The Basics

The Basics

Medicare is a U.S. federal program that provides health insurance for those 65 years old and older, and some people under 65 with certain disabilities. It is the largest health insurance program in the U.S.

Medicare was signed into law by President Lyndon Johnson on July 30, 1965, in Independence, Mo. The first person signed up for the program was Missouri’s own President Harry S. Truman.

Back then, there was only one section, what is now known as Medicare Part A. Over time, additional options were added. Each works differently from the others, which can be confusing.

Understanding Medicare

Here is a short video developed by the State Health Insurance Assistance Program (SHIP) and CLAIM to help you understand Medicare.

Today, the sections of Medicare are:

Medicare Part A
This helps pay for hospitals, home health, hospice, and skilled-nursing facility care. Most people pay for this while they are working, so there is no monthly cost. You will have to pay some money when using the benefits.

Medicare Part B
This helps pay for medical care. For example, it pays for doctors visits, outpatient hospital services, and medical equipment. Most people with Part B pay a monthly bill (usually taken from their Social Security) and share the cost each time they use the benefits.

Medicare Advantage
This is sometimes called Medicare Part C. Medicare Advantage Plans are different ways of getting benefits offered by Part A and Part B. The plans have contracts with the Medicare to provide insurance coverage. The plans may apply premiums deductibles and co-insurances. Some also include extra benefits like dental and vision screenings.

Medicare Part D
This helps pay for medicine. To join, you must pick a plan run by a private company. Each plan has a different monthly cost. You will normally pay some money when you pick up your medicine.

Medicare Part A and Part B are considered “Original Medicare.” These two form the basic Medicare coverage. Medicare Part D is the most recent addition to Medicare. Most people with Original Medicare also join Part D.

Am I eligible?

Most people can join Medicare when they turn 65. You can also join if you:

  1. Receive Social Security disability checks for 24 months, or
  2. Have permanent kidney failure, known as End-Stage Renal Disease (ESRD), or
  3. Have Lou Gehrig’s Disease, known as Amyotrophic Lateral Sclerosis (ALS).

Medicare provides an online Medicare Eligibility Tool that can help tell you if or when you will become eligible.

I’m Eligible. Now what?

Enrollment in Medicare varies  between programs and situations. Find yours below.

How to Enroll in Medicare A and B

Do you already get Social Security retirement, disability benefits or railroad retirement checks?

If so, you’re done! You don’t need to do anything else to join Medicare Part A and Part B.

Turning 65?

If you don’t receive Social Security, contact the Social Security office in your county or call the national program at 1-800-772-1213. You should do this about three months before your 65th birthday.

Do you have ALS?

You will be enrolled in Medicare Part A once you receive disability benefits.

Once you’re enrolled, you should receive information about Medicare and your Medicare “Red, White and Blue Card.” You will automatically be enrolled in Medicare Part A and Part B. Medicare Part A usually costs nothing.

Because most people have to pay a monthly fee, or “premium,” for Part B coverage, you have the option of turning it down. However, if you enroll late in Part B, you may have to pay a penalty. There are some exceptions, for instance, if you already have medical insurance through an employer.

Trouble enrolling?

Contact your county’s Social Security office or call Social Security’s hotline at 1-800-772-1213.

Common problems that may require a call include:

  • You are a disabled widow or widower between age 50 and age 65, but have not applied for disability benefits because you are already getting another kind of Social Security benefit;
  • You are a government employee and became disabled before age 65;
  • You, your spouse or your dependent child has permanent kidney failure;
  • You had Medicare medical insurance in the past but dropped the coverage; or
  • You turned down Medicare medical insurance when you became entitled to hospital insurance (Part A).

CLAIM can also help you sort through these and other enrollment issues.

Your Medicare CardSample Medicare Card

Once you are enrolled, you will receive a Medicare Card, sometimes called your “Red, White and Blue Card.” Sign this card, then keep it in a safe place, such as your wallet or purse. Bring it with you when you need medical care.

If there is a mistake on your card, contact Social Security (or the Railroad Retirement Board, if you receive railroad benefits).

If your card is ever lost or stolen, you can apply for a replacement card or call Social Security’s toll-free number, 1-800-772-1213.

Welcome to Medicare Exam

Finally, if you have enrolled in Part B, call your doctor to schedule your Welcome to Medicare physical exam.

This is a one-time-only exam that must be scheduled within six months of joining Medicare. It covers a variety of tests, including an important heart test called an electrocardiogram (EKG or ECG).

You will likely meet your Medicare deductible at this visit.

CLAIM Tip: If your birthday is late in the year, you may want to schedule your physical for January of the following year. Then your deductible will be paid for the whole year!