MedicareWhat’s inside
Contacting Social Security 3
Medicare 4
What is Medicare? 4
Who can get Medicare? 6
Help for some low-income people 9
Signing up for Medicare 10
Choices for receiving health services 15
If you have other health insurance 15Contacting Social Security
Visit our website
At our website, www.socialsecurity.gov, you can:
• Create a my Social Security account to review your
Social Security Statement, verify your earnings, print
a beneft verifcation letter, change your direct deposit
information, request a replacement Medicare card, get a
replacement 1099/1042S, and more;
• Apply for Extra Help with Medicare prescription drug
plan costs;
• Apply for retirement, disability, and Medicare benefts;
• Get the address of your local Social Security offce;
• Find copies of our publications; and
• Get answers to frequently asked questions.
Call us
Call us toll-free at 1-800-772-1213 or at our TTY number,
1-800-325-0778, if you’re deaf or hard of hearing.
We provide general information by automated phone
service 24 hours a day. You can also use this automated
response system to tell us a new address or request a
replacement Medicare card. We can answer your casespecifc questions from 7 a.m. to 7 p.m., Monday through
Friday. You’ll generally have a shorter wait time if you call
after Tuesday.
We treat all calls confdentially, and a second Social
Security representative monitors some telephone calls,
because we want to make sure you receive accurate and
courteous service.4
Medicare
This booklet provides basic information about what
Medicare is, who’s covered, and some of the options
you have for choosing Medicare coverage. For the latest
information about Medicare, visit the website or call the
toll-free number listed below.
Medicare
Website: www.Medicare.gov
Toll-free number: 1-800-MEDICARE
(1-800-633-4227)
TTY number: 1-877-486-2048
What is Medicare?
Medicare is our country’s health insurance program
for people age 65 or older. People younger than age 65
with certain disabilities, or permanent kidney failure, or
amyotrophic lateral sclerosis (Lou Gehrig’s disease), can
also qualify for Medicare. The program helps with the cost
of health care, but it doesn’t cover all medical expenses or
the cost of most long-term care. You have choices for how
you get Medicare coverage. If you choose to have original
Medicare coverage, you can buy a Medicare supplement
policy (called Medigap) from a private insurance company
to cover some of the costs that Medicare does not.
A portion of the payroll taxes paid by workers and
their employers cover most Medicare expenses. Monthly
premiums, usually deducted from Social Security checks
also cover a portion of the costs.
The Centers for Medicare & Medicaid Services is the
agency in charge of the Medicare program. But, you apply
for Medicare at Social Security, and we can give you general
information about the Medicare program.5
Medicare has four parts
• Medicare Part A (hospital insurance) helps pay for
inpatient care in a hospital or skilled nursing facility
(following a hospital stay). Part A also pays for some
home health care, and hospice care.
• Medicare Part B (medical insurance) helps pay for
services from doctors and other health care providers,
outpatient care, home health care, durable medical
equipment, and some preventive services.
• Medicare Part C (Medicare Advantage plans) are
available in many areas. People with Medicare Parts A
and B can choose to receive all their health care services
through a private insurance company approved by
Medicare to provide this coverage.
• Medicare Part D (Medicare prescription drug coverage)
helps cover the cost of prescription drugs.
You can get more details about what Medicare covers
from Medicare & You (Publication No. CMS-10050). To
get a copy, call the toll-free number or go to the Medicare
website shown on the previous page.
A word about Medicaid
You may think Medicaid and Medicare are the same,
but they’re two different programs. Medicaid is a staterun program that provides hospital and medical coverage
for people with low income. Each state has its own rules
about who’s eligible, and what Medicaid covers. Some
people qualify for both Medicare and Medicaid. For more
information about the Medicaid program, contact your local
medical assistance agency or social services offce.6
Who can get Medicare?
