Medicare Health Insurance Program
Medicare is the United States’ health insurance program for people age 65 or older. Certain people younger than age 65 can also qualify for Medicare—including those with disabilities and those who have permanent kidney failure.
The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care. You have choices for how you get Medicare coverage. If you choose to have Original Medicare (Part A and Part B) coverage, you can buy a Medicare Supplement Insurance (Medigap) policy from a private insurance company.
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 kidney transplant).
Medicare has different parts that help cover specific services:
Medicare Part A (Hospital Insurance)—Part A helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits. Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working.
Parts of Medicare
Social Security enrolls you in Original Medicare (Part A and Part B).
• Medicare Part A (hospital insurance) helps pay for inpatient care in a hospital or limited time at a skilled nursing facility (following a hospital stay). Part A also pays for some home health care and hospice care.
• Medicare Part B (medical insurance) helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists. Part B helps pay for these covered services and supplies when they are medically necessary. Most people pay a monthly premium for Part B.
Other parts of Medicare are run by private insurance companies that follow rules set by Medicare:
• Supplemental (Medigap) policies help pay Medicare out-of-pocket copayment, coinsurance, and deductible expenses.
• Medicare Advantage Plan (previously known as Part C) includes all benefits and services covered under Part A and Part B—prescription drugs and additional benefits such as vision, hearing, and dental—bundled together in one plan.
• Medicare Part D (Medicare prescription drug coverage) helps cover the cost of prescription drugs. Medicare prescription drug coverage is available to everyone with Medicare. To get Medicare prescription drug coverage, people must join a plan approved by Medicare that offers Medicare drug coverage. Most people pay a monthly premium for Part D.
Most people age 65 or older are eligible for free Medical hospital insurance (Part A) if they have worked and paid Medicare taxes long enough. You 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.
Should I Sign Up for Medical Insurance (Part B)?
Using the online application at https://secure.ssa.gov/iClaim/rib, you can sign up for Medicare Part A (hospital insurance) and Part B (medical insurance). Because you must pay a premium for Part B coverage, you can turn it down.
If you’re eligible at age 65, your initial enrollment period begins three months before your 65th birthday, includes the month you turn age 65, and ends three months after that birthday.
If you choose not to enroll in Medicare Part B and then decide to do so later, your coverage could be delayed and you may have to pay a higher monthly premium for as long as you have Part B. Your monthly premium will go up 10 percent for each 12-month period you were eligible for Part B but didn’t sign up for it—unless you qualify for a Special Enrollment Period (SEP).
If you don’t enroll in Medicare Part B during your initial enrollment period, you have another chance each year to sign up during a general enrollment period from January 1 through March 31. Your coverage begins on July 1 of the year you enroll.
If you have a Health Savings Account (HSA) or health insurance based on current employment, you may want to ask your personnel office or insurance company how signing up for Medicare will affect you.
Special Enrollment Period (SEP)
If you have medical insurance coverage under a group health plan based on your or your spouse's current employment, you may not need to apply for Medicare Part B at age 65. You may qualify for a Special Enrollment Period (SEP) that will let you sign up for Part B during:
• Any month you remain covered under the group health plan and you, or your spouse's, employment continues.
• The 8-month period that begins with the month after your group health plan coverage or the employment it is based on ends, whichever comes first.
How to Apply Online for Just Medicare
If you are within three months of age 65 (or are older) and not ready to start your monthly Social Security benefits yet, you can use the online retirement application to sign up just for Medicare and wait to apply for your retirement or spouses’ benefits later. It takes less than 10 minutes, there are no forms to sign, and usually no documentation is required.
Medicare Cards
To help protect your identity, your Medicare card has a Medicare number that’s unique to you. If you did not receive your red, white, and blue Medicare card, there may be something that needs to be corrected, like your mailing address. You can update your mailing address by signing in to or creating your personal my Social Security account.
Already Enrolled in Medicare
If you already have Medicare, you can get information and services online.
If you are already enrolled in Medicare Part A and you want to enroll in Part B, complete form CMS-40B, Application for Enrollment in Medicare—Part B (medical insurance). If you are applying for Medicare Part B due to a loss of employment or group health coverage, you will also need to complete form CMS-L564, Request for Employment Information.
You have three options to submit your enrollment request under the Special Enrollment Period. You can do one of the following:
1. Apply online at https://secure.ssa.gov/mpboa/medicare-part-b-online-application/ and complete CMS-40B and CMS-L564. Then upload your evidence of Group Health Plan or Large Group Health Plan.
2. Fax your CMS-40B and employer-signed CMS-L564 to 1-833-914-2016.
3. Mail your CMS-40B and employer-signed CMS-L564 to your local Social Security office.
When completing the CMS-L564:
• State on the form “I want Part B coverage to begin (MM/YY)” in the remarks section of the CMS-40B form or online application.
• If possible, your employer should complete Section B.
• If your employer is unable to complete Section B, complete that portion as best as you can on behalf of your employer without your employer’s signature and submit one of the following forms of secondary evidence:
o income tax form that shows health insurance premiums paid;
o W-2s reflecting pre-tax medical contributions;
o pay stubs that reflect health insurance premium deductions;
o health insurance cards with a policy effective date;
o explanations of benefits paid by the GHP or LGHP; or
o statements or receipts that reflect payment of health insurance premiums.
You’ll have Original Medicare (Part A and Part B) unless you make another choice. You can decide to add a drug plan (Part D) or buy a Medigap policy to help pay for costs that Original Medicare doesn’t cover. You can choose to join a Medicare Advantage Plan (Part C) and get all your Medicare coverage (including drugs and extra benefits like vision, hearing, dental, and more) bundled together in one plan.
Some people with limited resources and income may also be able to get extra help to pay for Part D drug costs.
What Happens After I Apply?
The Centers for Medicare & Medicaid Services (CMS) manages Medicare. After you are enrolled they will send you a Welcome to Medicare packet in the mail with your Medicare card. You will also receive the Medicare & You handbook, with important information about your Medicare coverage choices.
Other Medicare Enrollment Options
If you live in Puerto Rico you will not receive Medicare Part B (medical insurance) automatically. You will need to sign up for it during your initial enrollment period, or you will pay a penalty. To sign up, call this toll-free number: 1-800-772-1213 (TTY 1-800-325-0778). You also may contact your local Social Security office.
In Texas, as in all states, Medicare is a federal health insurance program primarily for individuals who are 65 or older, though it also covers younger individuals with certain disabilities and those with End-Stage Renal Disease. Medicare Part A covers hospital and inpatient services and is usually premium-free for those who have paid Medicare taxes while working. Part B covers outpatient medical services and has a monthly premium. Individuals can also choose to enroll in Medicare Advantage Plans (Part C), which offer additional benefits and may include prescription drug coverage, or they can add a standalone Medicare Part D plan for prescription drugs. Supplemental (Medigap) policies are available to cover out-of-pocket expenses not covered by Original Medicare. Enrollment in Medicare is typically around the age of 65, with specific enrollment periods and the possibility of penalties for late enrollment unless covered by a Special Enrollment Period (SEP) due to current employment. Texans can apply for Medicare online, by fax, or by mail, and upon enrollment, they will receive a Medicare card and a 'Welcome to Medicare' packet with further information.
