MedicareThe federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). is a federal health insuranceA type of insurance that pays for some or all of your medical expenses.
program.
Who is Eligible?
You are eligible for Medicare if you:
- Are age 65 or older.
- Have been receiving Social SecurityA federal program that provides retirement, disability, and survivor benefits. Most Social Security benefits are based on taxes that you paid on your wages while working. DisabilityAny condition of the body or mind that makes it more difficult for the person with the condition to do certain activities and interact with the world around them. Income (SSDI), usually for two years or more.
- Have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, also called Lou Gehrig’s disease), and you receive SSDI or you, your spouse, or a parent are receiving or will receive Social Security or Railroad Retirement benefits.
Types of Medicare
Original MedicareA fee-for-service health plan that includes hospital insurance (Part A) and medical insurance (Part B). (Parts A and B)
Unless you choose a MedicareThe federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). Advantage Plan (see below), you will be enrolled in Original Medicare, also known as Traditional or Fee-for-Service Medicare. Under Original Medicare, the federal government will pay healthcare providers directly for some care that you receive. See “What Medicare Covers” below to learn about what Medicare will pay for.
Medicare Advantage Plans (Part CAlso called Medicare Advantage Plans. Medicare contracts with private companies to provide Part A and B benefits.)
These plans are operated by private health insuranceA type of insurance that pays for some or all of your medical expenses.
companies. They include the same benefits as Original Medicare, but may also include additional benefits, like paying for prescription drugs.
Medicare Prescription Drug Coverage (Part DCovers prescription drugs.)
These plans are operated by private health insurance companies to help cover the costs of prescription drugs for people who are enrolled in Original Medicare or a Medicare Advantage Plan that does not cover prescription drugs. Before you decide to purchase Part D, take the time to learn how Part D works with your existing insurance and the Indian Health Service (IHS) or Veterans’ Benefits.
Medicare Savings Programs, Extra Help, and MedigapA kind of supplementary health insurance to fill in “gaps” in Original Medicare coverage.
These programs can help cover some of the costs of Medicare.
MedicaidA joint federal and state program that helps with medical costs for some people with limited income and resources. Dual EligibilityQualified to enroll in both Medicare and Medicaid.
If you are eligible for both Medicare and Medicaid, you can enroll in both programs to get services that are not covered by Medicare alone, such as long-term careServices for people who cannot do basic activities of daily living, like dressing or bathing. This includes medical and non-medical care. These services can be provided at home or in assisted living or nursing homes. Medicare and most health insurance plans do not pay for long-term care.. See the Seniors and Medicare and Medicaid Enrollees page on the Medicaid website for information.
What Medicare Covers
MedicareThe federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). Part ACovers hospital stays, care in a skilled nursing facility, hospice care, and some home health care. covers:
- Inpatient careHealth care that you get when you are admitted to a health care facility, like a hospital. in a hospital, including prescription drugs administered while in a hospital
- Skilled nursing facility care, with some restrictions
- Some home healthcare
- HospiceA special way of caring for people who are seriously or terminally ill. Hospice care involves a team-oriented approach that addresses the medical, physical, social, emotional, and spiritual needs of the patient. Hospice care prioritizes comfort and quality of life by reducing pain and suffering. Hospice also provides support to the patient’s family or caregiver. care
Medicare Part BCovers certain doctors’ services, outpatient care, medical supplies, and preventive services. covers:
- Physical health services, such as check-ups, preventative care, diagnostic tests, and treatment for illnesses and injuries
- Behavioral health services, meaning mental health and substance abuse services
- Some home healthcare, such as intermittent skilled nursing careRefers to a patient’s need for care that can only be performed by licensed nurses. This type of care is usually offered in hospitals, assisted living communities, Life Plan Communities, nursing homes and other certified locations., physical therapy, and occupational therapy
- Some prescription drugs, such as those administered by a doctor
- Some durable medical equipment, such as oxygen equipment, wheelchairs, and blood sugar test strips, if they are “medically necessary” to treat an illness or injury
- Ambulance services for emergencies and medically necessaryThis refers to care or equipment that your doctor has prescribed to treat an illness or condition. transportation assistance if there is no safe way for you to get to your appointment without assistance (for example: you are confined to a bed or you need medical services during the trip)
Medicare Part DCovers prescription drugs. covers:
- Prescription drugs on your Part D plan’s formularyA list of prescription drugs that an insurance plan will cover. Also called a “drug list.”, meaning the list of drugs that your health plan will pay for
Medicare Advantage Plans may cover a number of additional services, such as dental care, long-term careServices for people who cannot do basic activities of daily living, like dressing or bathing. This includes medical and non-medical care. These services can be provided at home or in assisted living or nursing homes. Medicare and most health insurance plans do not pay for long-term care., and alternative therapies. To find out exactly what your health plan will cover, call the number on the back of your health insuranceA type of insurance that pays for some or all of your medical expenses.