Medicare Part A (hospital insurance)
People age 65 or older, who are citizens or permanent
residents of the United States, are eligible for Medicare Part
A. You’re eligible for “Part A” at no cost at age 65 if:
• You receive or are eligible to receive Social Security
benefts; or
• You receive or are eligible to receive railroad retirement
benefts; or
• Your spouse (living or deceased, including divorced
spouses) receives or is eligible to receive Social Security
or railroad retirement benefts; or
• You or your spouse worked long enough in a government
job through which you paid Medicare taxes; or
• You are the dependent parent of a fully insured
deceased child.
If you don’t meet these requirements, you may be able
to get Medicare Part A by paying a monthly premium.
Usually, you can purchase this coverage only during
designated enrollment periods.
NOTE: Even though Social Security’s full retirement
age is no longer 65, you should sign up for Medicare three
months before your 65th birthday. You can apply on our
website at www.socialsecurity.gov.
Before age 65, you are eligible for Medicare Part A at no
cost if:
• You’ve been entitled to Social Security disability
benefts for 24 months; or
• You receive a disability pension from the railroad
retirement board and meet certain conditions; or
• You receive Social Security disability benefts because you
have Lou Gehrig’s disease (amyotrophic lateral sclerosis); or
• You worked long enough in a government job through
which you paid Medicare taxes, and you’ve been entitled
to Social Security disability benefts for 24 months; or7
• You’re the child or widow(er) age 50 or older, including
a divorced widow(er), of someone who’s worked long
enough in a government job through which Medicare
taxes were paid, and you meet the requirements of the
Social Security disability program; or
• You have permanent kidney failure and you receive
maintenance dialysis or a kidney transplant and
—You’re eligible for or receive monthly benefts under
Social Security or the railroad retirement system; or
—You’ve worked long enough in a Medicare-covered
government job; or
—You’re the child or spouse (including a divorced spouse)
of a worker (living or deceased) who has worked long
enough under Social Security or in a Medicare-covered
government job.
Medicare Part B (medical insurance)
Anyone who’s eligible for Medicare Part A at no cost
can enroll in Medicare Part B by paying a monthly
premium. Some people with higher incomes will
pay a higher monthly Part B premium. For more
information, read Medicare Premiums: Rules for
Higher-Income Benefciaries (Publication No. 05-10536),
or visit www.socialsecurity.gov/mediinfo.htm.
If you’re not eligible for Part A at no cost, you can buy
Part B, without having to buy Part A, if you’re age 65 or
older and you’re:
• A U.S. citizen; or
• A lawfully admitted noncitizen, who has lived in the
United States for at least fve years.
You can only sign up for Part B during designated
enrollment periods. If you don’t enroll in Part B when
you’re frst eligible for it, you may have to pay a late
enrollment penalty for as long as you have Part B coverage.
Read Signing up for Medicare on page 10.8
Medicare Part C (Medicare Advantage plans)
If you receive your Part A and Part B benefts directly
from the government, you have original Medicare. If
you receive your benefts from a Medicare Advantage
organization or other company approved by Medicare,
you have a Medicare Advantage plan. Many of these
plans provide extra coverage and may lower your
out-of-pocket costs.
If you have Medicare Parts A and B, you can join a
Medicare Advantage plan. Private companies, approved
by Medicare, offer Medicare Advantage plans. With these
plans, you can’t have a Medigap policy, because Medicare
Advantage plans cover many of the same benefts a Medigap
policy covers. This includes benefts like extra days in the
hospital after you’ve used days that Medicare covers.
Medicare Advantage plans include:
• Medicare managed-care plans;
• Medicare preferred provider organization plans;
• Medicare private fee-for-service plans; and
• Medicare specialty plans.
If you decide to join a Medicare Advantage plan, you use
the health card that you get from your Medicare Advantage
plan provider for your health care. Also, you might have to
pay a monthly premium for your Medicare Advantage plan
because of the extra benefts it offers.
