Medicare is the federal health insurance program for individuals who are: age 65 or older; people younger than 65 who have disabilities; people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant sometimes called ESRD).
There are multiple parts to Medicare:
- Medicare Part A: Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Most people do not pay a monthly premium for Part A, if you or your spouse paid Medicare taxes while working for a certain period of time. If you don’t qualify for premium-free Part A, you can buy Part A.
- Medicare Part B: Part B cover certain doctors’ services, outpatient care, medical supplies, and preventive services. Everyone with Medicare Part B pays a monthly premium for coverage.
- Medicare Part D: Part D helps cover the cost of prescription drugs, including many recommended shots and vaccines. To get Rx coverage, you must join a Medicare-approved plan that offers drug coverage. This can include a Medicare Part C/Medicare Advantage plan as described below. Each Part D plan can vary in cost and drug coverage (the drugs included in the plan formulary).
Alternative Coverage
Individuals can sign up for Medicare Part C, which is also known as Medicare Advantage. It is offered as an alternative to Medicare and can include Rx coverage.
Medicare Advantage is Medicare-approved plan from an insurer or other company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” Advantage plans include Part A, Part B, and usually Part D.
Some Medicare Advantage plans may offer extra benefits that Original Medicare does not cover — like vision, hearing, and dental services. Medicare Advantage Plans have annual contracts with Medicare and must follow coverage rules established by Medicare.
If you are working beyond the often-traditional retirement age of 65, and you continue to be covered under an employer-sponsored health plan, you may be able to delay your enrollment in Medicare. It depends on the size of your employer. The same goes for health insurance if you’re covered through a spouse’s employer-sponsored health plan.
For more information, check out this Q&A from AARP or the Medicare website.