Medicare Health Insurance

Medicare at a Glance

Who runs the Medicare program?

The Centers for Medicare & Medicaid Services (CMS) is the Federal agency that runs "Medicare." CMS is part of the Department of Health and Human Services.

What is Medicare?

Medicare is a health insurance program for

  • people age 65 or older,
  • people under age 65 with certain disabilities, and
  • people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or kidney transplant).

Medicare has

  • Part A (Hospital Insurance)
  • Part B (Medical Insurance)

To get Medicare, you must enroll in one or both of these parts.

What does Medicare Part A cover?

Medicare Part A helps cover inpatient care in hospitals, including critical access hospitals, skilled nursing facilities (Medicare doesn't pay for long-term or custodial care), hospice care, and some home health care.

What does Medicare Part B cover?

Medicare part B helps cover most doctors' services, outpatient care, medically necessary services and supplies, outpatient mental health care, clinical lab services, some home care and supplies, blood, and preventive services (such as cancer screenings and flu shots).

How do I pay for Medicare Part A and/or Part B?

You usually don't have to pay a monthly fee, called a premium, for Medicare Part A benefits. This is because you or your spouse paid Medicare taxes while working. If you or your spouse didn't pay Medicare taxes, you may be able to buy Medicare part A.

Most people must pay for Medicare Part B through a monthly premium ($96.40 in 2008). To make sure you don't pay higher premiums, it's important to sign up for Part B as soon as you are eligible. The cost of Part B may go up 10% for each full 12-month period that you could have had Part B but didn't sign up for it (except in special cases).

When can I get Medicare?

  • If you or your spouse get Social Security or Railroad Retirement Board (RRB) benefits, you will be automatically enrolled in Medicare part A and Part B the first day of the month you turn age 65. If you don't want Medicare Part B, follow the instructions that come with your Medicare card.
  • If you're under age 65 and disabled, you will be automatically enrolled in Medicare Part A and Part B after getting disability benefits from Social Security or the RRB for 24 months. If you don't want Medicare Part B, follow the instructions that come with your Medicare card.
  • If you're close to age 65 and don't currently get Social Security or RRB benefits, you must you must apply if you want Medicare Part A and/or Part B.

For information about enrolling in Medicare call the Social Security Administration at 1-800-772-1213. TTY users should call 1-800-325-0778. You can also look at www.medicare.gov on the web. Select "Medicare Eligibility Tool." If you're a railroad employee or Railroad Retirement beneficiary, call your local RRB office or 1-800-808-0772 to apply for Medicare.

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This information is from Publication No. CMS - 11082 September 2004