card or review your Member HandbookThe handbook you receive when you sign up for a health insurance plan. It includes information on what providers are in your network, what benefits are covered, and how much they will cost. .
What Medicare Costs
MedicareThe federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). costs will differ depending on what Parts you enroll in and how long you or your spouse have paid Social SecurityA federal program that provides retirement, disability, and survivor benefits. Most Social Security benefits are based on taxes that you paid on your wages while working. taxes while working. If you or your spouse have paid Social Security taxes for more than ten years, you will be eligible for Medicare Part ACovers hospital stays, care in a skilled nursing facility, hospice care, and some home health care. for free. If you or your spouse have not paid Social Security taxes for ten years, you can still get Medicare, but you will have to a pay a “premiumThe amount you pay for your health insurance every month. In addition to your premium, you may have to pay other costs for your health care, including a deductible, copayments, and coinsurance.” or monthly fee for each Part that you enroll in.
Applying for Medicare
If you receive Social SecurityA federal program that provides retirement, disability, and survivor benefits. Most Social Security benefits are based on taxes that you paid on your wages while working. or Railroad Retirement benefits, you will automatically be enrolled in MedicareThe federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). three months before you turn 65.
If you do not already receive Social Security benefits, you will need to enroll in Medicare. You can enroll starting three months before you turn 65 and until 3 months after you turn 65. This is called the 7-month initial enrollment period.
If you are not automatically enrolled in Medicare Parts A and B, you can apply in person at your local Social Security office or online.
You can get help applying, answering questions about Medicare or making changes to your health plan from the Benefits Coordinator at your local IHS or tribal clinic, or a Patient Navigator or insurance broker. Call BeWellNM at 1-833-862-3935 or TTY 1-855-851-2018 to find one. BeWellNM has counselors specifically for Native Americans; call 1-855-241-8137 or visit their office at 6403 Menaul Blvd. NE in Albuquerque, New Mexico.
You can also see the How Do I Get Parts A and B page on the Medicare website for detailed information on getting Parts A and B.
When you apply for Medicare, you may need to provide the following documents or information.
- Proof of age (for example: birth certificate, driver’s license, passport)
- Proof of citizenship (for example: birth certificate, passport, Tribal enrollment card, Certificate of Degree of Indian Blood)
- Social SecurityA federal program that provides retirement, disability, and survivor benefits. Most Social Security benefits are based on taxes that you paid on your wages while working. card
- Proof of all your sources of income (for example: paystubs, Social Security, SSI, Veterans benefits, any other income)
- Proof of assets (for example: bank statements)
- Proof of disabilityAny condition of the body or mind that makes it more difficult for the person with the condition to do certain activities and interact with the world around them.
- Proof of residence (for example: recent mail addressed to you, rent receipts, a copy of your mortgage)
- Proof of any other health insuranceA type of insurance that pays for some or all of your medical expenses.
(any other current health insurance cards)
You can also apply online. See the How to Apply Online for Just Medicare page on the Social Security website. You can also download a Checklist for Online Medicare, Retirement and Spouses Applications.
Using Medicare & Staying Covered
Whenever you go to a healthcare provider, including the IHS, bring your MedicareThe federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). card with you and make sure the provider’s office knows you have Medicare. See the Your Medicare Card page on the Medicare website for detailed information on what you need to know about your Medicare card, how to get a replacement card, and how to change your address.
Once you’re enrolled in Medicare, you need to continue to pay monthly premiums to stay enrolled.
Read all the material you receive from your health insuranceA type of insurance that pays for some or all of your medical expenses.
provider regarding any changes to your insurance that require your attention.