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Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.

Medicare 101: An Overview

Summary

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FOR MORE INFORMATION ABOUT THE FOLLOWING SUBJECTS, SEE THE OTHER SECTIONS OF THIS ARTICLE

Medicare is health insurance for people age 65 or older, people under age 65 with certain disabilities, and people of any age with End Stage Renal Disease or ALS. 

To receive Medicare, you have to sign up unless you are eligible for Medicare because you receive Social Security Disability Insurance (SSDI) benefits for 24 months. If you are eligible for Medicare because of SSDI, you are automatically enrolled in Medicare at the end of the 24 month period.

There are two types of Medicare: Original Medicare and Medicare Advantage.

  • Original Medicare is a fee-for-service (indemnity) type of health insurance provided by the federal government. Indemnity type policies provide freedom of choice about what doctors to see and what treatments to take.
    • At the minimum, Original Medicare covers inpatient care in hospitals and similar settings (Medicare Part A). It also covers a variety of preventive tests. There is no premium for Part A coverage.
    • At the insured's option, and with payment of a monthy premium, original Medicare can also cover:
      • Other medically necessary services such as a doctor's services (Medicare Part B).
      • Prescription drugs (Medicare Part D).
    • Private insurance companies offer "Medigap" policies that supplement Original Medicare. Medigap policies are standardized for easy comparison. It is difficult to get Medigap coverage if you have a pre-existing health condition unless you sign up during a period when no health insurance questions are asked, such as when you are first eligible for Medicare. These periods are known as "open enrollment periods". (For information about periods when insureds are guaranteed issuance despite a health history, click here offsite link.)
  • Medicare Advantage (sometimes called Medicare Part C) is an alternative to Original Medicare.  
    • Medicare Advantage plans are provided by private companies approved by Medicare, and must include a minimum set of benefits
    • Medicare Advantage plans are geared to save people money and/or increase covered health benefits.  
    • A variety of types of Medicare Advantage plans are available. Most restrict patients to using particular doctors and hospitals. The most popular type of Medicare Advantage plan is a managed care type plan (an HMO).

It is possible to have both Medicare and Medicaid (Medi-cal in California).

Medicare premiums are not affected by your past or current health condition.

If you have difficulty paying Medicare premiums and costs, there is assistance available. You can also get health care at a Federally-funded health center (also known as HRSA Health Centers) where deductibles and co-insurance may be reduced or waived all together.

NOTE: Identity theft happens with Medicare just like it happens with credit cards. It is wise to guard your Medicare card and Medicare number. Do not give the number to people who call, no matter how they identify themselves. 

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