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What is Medicare?

Medicare is our nation’s health insurance. It helps cover the costs of hospital and medical care and prescription drugs. 

Medicare is funded by FICA and Medicare taxes and premiums. The Social Security Administration determines Medicare eligibility and enrolls people.

Medicare is not the same as Medicaid (Apple Health, in WA). If you are not sure which you receive (you may be eligible for both), visit What Medical Benefits Do I Receive?

An example of a Medicare Health Insurance card.

Who is eligible for Medicare?

You may be eligible for Medicare if:

If you are under 65 and have a disability, your Medicare eligibility is connected to eligibility for disability-related Title II benefits (SSDI, SSCDB, and SSDWB. You do not receive Medicare through SSI). 

Medicare is not tied to SSI, though some SSI recipients may also be eligible for Title II and qualify for both Medicaid and Medicare.

What health coverage does Medicare provide?

Medicare’s health coverage is split into four parts. Each part has its own rules about what it covers, whether you must pay a monthly premium, and if you can choose to decline it. You may need to pay for a percentage of your medical bills with each of the parts.

Part A:
Hospital Coverage

What it covers: inpatient care in a hospital, limited time at a skilled nursing facility following hospital care, hospice, and some home health care. 

Who accepts it Most hospitals accept Medicare. Ask your local hospital if they accept Medicare. You can also visit Medicare’s list of providers. 

Monthly premium: No cost for most people. If you have a limited work history, you may be charged a premium. 

Can I decline it? No. Enrollment in Part A is automatic when you are eligible for Medicare.

Part B:
Medical Coverage

What it covers: Some doctor’s services, outpatient care, home health care, medical supplies, and preventative services.

Who accepts it:  Not all providers accept Medicare. Ask your doctor if they accept Medicare, or visit Medicare’s list of providers

Monthly premium  $174.70 per month (2024) for many people. This amount usually changes each year. Premiums can vary. 

If you also receive Medicaid, your Part B premium will be covered by Medicaid. 

Can I decline it?  Yes. However, if you decline it, and you do not have equal or better coverage already (called Creditable Coverage), you may be penalized by later paying higher Part B premiums.

Part C:
Medicare Advantage

What it covers: An Advantage Plan acts as your insurance and coordinates payment with Medicare. It pays for services covered under Medicare Parts A, B, and sometimes D. It may also provide additional health coverage.

Who accepts it: It depends on the Advantage Plan. You may find more doctors who take some Advantage Plans than Medicare only. 

Monthly premium: Varies by plan. 

Can I decline it?  Yes. Part C is optional. There is no penalty for not having an Advantage Plan.

You may receive a lot of information from providers about their Advantage Plans. We recommend you do your research before signing up for any plan to make sure it will meet your needs. You may find that Medicare alone, or Medicare combined with Medicaid or your private insurance, works well for you.

Part D:
Prescription Drug Coverage

What it covers: some prescription drugs and vaccines

Who accepts it: It depends on the prescription drug plan. Drug plans are managed by private insurance companies, and pharmacists do not take all drug plans.

Monthly Premium:  Varies by prescription drug plan. If you are also eligible for Medicaid, you will automatically pay the least amount for your prescriptions.

Can I decline it?  Yes, if you do not also receive Medicaid. However, if you decline it, and you do not have similar or better coverage already (called “creditable” coverage), you may be penalized by later paying higher premiums. 

You cannot decline Medicare Part D if you also receive Medicaid.

  • You are automatically enrolled in a Medicare Part D Plan by the state, if you do not choose one yourself.
  • You can change your Part D plan at any time
  • If you live in an institution or are eligible for a Home and Community-based Waiver, you do not have to pay Part D copayments
  • Medicaid will continue to cover some drugs not covered in Part D, including certain over-the-counter medications.

To learn more about Medicare, visit the Medicare FAQ page

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