The Basics

Medicare is health insurance. While you work, some of the money you earn automatically comes out of your paycheck and goes into a Medicare fund with other people’s contributions. If you have to stop working because of a disability, Medicare will take money from this fund and use it to help you pay for your medical costs.

Like any insurance program, there are detailed rules about who can participate in Medicare and limits to what medical costs Medicare will help pay for.

The federal government is in charge of Medicare. Some parts of Medicare are now run by private companies, but those companies have to follow rules laid out by Medicare.

“Medicare” is actually a collection of related programs. Each program will help pay for a different aspect of your medical care. The programs are called “parts” and are named by letters. In general:

  • Medicare Part A helps pay for medical care you get while you’re in a hospital.
  • Medicare Part B helps pay for medical care you get outside of a hospital, like when you go to the doctor’s office.
  • Medicare Part C, also known as Medicare Advantage, is a way to get Part A, B, and sometimes Part D coverage through private companies.
  • Medicare Part D helps pay for prescription drugs.

Each Medicare Part has different rules for how you sign up, how much it costs, which medical costs it helps with, and how much of the costs it will help pay for.

Medicare and Covered California

The Affordable Care Act (ACA) has made big changes to our health care system, which can cause some confusion. Here are some important things to know about Medicare:

  • If you have Medicare now, you can keep your coverage. There is nothing you need to do.
  • This year’s Medicare Open Enrollment Period is October 15 - December 7. This is the time when you can make changes to your Medicare plan. You do not have to do anything to stay enrolled. For more information on changing plans, keep reading this article and call 1-800-MEDICARE (1-800-633-4227).
  • Most people who qualify are enrolled in Medicare automatically. Nothing has changed about this. Keep reading this article for the details on enrollment.
  • You still have the choice of getting Original Medicare or Medicare Advantage.

Note: You cannot use Covered California to sign up for Medicare, Medicare supplements (also called Medigap policies), or Medicare Advantage.

The bottom line: If you qualify for Medicare, it is your best option for health care coverage. Nothing is changing about how you enroll for Medicare, or make changes to your plans. If you have a Medicare plan, you do not need to do anything on Covered California.

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