Medicare

Use the resources below to find learn all about Medicare—and how the Affordable Care Act will improve benefits and expand choices.

• What is Medicare?
• How can I get Medicare?
• What does Medicare cost?
• What does Medicare cover?
• How does the health care law affect Medicare?

What is Medicare?

Medicare is health insurance for people age 65 or older, people under 65 with certain disabilities, and people of all ages with End-Stage Renal Disease. (ESRD is permanent kidney failure requiring dialysis or a kidney transplant.) Different parts of Medicare help cover specific services if you meet certain conditions.

For more information about Medicare, visit www.medicare.gov, or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

How can I get Medicare?

Seniors

You are generally eligible for Medicare if:

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

Find out if you are eligible for coverage at www.medicare.gov.

People with Disabilities

To be eligible for this coverage, you have to be getting Social Security Disability Insurance (SSDI) benefits or disability benefits from the Railroad Retirement Board (RRB).

Once you get your SSDI or RRB disability benefits, you generally have to wait 24 months before becoming eligible for Medicare.  For information on this process, read more about disability benefits. Note that during the 24-month waiting period, you might be eligible for Medicaid.

If your disability is amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), you don’t have to wait 24 months. You can get Medicare as soon as you become entitled to SSDI.

People with Kidney Failure

Medicare provides benefits to people, regardless of their age, who have End-Stage Renal Disease (ESRD or kidney failure).  People with ESRD are either undergoing a regular course of renal dialysis or have had a kidney transplant.  For more information, read the booklet “Medicare Coverage of Kidney Dialysis and Kidney Transplant Services.” (PDF – 815 KB)

What does Medicare cost?

You may be responsible for cost sharing for Medicare benefits, including deductibles, co-insurance, copayments, and premiums.  If you have limited income and resources, there may be help for you from your state or from Medicare.  Learn more about Medicare costs and premiums.   

If you’re eligible for both Medicaid and Medicare, Medicaid may help you pay Medicare deductibles, co-insurance, copayments, and premiums.

To learn more about your state Medicaid program and other options available to you, use the insurance and coverage finder.

What does Medicare cover?

• Medicare Part A helps cover inpatient care in hospitals, skilled nursing facility care, hospice, and home health care.
• Medicare Part B helps cover doctor services and preventive services.
• Medicare Part C is a way to get your Medicare benefits through private companies approved by Medicare. It includes Part A and Part B and in most cases Part D.
• Medicare Part D helps cover prescription drugs.

For information on how Medicare works, read an overview of Medicare benefits.

Medicare provides comprehensive coverage. Some services may not be covered, however, such as hearing aids and long-term care. For information on Medicare benefits, read more about Medicare coverage. 

You might be eligible for both Medicare and Medicaid. If so, Medicaid will cover many of the services that Medicare doesn’t cover.

To learn more about your state Medicaid program and other options available to you, use the insurance and coverage finder.

How does the Affordable Care Act affect Medicare?

The federal government is taking strong action to reduce payment errors, waste, fraud, and abuse in Medicare. The law makes a 10-year, $350 million investment to prevent, detect, and fight fraud in Medicare, Medicaid, and the Children’s Health Insurance Program—including criminal efforts to exploit the new law.  Visit Stop Medicare Fraud for more information.

In addition to strengthening Medicare, the health care law provides these benefits to seniors:

• $250 prescription drug rebate in 2010
• 50% discount on brand-name drugs in the donut hole in 2011
• Closes the donut hole by 2020 (PDF – 1 MB)
• Annual wellness exam at no cost to you
• No copayment for certain preventive services
• Coordination of care between doctors
• Improved quality of care at hospitals

Starting in 2014, the Affordable Care Act offers additional protections for Medicare Advantage Plan members by taking strong steps that limit the amount these plans spend on administrative costs, insurance company profits, and things other than health care.