Medicare is health insurance for people age 65 or older, under 65 with certain disabilities, and any age with End-Stage Renal Disease (ESRD). ESRD is permanent kidney failure requiring dialysis or a kidney transplant. The different parts of Medicare help cover specific services if you meet certain conditions. Make sure your coverage is working for you.

Medicare Part A (Hospital Insurance)

• Helps cover inpatient care in hospitals (includes critical access hospitals, inpatient rehabilitation facilities and long-term care hospitals).
• Helps cover skilled nursing facility (not custodial or long-term care), hospice and home health services.

Medicare Part B (Medical Insurance)

• Helps cover some preventive services to maintain a person’s health and to keep certain illnesses from getting worse.
• Generally pays 80% of the Medicare-approved amount for covered services.

Medicare Part C (Medicare Advantage Plans)

• A way to get Medicare benefits through private companies approved by and under contract with Medicare.
• Includes Part A, Part B, and usually other benefits Medicare doesn’t cover. Most plans also provide prescription drug coverage.

Medicare Part D (Prescription Drug Coverage)

• Run by private companies approved by Medicare, which can either be Medicare Advantage plans or separate Medicare prescription drug plans.
• Helps cover the cost of prescription drugs.
• Each plan can vary in cost and drugs covered.
• For further prescription assistance visit  MyHealthResource.

 What is Medigap?

Many people purchase supplemental insurance policies that cover the gaps in Medicare coverage. This supplemental insurance usually is provided by private health insurance companies and is referred to as Medigap. In general, you won’t need a Medigap policy if your Medicare coverage is through a managed care plan or if you’re qualified for Medi-Cal because of a low income.

What About Healthcare Reform?

The Affordable Care Act will make Medicare stronger into the future in the following ways: 

• The life of the Medicare Trust fund will be extended to at least 2029, a 12-year extension as a result of reducing waste, fraud and abuse, and slowing cost growth in Medicare. This will provide you with future cost savings on your premiums and coinsurance.
• Medicare will take strong action to reduce payment errors, waste, fraud, and abuse in Medicare. The President has made a commitment to reduce Medicare fraud 50% by 2012. The Affordable Care Act makes an historic, 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 2011, if you hit the prescription drug donut hole, you will get a 50% discount on brand-name drugs. Every year after, you will pay less for your prescription drugs in the donut hole until there’s complete coverage of the donut hole in 2020. Between now and then, you will get continuous Medicare coverage for your prescription drugs.
• The coordination of care between doctors and the overall quality of care will improve so that you will be less likely to experience preventable and harmful re-admissions to the hospital for the same condition.
• Hospitals will have new, strong incentives to improve your quality of care.
• 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 healthcare.

Additional Resources

The Medicare Eligibility Tool is designed to provide you information about Medicare eligibility and enrollment. You will be asked to answer a series of questions. Please note that Social Security will make the final decision on your eligibility and enrollment status.

Click here for Medicare & You, a summary of Medicare benefits, coverage options, rights and protections, and answers to most frequently asked questions.

Want to know how The Affordable Care Act will affect Medicare benefits?  Click here.

Learn more about Medicare and related services by visiting MyHealthResource.