Medicare FAQs.

Who Qualifies for Medicare?

You qualify for Medicare if you are a US citizen or a legal resident who has lived in the United States for at least five consecutive years, and have also paid into Medicare for 40 quarters or qualify based on your spouse’s qualifications.

You must also meet one of the following criteria:

• You are 65 years or older.
• You are younger than 65 but have a qualifying disability.
• You are younger than 65 but have a diagnosis of end-stage renal disease or amyotrophic lateral sclerosis (ALS).

When Do You Apply for Medicare?

For most people, the Medicare enrollment period opens three months before your 65th birthday. The enrollment window remains open during your birthday month and closes three months later.

For example, if your birthday is on June 6th, your enrollment window will open on March 1st and close on August 31st.

You can also sign up or change plans during the Medicare open enrollment period, which runs from October 15th to December 7th each year. You can learn more about open enrollment on the US Centers for Medicare & Medicaid Services website. If you miss your initial enrollment period of 7 months, you’ll have to wait for GEP or General Election Period.

Medicare Part A

Medicare Part A provides coverage for hospital stays and expenses. It also includes coverage for most inpatient services that you would receive at one of these facilities.

Your coverage will include the following benefits:

• A semi-private room
• Hospital meals
• Skilled nursing services
• Hospice care for the terminally ill
• Care in specialized units, such as intensive care
• Operating room and recovery room services
• Laboratory tests, x-rays, and medical equipment
• Drugs and medical supplies during an inpatient stay

Medicare Part B

Medicare Part B provides coverage for care that you receive at a clinic, as well as outpatient hospital services. This coverage will include the following services:

• Doctor’s visits
• Skilled nursing services
• Mental health care
• Your annual wellness visit
• Preventive services, such as flu shots
• Clinical laboratory services, like blood and urine tests
• Diagnostic tests such as MRIs and x-rays
• Certain health programs, like smoking cessation
• Home medical equipment, like wheelchairs
• Diabetes education, supplies, and screenings
• Ambulance and emergency room services

Medicare Part C aka Medicare Advantage

Medicare Part C, or Medicare Advantage, is a plan that you enroll in through a private insurance carrier. These plans combine Part A and Part B benefits, and many provide additional benefits:

• Prescription drug coverage, or Medicare Part D
• Hearing exams and hearing aids
• Eye exams, eyeglasses, and contact lenses
• Wellness benefits, like gym memberships
• Transportation to medical appointments
• Dental exams, cleanings, and routine care

Medicare Part D

Medicare Part D provides coverage for prescription medications and some vaccines. You can enroll in a stand-alone Part D plan or receive this coverage as part of a Medicare Advantage Plan.

Usually, Part D includes the following benefits:

• Drugs that Medicare requires Part D plans to cover under federal standards
• Specific brand-name and generic drugs in the plan’s formulary
• Commercially available vaccines that Part B does not cover

Medicare Supplement Plans

Medicare supplement insurance, also known as Medigap, works alongside Original Medicare to pay for costs that you would otherwise pay out of pocket.

Coverage can vary, but all Medigap plans include the following benefits:

• Coinsurance plus coverage for 365 additional days for hospital stays
• Coinsurance for hospital outpatient services and hospice stays
• Coverage for the first three pints of blood transfusions per calendar year