Medicare 101

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Medicare is a federal health insurance program for: 

· People age 65 or older

· People under age 65 with certain disabilities

· Individuals with End-Stage Renal Disease (permanent kidney failure)

Medicare has four different parts, each covering different services. People enrolling in Medicare will choose what works best for their situation. Everyone’s situation and needs can be different depending on your health, budget, and the area you reside in. For more information specific to your needs, contact Senior HealthPlan Services.

• Inpatient hospital care
• Skilled nursing facility care
• Home healthcare
• Hospice

• Medical insurance
• Doctor's visits
• X-rays, MRIs, CT scans
• Outpatient services
• Has additional monthly premium

• Medicare Advantage plan
• HMO, PPO, Medical Savings Account, Private-Fee-For-Service, Special Needs Plans
• Managed care plans
• Combines Parts A and B of Original Medicare and can include Part D

• Prescription drug coverage
• Offered through private insurance companies
• Low income subsidies available

Medicare is a government-financed medical insurance program that is available to US citizens or permanent residents aged 65 and over.  To receive Medicare, you must be at least 65 years old and you must have worked for a minimum of 10 years (40 quarters) at a job that has paid money into the Medicare system, or be a spouse of someone who has worked for a minimum of 10 years.  However, people aged 65 who have not met the minimum work requirements may still be able to get Medicare by paying a premium.  Medicare is also available to some disabled people under age 65, and to people of all ages with permanent kidney failure who are being treated by dialysis or by a transplant.

Basic access to Medicare is not means-tested, and eligibility is not affected by how much income you earn or by how many financial resources you have.  You do not necessarily have to be retired to be eligible for Medicare, you can work full-time and still be on Medicare.  All you have to be is a US citizen or a permanent resident who is aged 65 or over and who has worked at least ten years in a job that has paid Medicare taxes. There are no exclusions for pre-existing conditions, and anyone eligible for Medicare can participate, no matter what the status of their health.

Medicare is closely coupled with Social Security, but you do not necessarily have to be receiving Social Security benefits to be eligible for Medicare. You may have reached age 65 but might not yet have applied for Social Security benefits.  Nevertheless, once you reach age 65, you are eligible for Medicare whether or not you are drawing Social Security benefits.  People under 65 can sometimes receive Social Security, but they are still not eligible for Medicare until they turn 65.  

People under 65 can still be eligible for Medicare, but only if they have a qualifying disability.  This eligibility for Medicare benefits is tightly tied to eligibility for Social Security Disability Income benefits. In order to qualify for SSDI, one generally has to have been unable to work for at least a year because of a qualifying physical or mental disability.  Social Security disability can be very difficult to obtain, and a lot of claims get turned down.  If you qualify for SSDI, you automatically get Medicare after you have been recieving disability benefits from Social Security for two years.  Unfortunately, the imposition of this two-year waiting period before a person on SSDI can get Medicare can be a great financial hardship.

We can help you to decide which plan best suits you and your families needs. We are appointed with the best rated companies in Arizona such as Aetna, Humana, United Healthcare, Mutual of Omaha, and Blue Cross Blue Shield. Contact us today to schedule a free consultation.

There are  four distinct parts to Medicare, formally labeled Part A, Part B, Part C, and Part D.  When Medicare was originally created back in 1965, there were only two parts—Part A that covered hospital bills and Part B that covered doctor bills and outpatient costs.  Part A and Part B together are sometimes referred to as Original Medicare or Traditional Medicare.   Part C and Part D came later—Part C in 1997 when private insurance carriers were brought into the program, and Part D in 2006 when prescription drug coverage was added to the program.