Medicare FAQs - General
1. What is Medicare?
Medicare is a federally-funded health insurance program. Medicare has four parts: Part A, Part B, Part C and Part D.
2. What does Medicare Part A cover?
Medicare Part A is hospital insurance and helps cover inpatient care in hospitals. Part A also helps cover skilled nursing facilities, hospice and home healthcare if certain conditions are met.
3. What does Medicare Part B cover?
Medicare Part B is medical insurance and helps cover medically-necessary services such as doctors' visits and outpatient care. Part B also covers many preventative services, such as flu shots, mammograms and Pap tests.
4. What does Medicare Part C cover?
Medicare Part C (also called Medicare Advantage) is another way to get Medicare benefits. Medicare Part C combines Part A, Part B and, sometimes, Part D (prescription drug coverage).
5. What does Medicare Part D cover?
Medicare Part D helps cover prescription drugs.
6. How do I become eligible for Medicare?
Generally, there are several ways to become eligible for Medicare:
- Most people become eligible for Medicare when they turn 65.
- If you're awarded Social Security Disability Insurance benefits for something other than Lou Gehrig's disease (ALS), you will become eligible for Medicare 24 months after the date of entitlement to cash benefits.
- If you have ALS, you will automatically be eligible for Medicare once you begin getting Social Security Disability Insurance (SSDI).
- If you have been diagnosed with ESRD or kidney failure, you will be eligible for Medicare three months after starting dialysis. If you choose self-dialysis, then Medicare coverage begins retroactively to the first month of dialysis.
7. How do I enroll in Medicare?
If you are aged 65 or older and are not disabled, getting benefits from Social Security or the RRB and have not been awarded SSDI benefits, you will need to contact the Social Security Administration (SSA) office to enroll.
If you are getting Social Security or RRB benefits, have been awarded SSDI benefits or have been diagnosed with ALS, you will be automatically enrolled in Medicare. If you have been diagnosed with ESRD, you will need to contact the SSA to enroll.
8. Once I'm eligible for and enrolled in Medicare, what do I do?
Once you're enrolled in Medicare, you'll have a variety of options to choose from to get complete coverage. You can either choose a single plan to cover all your needs or you can choose a combination of plans. But before you make a decision, you should assess your health and finances and compare these with the Medicare options available to you. Your Medicare options will generally fall under two main categories: Original Medicare (also known as traditional Medicare, which includes Part A and Part B) and Medicare Advantage plans. There also are other specialized Medicare plans available.
9. What is CMS?
CMS stands for Centers for Medicare & Medicaid Services, the agency within the U.S. Department of Health and Human Services that oversees Medicare, Medicaid, the State Children's Health Insurance Program and other programs.
10. What are my rights and protections under Medicare?
No matter what kind of coverage you have, you have the right to:
- Get a decision regarding coverage and payment of healthcare services
- Appeal a decision regarding payment and coverage
- Get emergency and urgently-needed care
- Get information on covered services and costs
- File complaints, including quality-of-care complaints
- Know treatment options and participate in treatment decisions
- Privacy and confidentiality