Medicare has four parts, Parts A through D:
- Hospital insurance (Part A) helps pay for inpatient hospital care and certain follow-up services.
- Medical insurance (Part B) helps pay for doctors’ services, outpatient hospital care and other medical services.
- Medicare Advantage plans (Part C) are available in many areas. People with Medicare Parts A and B can choose to receive all of their health care services through a provider organization under Part C.
- Prescription drug coverage (Part D) helps pay for medications doctors prescribe for medical treatment.
Medicare Part A premiums are waived if:
- You are 65 years or older and a U.S. citizen or have been permanent legal resident for 5 continuous years, and you and your spouse (if applicable) have paid Medicare taxes for at least 10 years.
- You are under 65, disabled, and have been receiving Social Security Disability Insurance Benefits (SSDI). You must receive SSDI for at least 24 months from the date of entitlement (first disability payment) before becoming eligible to enroll in Medicare.
- You get continuing dialysis for end stage renal disease (ESRD) or need a kidney transplant.
- You are eligible for Social Security Disability Insurance and have amyotrophic lateral sclerosis (known as ALS or Lou Gehrig’s disease).
If you are 65 or older, you must pay a monthly premium to remain enrolled in Medicare if or your spouse have not paid Medicare taxes over the course of 10 years while working.
Individuals with disabilities who receive SSDI are eligible for Medicare while they continue to receive SSDI payments. These individuals may lose eligibility for Medicare based on the disability if they stop receiving SSDI. The 2 year exclusion means that people who become disabled must wait 2 years before receiving government medical insurance, unless they have one of the listed diseases or are eligible for Medicaid or medical.
In some states, for example California, for individuals who have limited resources, Medicaid will pay the beneficiaries’ Part B premium as well as coveringany prescription drugs that are not covered by Part D.
Medicare Part A covers inpatient care at hospitals. Part A also covers the cost of a blood transfusion if the hospital must purchase blood for the patient, for up to 100 days per each benefit period in a skilled nursing facility, and hospice care for those with a life expectancy of six months or less due to a terminal illness. Part A coverage costs nothing for the patient, except deductibles or copayments, and coverage gaps. These items must be paid by you or covered by other insurance.
Medicare Part B covers doctors visits and services, outpatient care, rehabilitative care under a physical therapist, occupational therapist, or speech-language pathologist, and some preventative services such as flu shots and mammograms. The premium for Part B coverage depends on your resources. Most individuals will pay the standard Part B premium.