What is Medicare?

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Medicare is a health insurance program run by the federal government. Some Medicare services are provided by private companies, but these companies must follow rules laid out by Medicare.

How many programs does Medicare have?

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Medicare has three main parts. Each part helps pay for a different aspect of your medical care. In general:

Medicare Part C, also known as Medicare Advantage, is a way to get Part A, B, and often Part D coverage through a private company.

How do I become eligible for Medicare?

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To be eligible for Medicare you must be:
  • 65 years old and have worked and paid Social Security taxes for enough time; or
  • A Social Security Disability Insurance (SSDI) or Childhood Disability Benefits (CDB) beneficiary who has received at least 24 months of SSDI or CDB benefits; or
  • A person with End-Stage Renal Disease (permanent kidney failure); or
  • A person with Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease).

What is the Medicare waiting period?

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Once you start getting Social Security Disability Insurance (SSDI) payments, you generally have to wait two years before getting Medicare. People with Lou Gehrig’s Disease or End Stage Renal Disease don’t have to wait this long for Medicare coverage to start.

How do I get help paying for medical costs during the Medicare waiting period?

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You may be able to get help paying for medical costs during the waiting period through:

Am I automatically enrolled in Parts A and B if I’m on SSDI?

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Yes. Once you’ve received 24 months of Social Security Disability Insurance (SSDI) payments, you’ll automatically be enrolled in Medicare Part A and Part B.

Does Medicare pay for every type of medical service?

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No. The general rule is that Medicare will only help pay for care it considers reasonable and necessary.

Will Medicare pay for the entire cost of services that it covers?

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No. For certain services, you’ll pay a deductible, copayment, or coinsurance before Medicare will begin to help pay for that service. If you need a service that Medicare doesn’t cover, you’ll have to pay for it yourself, unless you have other coverage.

What is a Medigap policy?

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A Medigap policy (also known as Medicare Supplemental Insurance) is a private health insurance policy that helps pay for services that Original Medicare doesn’t pay for.

Can I be on Medicare and another form of health coverage at the same time?

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Yes. Other types of coverage that you can have with Medicare include:
  • Coverage from a current employer;
  • Coverage from a spouse’s employer;
  • Continued coverage from a former employer through COBRA;
  • Medi-Cal
  • Retiree plans;
  • Veterans (VA) benefits;
  • Military (TriCare for Life) benefits; or
  • Individual health insurance.

What do Medicare Savings Programs pay for?

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What if I return to work before I retire? How does that affect my Medicare coverage?

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As long as Social Security finds you still have a disability, you can return to work and keep your Medicare coverage for about 8.5 years. Once you turn 65 years old, you will never lose your Medicare eligibility.

What happens to my Medicare when I turn 65 years old?

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At 65, you receive Medicare under your retirement benefits, which will include premium-free Medicare Part A.

What does “assignment” mean?

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Assignment is an agreement between Medicare and doctors and suppliers of health care equipment and supplies. To accept assignment means the providers or suppliers agree to receive direct payment from the Medicare program and agree to accept the Medicare approved amount as the full amount of the bill.

What is a Medicare Summary Notice?

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The Medicare Summary Notice (MSN) tells you how much Medicare helped pay for medical costs in a given time period. You’ll get an MSN every three months, or you can view it on the Medicare.gov website.

What if I don’t agree to the charges I see on my Medicare Summary Notice?

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You may think that Medicare should have helped pay for a service that they didn't help with, or that they should have paid more than they did. When you disagree with Medicare, you can file an appeal. For people in Original Medicare, you can file an appeal by following the instructions on your Medicare Summary Notice.