Medicare Basics:  What You Need to Know

Medicare is a health insurance program for:

• people age 65 or older,
• people under age 65 with certain disabilities, and
• people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

Medicare is separated into "Parts":

Part A Hospital Insurance - 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.  Medicare Part A (Hospital Insurance) 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.

Part B Medical Insurance - Most people pay a monthly premium for Part B.  ($185 in 2025, estimated $206 in 2026).  Medicare Part B (Medical Insurance) helps cover outpatient medical services and preventitive care.  This includes doctor's visits, lab tests, durable medical equipment, mental health services and some (In Office) prescription drugs.  It also covers a variety of services such as screenings and vaccinations. 

"Part C" - Medicare Advantage Plans - Also referred to MAPD Plans.  These are plans available from private insurance companies (United/UHC, Humana, Aetna, etc) that include your coverage from Parts A, B & D plus a few extras.  See HERE for more info.

Part D - Prescription Drug / Rx Coverage - Many people will not pay a monthly premium for this coverage unless they need a more specialized plan with better Tier Pricing.  On January 1, 2006, Medicare prescription drug coverage became available to everyone with Medicare.  This coverage is to help you lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and MAY pay a monthly premium.  If a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.

Most of this information comes from CMS.gov  

Are You Eligible for Medicare?

Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States.

If you are not 65, you might also qualify for coverage if you have a disability or with End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant).

Here are some simple guidelines:

You can get Part A at age 65 without having to pay premiums if:

• You already get retirement benefits from Social Security or the Railroad Retirement Board.
• You are eligible to get Social Security or Railroad retirement benefits but have not yet filed for them.
• You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A without having to pay premiums if:

• You have received Social Security or Railroad Retirement Board Disability benefit for 24 months.
• You are a kidney dialysis or kidney transplant patient (ESRD).

While you don’t have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it in most cases (without Medicaid Coverage).  It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t get any of the above payments, Medicare sends you a bill for your Part B premium every 3 months.

To Review Your Best Options, can Call / Text at 346-567-8300, E-mail or Schedule an Appointment at the top right of this web site.

Medicart Parts A&B Sign-Up

SSA.gov - Official PDF Instruction Booklet

https://www.ssa.gov/pubs/EN-05-10530.pdf

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Have questions? Give us a call and let us help you with your Medicare Health insurance needs.

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