Learn about Medicare
Medicare is a federal government program that provides health insurance for people age 65 and over or those under age 65 with certain disabilities.
The Centers for Medicare and Medicaid Services (CMS) is the federal agency that runs Medicare. The program is funded in part by Social Security and Medicare taxes paid by people who are working.
While also a government program, Medicare is not the same as Medicaid or Social Security.
- Medicaid is a state-provided health insurance program for those with limited income.
- Social Security provides benefits and assistance to retired people and to those who are unemployed or disabled.
Medicare and Social Security are linked. Both serve people are 65 and over as well as those receiving Social Security Disability Insurance due to a disability. To enroll in Medicare, you must sign up through the Social Security Administration.
Who is eligible for Medicare? Generally, people who are:
- Age 65 and over
- Under age 65 with a qualifying disability; or
- Age 21 and over who qualify due to end-stage renal disease
There are premiums for Medicare insurance. If you have a limited income, you may qualify for a program called Extra Help to pay for your monthly plan premium and prescription drugs.
Medicare Has Four Parts
Covers hospital insurance
Covers medical insurance, like doctor visits
In addition to Part A and Part B (Original Medicare) you have the option to purchase:
- Part D, a separate prescription drug plan
- Supplemental insurance, sometimes called MediGap or MedSupp plans
MediGap and MedSupp plans usually cover items such as:
- health care you get outside the U.S.
They usually don’t help cover:
- vision care and eyeglasses
- hearing aids
- dental care
- long-term care
- private-duty nursing
Original Medicare does not cover expenses incurred by you if you are traveling outside of the United States, even if it is an emergency. Medicare Advantage plans typically have coverage for foreign travel outside the United States and Medicare Supplement plans may cover foreign travel as well. Another option is to replace Original Medicare with a Medicare Advantage plan.
Medicare Advantage Plans
Helps pay for prescription drugs
Part C, Medicare Advantage
- Can be purchased from private insurance companies such as Virginia Premier
- Combines Part A and Part B into one plan for full coordination of your care and usually includes a Part D prescription drug plan
- Provides everything that Original Medicare covers and can also include additional benefits like dental, hearing, vision, wellness services and a nurse phone line
To be eligible for Medicare Parts C and D you must:
- Reside in the approved service area;
- Have Parts A and B; and
- Not be diagnosed with end-stage renal disease
Get the most from Medicare with a Dual Eligible Special Needs Plan (D-SNP)
D-SNPs are Medicare Advantage plans that offer:
- more coverage than Original Medicare.
- extra benefits at no extra cost.
- a dedicated care coordinator.
Do you have both Medicare and Medicaid?
This Dual-Eligible Special Needs (D-SNP) is for people with unique healthcare needs who have both Medicare and Medicaid.
Frequently Asked Questions
I am still working and on my employer’s health insurance plan. When I turn age 65, do I need to sign up for Part B during my Initial Enrollment Period?
No. You can wait until you are ready to retire and move off your employer plan or your spouse’s insurance plan if that is an option. When you do so, you will be eligible for a Special Enrollment Period and have an eight-month window to sign up for Part B. The eight-month period begins when your employer or union coverage ends or when your employment ends, whichever is first. Be sure to elect Part B at that time so you don’t have to pay a late enrollment penalty. That penalty is 10% a year for late enrollment.
If I am covered by Medicare, is my spouse automatically covered as well?
No. Medicare is an individual enrollment. Both you and your spouse must sign up for separate coverage and the policies are not related. There is no family coverage under Medicare.
If I enroll in Medicare Parts A and B with Social Security, do I also enroll for Part D prescription drug coverage?
No. Part D is not related to your Original Medicare coverage. It is additional coverage for prescription drugs your doctor prescribes. You must enroll with a private insurance plan that contracts with Medicare. You have two choices: You can take Original Medicare and then sign up for a Part D plan, or you could enroll in a Medicare Advantage Part C plan that has prescription drug and medical in an all-in-one plan.
When I decide to enroll in Medicare and choose a Medicare Advantage plan, do I need to stay with the same insurance company I had with my employer?
No. When you leave your employer and no longer have health insurance coverage, you can choose a Medicare Advantage plan from any company that offers service in your area. You also can stay in Original Medicare and buy a Medicare Supplement plan and a Part D prescription drug plan.
Health insurance counseling is available
If you have questions, check with your State Health Insurance Program — the Virginia Counseling and Assistance Program (VICAP). VICAP offers free unbiased, confidential counseling on health insurance, education and assistance to seniors and adults with disabilities and their families. This program can help in understanding Medicare and making decisions about prescription drug plans, Medicare Advantage plans, Medicare Supplement plans or long-term care insurance.
How can I reach VICAP?
Virginia Division for the Aging (DARS)
1610 Forest Avenue, Suite 100
Richmond, VA 23229