 | | | Medicare: Frequently Asked Questions
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1) What is the Medicare program? |
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Medicare is a federal health insurance program for individuals. To be eligible for Medicare an individual must be:
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2) What services are covered under Medicare? |
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Medicare comes in three parts:
- Part A (Hospital Insurance) includes hospitalization, limited skilled nursing, limited home health following a hospital stay, hospice care and blood.
- Part B (Medical Insurance) includes doctors’ services and outpatient hospital care, lab and x-ray services, medical equipment and supplies, ambulance services, some preventive care services, outpatient physical, speech and occupational therapy, and some home health care not covered under Part A.
- Part D (Prescription Drug Coverage) includes prescription drugs covered by your Part D plan.
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3) Is the Medicare program the same in all states? |
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Yes. The Medicare program is the same in all states.
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4) Who is eligible for the Medicare program? |
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To be eligible for Medicare an individual must be:
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5) How much will Medicare cost for Social Security Disability Insurance (SSDI) beneficiaries or individuals with End Stage Renal Disease (ESRD)? |
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Part B (Medical Insurance) costs $96.40 per month and is automatically deducted from a beneficiary's SSDI or CDB payment. Note: Individuals earning more than $82,000 annually (or $164,000, if married filing jointly) may pay a higher premium.
Part D (Prescription Drug Coverage) costs depend on the details of your specific plan. Some people qualify for help with the costs of the plan. |
6) What prescription drug coverage comes with Medicare? |
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Medicare's prescription drug coverage is called Medicare Part D. It offers coverage through private insurance plans. |
7) What are the medical eligibility requirements for Medicare? |
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If you are under age 65, you must meet one of the following medical eligibility requirements for Medicare:
- Be a Social Security Disability Insurance (SSDI) beneficiary and have a medical determination of disability by the Social Security Administration (SSA); or
- Have permanent kidney failure, known as End Stage Renal Disease (ESRD).
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8) Does what I have in the bank and/or what I own, such as a home or car, affect my eligibility for the Medicare program? |
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No. Medicare does not consider your assets when determining your eligibility for the program.
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9) How soon after applying will I be eligible for benefits from Medicare? |
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If you are a Social Security Disability Insurance (SSDI) beneficiary, benefits automatically begin in the 25 th month following SSDI payments or in the 30 th month after Social Security’s determination of your disability onset date. If you have permanent kidney failure, known as End-Stage Renal Diseases (ESRD), you will be eligible for Medicare within 3 months of dialysis.
If you have a disability determination from Social Security for Amyotrophic Lateral Sclerosis (ALS), known as Lou Gehrig’s Disease, there is no waiting period for Medicare.
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10) What is the difference between the Medicare program and California’s Medi-Cal program?
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Medicare is a federal health insurance program that serves:
Medi-Cal, on the other hand, is a federal health program administered by individual states that serves some low-income individuals, families, and children that demonstrate need.
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11) Can I qualify for the Medicare program while I am eligible for private health coverage? |
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When you become Medicare eligible; and
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What type of private health coverage (group or individual) you have.
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12) Can I qualify for the Medicare program if I already have Medi-Cal? |
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Yes. If you have Medi-Cal and you qualify for Medicare you can use both programs. However, if you are a dual-eligible, you will be ineligible for the Low-Income Transitional Assistance Program. |
13) What happens if I decline Medicare coverage during the initial enrollment period? |
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If you decline Medicare during the initial enrollment period, your premiums for Part B can be increased by 10% for every 12 month period that you did not have Part B. The exception is if you are receiving employment-based health coverage, through an employer, association or union. The employer, however, must cover a minimum of 100 employees. In this case, you would be eligible for a special enrollment period. There's a similar rule for Part D. If you're not on Medi-Cal and don't have coverage that's as least as good as the Part D benefit (called creditable coverage), there's a 1% penalty for each month that you don't sign up after your Part D initial enrollment period ends. The Part D program description has more information on these rules.
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14) What is a Part B special enrollment period? And how can I be eligible for one? |
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A special enrollment period occurs during the first eight months following the loss of employer coverage as a dependent or employee.
To be eligible for a special enrollment period, you must have had employer-based health coverage that covers 100 or more employees. Health coverage can be through an employer, association, union or employed spouse. The special enrollment period protects you from a penalty Medicare applies when you do not accept Part B during the initial enrollment period. To use the special enrollment period, you must submit an application within 8 months of the end of employment.
The special enrollment period also allows a beneficiary to sign up for Medigap without a pre-existing condition waiting period.
Note: Individuals using continuation coverage, such as COBRA or Cal-COBRA, are not entitled to a special enrollment period.
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15) How do I stay enrolled/eligible in Medicare? How often do I have to reapply? |
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To stay enrolled in Medicare you need to continue making premium payments for Part B. |
16) Can I use Medicare with continuation of employer group health coverage through COBRA, Cal-COBRA or OBRA? |
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No. Once you become Medicare eligible COBRA, Cal-COBRA and OBRA continuation coverage ends. Although, if you are already eligible for Medicare at the time of a qualifying event for COBRA or Cal-COBRA, you may qualify. |
17) Are there rules for immigrants to qualify for the Medicare program? |
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Yes. To be eligible for Medicare, you must be a legal United States resident.
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18) What happens if I work while receiving Medicare through Social Security Disability Insurance (SSDI) program? |
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For SSDI beneficiaries regular SSDI work rules apply. If you begin to work, you will continue to be eligible for Medicare during the Trial Work Months and Extended Period of Eligibility. In addition, you will be eligible for Medicare for up to 60 months (5 years) once you start working. Note: During any month in which you do not receive a cash benefit from social security, you will be responsible for paying Part B premiums.
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