Frequently Asked Questions

If you or your spouse works enough time while paying Medicare taxes, you qualify for Medicare:

• When you turn 65
• After you get Social Security Disability Insurance (SSDI) benefits for two years, or
• If you have Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS) or end-stage kidney disease (ESRD).

If your disability starts before you are 22 years old, you start getting Medicare if you get Childhood Disability Benefits (CDB) benefits for two years based on a parent’s work record.

Note: For full Medicare coverage, you have to be a U.S. citizen or have been living in the U.S. for the last five years as a lawfully admitted permanent resident.

You automatically get Original Medicare coverage if you get SSDI for two years or start getting Social Security retirement benefits before you turn 65. Otherwise, you may need to sign up.

If you have government-run Original Medicare, you have the options of also getting a privately managed Part D prescription drug policy and, if you are 65 or older, a privately run Medicare supplement policy (Medigap).

Or, you may decide that you want a privately run Medicare Advantage plan that includes all the benefits you need. Note: Most Medicare Advantage plans include prescription drug coverage, but some allow you to sign up for a separate Part D plan instead.

For all of these types of privately managed Medicare benefits, the signup process is basically the same:

1. You decide which types of plans you want to sign up for.
2. You research the private plans you are looking at. One way of comparing plans is by using the Medicare Plan Finder.
3. You sign up:
   • On Medicare.gov
   • By calling Medicare at 1-800-633-4227 or 1-877-486-2048 (TTY)
   • By calling the Health Insurance Counseling & Advocacy Program (HICAP) at 1-800-434-0222
   • By completing a paper application with the plan, or
   • By contacting the plan directly.

For more help in understanding Medicare, you can:

• Call Medicare at 1-800-633-4227 or 1-877-486-2048 (TTY), or
• Call the Health Insurance Counseling & Advocacy Program (HICAP) at 1-800-434-0222.

Original Medicare has three main parts:

• Part A helps pay for medical care you get while you’re admitted in a hospital.
• Part B helps pay for outpatient medical care.
• Part D helps pay for prescription drugs.

Medicare Advantage is a way to get a single combined plan including Parts A, B, and D through a private company. With Medicare Advantage plans, you may have less flexibility, but your costs could be lower.

Whether Original Medicare or Medicare Advantage is right for you depends on your situation and preferences. There is no answer that is right for everyone. In California, 45% of Medicare beneficiaries choose Original Medicare and 55% choose Medicare Advantage.

Learn more about the reasons one or the other might be right for you.

No. Medicare only helps pay for care that it considers reasonable and necessary. If you need a service that Medicare doesn’t cover, you have to pay for it yourself, unless you have other coverage, such as Medi-Cal or employer-sponsored coverage.

For some services, you pay a deductible, copayment, or co-insurance before Medicare begins to help pay for that service. For Medicare Part B or Part D, or for Medicare Advantage, you may have to pay a monthly premium, unless you qualify to get help paying for your Medicare premiums, copayments, and deductibles through Medi-Cal, Medi-Cal's Working Disabled Program, a Medicare Savings Program, or the Low Income Subsidy (LIS).

Regardless of whether you have Original Medicare or Medicare Advantage, you may qualify for help paying for Medicare. There are two main types of help:

• Medicare Savings Programs (MSPs) help people with low income pay Medicare premiums. Depending on the MSP, it may also help with other expenses, such as copayments, co-insurance, and deductibles.
  • For people with Original Medicare, MSPs can help with Parts A and B.
  • MSPs can help with any Medicare Advantage plan.
• The Low Income Subsidy (LIS), also known as Extra Help, helps pay premiums, copayments, co-insurance, and deductibles for prescription drug coverage.
  • For people with Original Medicare, the LIS can help with Part D plan expenses.
  • The LIS can help with Medicare Advantage plans that include prescription drug coverage, sometimes call MA-PD plans.

Note: If you have both Medi-Cal (or Medi-Cal's Working Disabled Program) and Medicare coverage, your Medi-Cal coverage may also help pay for your Medicare expenses or you may automatically get help from an MSP and the LIS.

If you have any questions about Medicare Savings Programs and the LIS, call the Health Insurance Counseling & Advocacy Program (HICAP) at 1-800-434-0222

Learn more about getting help paying for Medicare and how to apply for it.

A Medigap policy (also called Medicare Supplement Insurance) is a private plan that helps cover some Original Medicare expenses, such as copayments and deductibles. In California, you cannot sign up for a Medigap policy if you are less than 65 years old.

Medicare.gov lists the most common levels of Medigap plan and what benefits they provide.

You should only opt out of Part B coverage if you both:

• Have an employer-sponsored insurance policy and your employer or insurer says it's safe for you to opt out of Part B, and
• Do not qualify for Medi-Cal, WDP, or a Medicare Savings Program.

If you opt out of Part B coverage, you may have to pay monthly penalties if you want Part B later. If you qualify for Medi-Cal or an MSP, they help pay for your Part B expenses and you are better off overall with Part B.

If you have Original Medicare, you should sign up for Part D unless you both:

• Have creditable coverage that pays for your medications, and
• Do not qualify for Medi-Cal or the Low Income Subsidy (Extra Help).

If you do not have creditable coverage, you have to pay a monthly penalty if you want Part D later. If you qualify for Medi-Cal or the Low Income Subsidy, they help pay your Part D costs and you are better off overall with Part D.

Note: If you have Medicare Advantage, it may already include prescription drug coverage. Check with your plan. (The LIS also helps pay for Medicare Advantage plans that cover prescription drugs.)

Yes. Other types of coverage that you can have with Medicare include:

• Medi-Cal
• Medi-Cal's Working Disabled Program
• Employer-sponsored coverage
• Continued coverage from a former employer through COBRA
• Retirement plans
• Veterans (VA) benefits
• Military (TriCare for Life) benefits, or
• Individual health insurance.

Learn more about how Medicare interacts with other types of coverage.

No, Medicare does not generally pay for long-term care. Medi-Cal may help pay for some of these costs.