You can enroll in a Medicare Advantage plan during your
initial enrollment period (as explained under Signing up
for Medicare on page 10), the frst time you’re eligible for
Medicare. You can also enroll during the annual Medicare
open enrollment period from October 15 – December 7
each year. The effective date for the enrollment is January 1
of the upcoming year. There are also special enrollment
periods for some situations.9
Medicare Part D (Medicare prescription
drug coverage)
Anyone who has Medicare Part A or Part B is eligible
for Part D (Medicare prescription drug coverage). Joining
a Medicare prescription drug plan is voluntary, and
you pay an extra monthly premium for the coverage.
Some benefciaries with higher incomes will pay a
higher monthly Part D premium. For more information,
read Medicare Premiums: Rules for Higher-Income
Benefciaries (Publication No. 05-10536), or visit
www.socialsecurity.gov/mediinfo.htm. If you don’t
enroll in a Medicare drug plan when you’re frst eligible,
you may pay a late enrollment penalty if you join a plan
later. You’ll have to pay this penalty for as long as you
have Medicare prescription drug coverage. However, you
won’t pay a penalty if you have Extra Help (see below), or
another creditable prescription drug plan. To be creditable,
the coverage must pay, on average, at least as much as
Medicare’s standard prescription coverage.
You can enroll during your initial enrollment period (as
explained under Signing up for Medicare on page 10), the
frst time you’re eligible for Medicare. You can also enroll
during the annual Medicare open enrollment period from
October 15 – December 7 each year. The effective date for
the enrollment is January 1 of the upcoming year. There are
also special enrollment periods for some situations.
Help for some low-income people
If you can’t afford to pay your Medicare premiums and
other medical costs, you may be able to get help from
your state. States offer programs for people entitled to
Medicare who have low income. Some programs may pay
for Medicare premiums and some pay Medicare deductibles
and coinsurance. To qualify, you must have Medicare Part
A and have limited income and resources.10
You can go online to get more information about these
programs from the Centers for Medicare & Medicaid
Services website. Visit www.medicare.gov/publications
and fnd Get help with your Medicare costs (Publication
No. CMS-10126) at the “Your Medicare Costs” tab.
Only your state can decide if you qualify for help under
these programs. To fnd out, contact your state or local
medical assistance (Medicaid) agency, social services, or
welfare offce.
You may also be able to get Extra Help paying for the
annual deductibles, monthly premiums, and prescription
co-payments related to the Medicare prescription drug
program (Part D). You may qualify for Extra Help if you
have limited income (tied to the federal poverty level)
and limited resources. These income and resource limits
usually change each year, and you can contact us for the
current numbers.
You automatically qualify and don’t need to apply for
Extra Help if you have Medicare and meet one of the
following conditions:
• Have full Medicaid coverage;
• Have Supplemental Security Income (SSI); or
• Take part in a state program that pays your
Medicare premiums.
For more information about getting help with your
prescription drug costs, call Social Security’s toll-free
number or visit our website. You can also apply online
at www.socialsecurity.gov/extrahelp.
Signing up for Medicare
When should I apply?
If you’re already getting Social Security benefts or railroad
retirement checks, we’ll send you information a few months
before you become eligible for Medicare. If you live in one
of the 50 states, Washington, D.C., the Northern Mariana
Islands, Guam, American Samoa, or the U.S. Virgin Islands,11
we’ll automatically enroll you in Medicare Parts A and
B. However, because you must pay a premium for Part B
coverage, you can choose to turn it down.
NOTE: Residents of Puerto Rico or foreign countries won’t
receive Part B automatically. They must elect this beneft.
If you’re not already getting benefts, you should contact
Social Security about three months before your 65th
birthday to sign up for Medicare. You can sign up for
Medicare even if you don’t plan to retire at age 65.
After you enroll in Medicare, you’ll receive a red,
white, and blue Medicare card showing whether you
have Part A, Part B or both. Keep your card in a safe
place so you’ll have it when you need it. If your card
is lost or stolen, you can apply for a replacement card
online by setting up a my Social Security account at
www.socialsecurity.gov/myaccount, or call Social
Security’s toll-free number. You’ll also receive a Medicare &
You handbook (Publication No. CMS-10050) that describes
your Medicare benefts and plan choices.
