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Medicare at a Glance

Who runs the Medicare Program?

The Centers for Medicare & Medicaid Services (CMS) is the Federal agency that administers that program. CMS is part of the U.S. Department of Health and Human Services.

What is Medicare?

Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with End-Stage Renal Disease (ESRD - permanent kidney failure requiring dialysis or kidney transplant).

Medicare offers:

  • Part A (Hospital)
  • Part B (Medical)
  • Part C (Medicare Advantage Plans)
  • Part D (Medicare Prescription Drug Coverage)

What is Medicare Part A?

Medicare Part A helps cover inpatient care in hospitals. This includes critical access hospitals and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and home health care. You must meet certain conditions to get these benefits.

Cost: Ther normally is not a premium for Medicare Part A benefits. This is because you or your spouse paid Medicare taxes while working. If you do not get Part A free, you may be able to purchase it.

What is Medicare Part B?

Medicare Part B helps cover medical services like doctors' services, outpatient care, and other medical services that Part A doesn't cover that are medically necessary. Part B also covers preventative services which  include a one-time "Welcome to Medicare" physical exam, bone mass measurements, flu and pneumococcal shots, cardiovascular screenings, cancer screenings, and diabetes screenings, and more.

Cost: Most people pay the standard Part B premium. As of January 1, 2007, some people pay a higher premium based on their income. Your monthly premium will be higher than the standard premium if you are single (file an individual tax return), and your annual income is more than $80,000, or if you are married (file a joint tax return) and your annual income is more than $160,000.

What isn't covered by Medicare Part A and Part B?

Medicare doesn't cover dental care, health care you get while traveling outside of the United States (except in limited cases), hearing aids, most hearing exams, long-term care, most eyeglasses, and more.

What is Medicare Part C?

Medicare Advantage Plans are health plan options that are approved by Medicare but run by private companies. They are part of the Medicare Program and sometimes called "Part C." They provide all your Part A and Part B coverage and must cover medically-necessary services. Most include Part D drug coverage.

Cost: Some Medicare Advantage Plans charge a monthly premium in addition to your Part B premium. Costs vary by plan and the services you use.

What is Medicare Part D?

Medicare offers prescription drug coverage for everyone with Medicare. This may be called "Part D." This coverage may help lower prescription drug costs and help protect against higher costs in the future. These plans are run by insurance companies and other private companies approved by Medicare. Part D is optional.

Cost: If you join a Medicare drug plan, you usually pay a monthly premium. If you decide not to enroll in a Medicare drug plan when you are first eligible, you may pay a penalty if you choose to join later. If you have limited income and resources, you might qualify for federal assistance.

For information on how to get this federal assistance with prescription drug costs and how to apply, visit www.socialsecurity.gov on the web or call 1-800-772-1213. TTY users should call 1-800-325-0778.

There are two ways to get Medicare prescription drug coverage:

  1. Join a Stand Alone Medicare Prescription Drug Plan that adds drug coverage to the Original Medicare Plan.
  2. Join a Medicare Advantage (like an HMO or PPO) that includes prescription drug coverage as part of the plan. These plans provide all of your Medicare coverage, including prescription drugs.

When can I switch my Medicare plan?

The Annual Enrollment Period for Medicare Part D and Medicare Advantage Plans is October 15 through
December 7.

Can I have other types of health insurance?

Yes. You may already have health care coverage such as employer or retiree coverage. There are times when your other health insurance must pay before Medicare.

How can I get help to pay health care and prescription costs?

There are programs that help millions of people with Medicare save money each year. If you have limited income and resources, your State may help pay Medicare premiums and, in some cases, may also pay Medicare deductibles and coinsurance. Help is also available paying prescription drug costs. Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.