65th birthday, includes the month you turn 65 and ends three months after that birthday. 

Keep in mind that if you don’t get Medicare during this Initial Enrollment Period, you may have to pay Medicare Part B or Part D late enrollment penalties. Plus, you could be missing out on coverage and benefits that can help protect your health and finances. That’s why it’s generally a good idea to enroll as soon you can. How you enroll generally depends on if you’re getting benefits from Social Security, the Railroad Retirement Board or the Office of Personnel Management. 

If you're receiving benefits from any of these sources at least four months before you turn 65:

• You’ll automatically get Medicare Part A and Part B starting the first day of the month you turn 65. 

• If your birthday is on the first day of the month, Part A and Part B will start the first day of the prior month. 

If you're under 65 and having a qualifying disability, you'll automatically get Part A and Part B: 

• After you get disability benefits from Social Security for 24 months. 

• After you get certain disability benefits from the RRB for 24 months. 

• The month your disability benefits begin if you have ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig’s Disease). 

If you have ESRD (End Stage Renal Disease), you can choose to enroll in Part A and Part B: 

• You’ll need both Part A and Part B to qualify for the full benefits that cover certain dialysis and kidney transplant services. 

• You can apply online at socialsecurity.gov, at your local Social Security office or by calling Social Security at 1-800-772-1213 (TTY: 1-800-325-0778).

Turning 65 doesn’t always mean you have to sign up for Medicare right away — especially if you’re still working. If you or your spouse are actively employed by a company with 20 or more employees and you’re receiving health insurance through that employer, you can:

• Stay with the employer health plan as your primary coverage and delay Medicare enrollment.

• Enroll in Medicare Part A and use it as secondary coverage to help pay for things the employer health plan doesn’t cover.

• Choose to delay enrolling in Medicare Part B until the employment ends or the coverage stops, without paying late enrollment penalties if you enroll later.

Get personalized guidance. Connect with a one of our licensed Medicare enrollment specialists.