Special enrollment situations
You should also contact Social Security about applying
for Medicare if:
• You’re a disabled widow or widower between age 50
and age 65, but haven’t applied for disability benefts
because you’re already getting another kind of
Social Security beneft;
• You’re a government employee and became disabled
before age 65;
• You, your spouse, or your dependent child has
permanent kidney failure;
• You had Medicare Part B in the past, but dropped
the coverage;
• You turned down Medicare Part B when you frst got
Part A; or
• You or your spouse worked for the railroad industry.12
Initial enrollment period for Part B
When you frst become eligible for Medicare Part A, you
have a seven-month period (your initial enrollment period)
in which to sign up for Part B. If you’re eligible at age 65,
your initial enrollment period begins three months before
your 65th birthday, includes the month you turn age 65,
and ends three months after that birthday. If you’re eligible
for Medicare based on disability or permanent kidney
failure, your initial enrollment period depends on the date
your disability or treatment began.
NOTE: If you don’t enroll in Part B when you’re frst
eligible for it, you may have to pay a late enrollment
penalty for as long as you have Part B coverage. Also, you
may have to wait to enroll, which will delay this coverage.
When does my enrollment in Part B
become effective?
If you accept the automatic enrollment in Medicare Part B,
or if you enroll during the frst three months of your initial
enrollment period, your coverage will start with the month
you’re frst eligible. If you enroll during the last four months,
your coverage will start from one to three months after
you enroll.
The following chart shows when your Medicare Part B
becomes effective:
If you enroll in this month of
your initial enrollment period
Then your Part B Medicare
coverage starts
One to three months before you
reach age 65 The month you reach age 65
The month you reach age 65 One month after the month you
reach age 65
One month after you reach age 65 Two months after the month of enrollment
Two or three months after you
reach age 65
Three months after the month of
enrollment13
General enrollment period for Part B
If you don’t enroll in Medicare Part B during your
initial enrollment period, you have another chance each
year to sign up during a “general enrollment period” from
January 1 through March 31. Your coverage begins on July 1
of the year you enroll. However, you may have to pay a late
enrollment penalty for as long as you have Part B coverage
Your monthly premium will go up 10 percent for each
12-month period you were eligible for Part B, but didn’t
sign up for it
Special enrollment period for people leaving Part C
If you’re in a Medicare Part C (Medicare Advantage plan),
you can leave that plan and switch to original Medicare
from January 1 through February 14. If you use this
option, you also have until February 14 to join a Medicare
Part D (Medicare prescription drug plan). Your coverage
begins the frst day of the month after the plan gets your
enrollment form.
Special enrollment period for people covered under
an employer group health plan
If you’re 65 or older and covered under a group health
plan, either from your own or your spouse’s current
employment, you may have a “special enrollment period”
in which to sign up for Medicare Part B. This means that
you may delay enrolling in Medicare Part B without having
to wait for a general enrollment period and paying the
penalty for late enrollment. There are limits, so we strongly
advise you to contact the Centers for Medicare & Medicaid
Services (CMS) for more information. The CMS contact
information is on page 4 of this booklet. The rules allow
you to:
• Enroll in Medicare Part B any time while you have a
group health plan based on current employment; or
• Enroll in Medicare Part B during the eight-month period
that begins the month after the employment ends or the
group health coverage ends, whichever happens frst.14
You can’t enroll using a special enrollment period if your
employment or the employer-provided group health plan
coverage ends during your initial enrollment period.
When you enroll in Medicare Part B while you’re still in
the group health plan, or during the frst full month when
you are no longer in the plan, your coverage begins either:
• On the frst day of the month you enroll; or
• By your choice, on the frst day of any of the following
three months.
If you enroll during any of the remaining seven months
of the “special enrollment period,” your Medicare Part B
coverage begins on the frst day of the following month.
If you don’t enroll by the end of the eight-month period,
you’ll have to wait until the next general enrollment period,
which begins January 1 of the next year. You may also have
to pay a late enrollment penalty for as long as you have Part
B coverage, as described previously.
