Medicare

Medicare is a health insurance program administered by the federal government for people age 65 and over, people under 65 who have received at least 24 months’ worth of disability benefits, people with ALS and certain people with kidney failure. Medicare helps with the cost of health care, but it does not cover all medical expenses or long-term care costs. Typically, Medicare covers 80% of health care costs and patients are responsible for the remaining 20%. There are four parts to Medicare:

  • Part A is hospital insurance. It helps pay for an inpatient stay at a hospital or skilled nursing facility for rehabilitation, as well as some home health care and hospice care. Most people do not pay a monthly premium for Medicare Part A, but there is a deductible and coinsurance charges depending on the number of days hospitalized.
  • Part B is medical insurance. It helps pay medical services and supplies not covered by hospital insurance. Most people pay a monthly premium of $104.90 or $134 for Part B coverage. There are various copays and coinsurance amounts that people who have Medicare Part B are responsible for. Some people may be eligible to receive help paying for their Medicare Part B premiums through a Medicare Savings Program. For more information on Medicare Savings Programs, see the Medicare Savings Program section of this guide.
  • Part C is private, supplemental health insurance that may include prescription drug coverage. Part C plans are supplemental health insurance policies offered by private insurance companies who contract with Medicare. While they vary in structure and service-delivery model, Part C plans generally help to cover the 20% of costs that Medicare Parts A and B do not. Part C plans often include prescription drug coverage and have monthly premiums, which vary based on the plan you choose, the medications you take, and the number of services for which you would like to have coverage. 
  • Part D is prescription drug coverage. It helps pay for prescription medications only. Part D premiums vary based on which plan you choose and which medications you take. Social Security administers a low-income subsidy program called "Extra Help" that may help reduce out-of-pocket drug costs:

Eligibility
In order to be eligible for Medicare, a person must be 65 years of age or older, have ALS or certain types of kidney failure, or have received at least 24 months’ worth of cash Disability Benefits.

If you decide not to enroll in Medicare Part B during your initial period of eligibility, you may have to pay a fee for late enrollment if you decide to enroll later, unless you’ve opted out of enrolling because of access to insurance through an employer. You may be eligible to receive help in paying for your Medicare Part B premiums by applying for a Medicare Savings Program through the county you live in. To apply for a Medicare Savings Program, complete an Application for Certain Populations.

You must have Medicare Part A to enroll in Medicare Part D, and you must have both Medicare Parts A and B to enroll in Medicare Part C. You should enroll in a Medicare prescription drug plan during your initial enrollment period if you don't have comparable prescription coverage under another plan. Otherwise, you will have to pay a penalty if you decide to enroll later. Unless you are eligible for Extra Help, you are only able to enroll in a Part D or Part C plan or change your existing plan during open enrollment (October 15 – December 7) each year.

How to Apply

There are certain periods of time in which a person may enroll in a Medicare policy that includes prescription drug coverage. Open enrollment for Medicare Part D and Part C plans is from October 15th to December 7th every year.