If you get Social Security disability benefts and have
coverage under a large group health plan from either your
own or a family member’s current employment, you may
also have a special enrollment period. If so, you have
premium rights similar to those for current workers age
65 or older. For more information, contact the Centers for
Medicare & Medicaid Services.
NOTE: COBRA and retiree health coverage don’t count
as current employer coverage.15
Choices for receiving health services
Medicare benefciaries can have choices for getting
health care services.
You can get more information about your health care
choices from the following publications:
• Medicare & You (Publication No. CMS-10050) — CMS
mails this guide to people after they enroll in Medicare
and sends them an updated version each year after that.
• Choosing a Medigap Policy: A Guide to Health
Insurance for People with Medicare (Publication
No. CMS-02110) — This guide describes how other
health insurance plans supplement Medicare and offers
some shopping hints for people looking at those plans.
To get a copy of these publications, visit
Medicare.gov/publications, or call the toll-free number,
1-800-MEDICARE (1-800-633-4227). If you’re deaf or hard
of hearing, call TTY 1-877-486-2048.
If you have other health insurance
Medicare Part A (hospital insurance) is free for almost
everyone. You have to pay a monthly premium for Medicare
Part B (medical insurance). If you already have other health
insurance when you become eligible for Medicare, is it
worth the monthly premium cost to sign up for Part B?
The answer varies with each person and the kind of other
health insurance you have. Although we can’t give you
“yes” or “no” answers, we can offer information that can
help you decide. We can also advise if you’ll be subject to a
late enrollment penalty if you delay signing up.16
If you have a private insurance plan
Get in touch with your insurance agent to see how your
private plan fts with Medicare Part B. This is especially
important if you have family members who have coverage
under the same policy. And remember, just as Medicare
doesn’t cover all health services, most private plans
don’t either. In planning your health insurance coverage,
keep in mind that most nursing home care isn’t covered
by Medicare or private health insurance policies. One
important word of caution: For your own protection, do
not cancel any health insurance you now have until your
Medicare coverage begins
If you have insurance from an employer-provided
group health plan
By law, group health plans of employers with 20 or
more employees have to offer current workers and their
spouses who are age 65 (or older) the same health benefts as
younger workers.
If you or your spouse are still working and covered
under an employer-provided group health plan, talk to the
personnel offce before signing up for Medicare Part B.
If you have health care protection from other plans
If you have TRICARE (insurance for active-duty, military
retirees, and their families), your health benefts can change
or end when you become eligible for Medicare. This applies
for any reason, regardless of age or place of residence. If you’re
retired from the military or are a military retiree’s family
member, you must enroll in Part A and Part B when frst
eligible to keep TRICARE coverage. You can fnd a military
health benefts adviser at milconnect.dmdc.mil, or call the
Defense Manpower Data Center, toll-free at 1-800-538-9552
(TTY 1-866-363-2883) before you decide whether to enroll in
Medicare medical insurance (Part B).17
If you have health care protection from the Indian Health
Service, Department of Veterans Affairs, or a state medical
assistance program, contact those offces to help you decide
if it’s to your advantage to have Medicare Part B.
IMPORTANT: If you have VA coverage and don’t enroll
in Part B when you’re frst eligible, you may have to pay
a late enrollment penalty for as long as you have Part B
coverage. Also, you may have to wait to enroll, which will
delay this coverage.
For more information on how other health insurance
plans work with Medicare, visit Medicare.gov/publications
to view the booklet Medicare and Other Health Benefts:
Your Guide to Who Pays First (Publication No. CMS-02179),
or call the Medicare toll-free number, 1-800-MEDICARE
(1-800-633-4227). If you’re deaf or hard of hearing,
call TTY 1-877-486-2048.18
Notes19
NotesPrinted on recycled paper
Produced and published at U.S. taxpayer expense
Social Security Administration
SSA Publication No. 05-10043
ICN 460000
Unit of Issue (HD – one hundred)
April 2016 (Recycle prior editions)
Medicare Information Booklet

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