While we are not affiliated with the government in any way, our private company engaged writers to research the LIHEAP program and compiled a guide and the following answers to frequently asked questions. Our goal is to help you get the benefits that you need by providing useful information on the process.
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We are not affiliated with the government in any way. We are a private company that engaged writers to research the Medicare program and compiled a guide and the following answers to frequently asked questions. Our goal is to help you get the benefits that you need by providing useful information on the process. We are not providing legal or financial advice. If you need such advice please contact an attorney or a financial advisor.
Medicare is a federal health insurance program that provides benefits to qualifying seniors and disabled individuals.
The Medicare program is different than the Medicaid program. While Medicaid provides health insurance benefits based on financial need, income does not impact Medicare eligibility.
However, low-income Medicare beneficiaries may also be eligible to receive Medicaid benefits. Beneficiaries that are considered dually eligible can receive help paying for Medicare’s cost and may receive extra coverage benefits that Medicare does not provide. You can learn more about dual eligibility here.
Medicare is administered by the U.S. Centers for Medicare and Medicaid Services (CMS). Learn more about the Medicare program here.
Medicare provides comprehensive health insurance to those who qualify. Beneficiaries can build their own coverage plan through Medicare Part A, B, C, and D. Each part of Medicare provides different forms of coverage and different premiums, copayments, and other related costs.
Your Medicare coverage will depend on the parts of Medicare that you choose to enroll in. Your Medicare plan can include:
Medicare Part A and Part B are referred to as Original Medicare.
Medicare Part A includes coverage benefits such as:
Learn more about Medicare Part A coverage here.
Medicare Part B includes medically necessary services and supplies as well as preventative care. Part B provides coverage benefits such as:
Learn more about Medicare Part B coverage here.
Some Medicare beneficiaries choose to add Medicare Part D to their Medicare health plan. Medicare Part D provides comprehensive prescription drug coverage and may also include coverage for vaccines and shots.
Learn more about Medicare Part D coverage here.
Original Medicare doesn’t provide health insurance coverage for everything. If you enroll in Original Medicare, you will not receive coverage for services such as:
Learn more about services that are not included in original Medicare here.
Alternatively, beneficiaries can choose to enroll in Medicare Part C, referred to as Medicare Advantage Plans. Medicare Advantage Plans are comprehensive health insurance plans that include coverage offered with Medicare Part A, B, and C. Some plans also include additional benefits, such as vision and dental care. Medicare Advantage Plans are offered through Medicare-approved private companies, so plan availability can vary based on your location and other eligibility requirements.
Learn more about Medicare Advantage Plans here.
If you would like to know if Medicare covers a specific item, test, or service, you can perform a search online here.
Like Medicare coverage, your Medicare plan’s cost will depend on the plan that you choose to enroll in.
Most Medicare Part A beneficiaries do not pay a premium for coverage. You will not be charged a premium for Medicare Part A if you are at least 65 years of age and meet one of the following criteria:
If you are under the age of 65, you will not be charged a premium for Medicare Part A if you meet one of the following criteria:
If you do not meet any of the above criteria, you may have to pay a premium for Medicare Part A if you choose to enroll in the plan. The amount that you will pay is determined by annual amounts and the length of time you or your spouse has worked and paid into Medicare taxes. For 2023, enrollees may need to pay either $278 or $506 each month based on their work history.
Learn more about Medicare Part A premium costs here.
Additionally, Medicare Part A includes a $1,600 deductible (per benefit period) and coinsurance amounts based on the amount of time that you are hospitalized.
Medicare Part B includes premiums, deductibles, and coinsurance costs. In 2023, the standard Medicare Part B premium is $164.90. However, your premium will be higher if you are single and you earn more than $97,000 annually, or you are married and you earn more than $194,000 annually.
If you enroll in Medicare Part B, you will need to pay a deductible each year before Medicare begins to pay for your coverage. In 2023, that deductible will be $226. After you have met your annual deductible, you will generally pay 20 percent of the cost of approved Medicare services such as:
You can learn more about the cost of Medicare Part B here.
Learn more about common Medicare costs here.
You can qualify for the Medicare program if you:
Learn more about Medicare eligibility requirements here.
Check your Medicare eligibility and calculate your estimated premium online here.
Knowing when to enroll in Medicare is crucial. If you do not enroll in Medicare Part B during your initial or special enrollment period, you may experience a delay in coverage or have to pay a higher monthly premium for the duration of your Part B coverage.
If you are eligible for Medicare based on your age, your initial enrollment period (IEP) begins three months before you turn 65 years old. Your initial enrollment period includes the month that you turn 65 and will end three months after your 65th birthday.
You may qualify for a special enrollment period (SEP) if you are currently covered by a group health plan based on your current employment or spouse’s current employment. If you qualify for a SEP, you can enroll in Medicare without penalty:
Learn more about Medicare enrollment periods for Medicare eligibility based on age here.
If you are eligible for Medicare based on a disability, your initial enrollment period will begin on the 25th month of your disability benefit entitlement and will end three months afterward. If you are receiving Social Security or Railroad Retirement Board disability benefits, you will automatically be enrolled in Medicare.
You can learn more about Medicare enrollment periods for Medicare eligibility based on disability here.
If you did not enroll for Medicare during your initial enrollment period or special enrollment period, the general enrollment period is from January 1st through March 31st.
If you currently receive Social Security Benefits or benefits from the Railroad Retirement Board, you will automatically be enrolled in Medicare Part A and Part B. Your enrollment will begin on the first day of the month that you will be turning 65 years old.
If you are receiving disability benefits through the Railroad Retirement Board or Social Security, you will automatically be enrolled in Medicare Part A and B. Your enrollment will begin on the 25th month of your disability benefits. If you are receiving disability benefits for Lou Gehrig’s disease (ALS), you will be enrolled into Medicare the first month that you receive disability benefits.
If the above scenarios do not apply to your situation, you can apply for Medicare by completing the following three steps:
1. Review the application requirements and gather documentation necessary to process your application.
Learn what documents you need here.
2. Choose how you are going to apply, whether online or by phone.
To apply for Medicare online, click here to begin the online application.
To apply for Medicare by phone, call the Medicare Contact Center at 1 (800) 633-4227.
3. Submit your application.
If you have any questions about the application process or require assistance, contact the Medicare Contact Center at 1 (800) 633-4227.
For more on how to apply for Medicare, click here.
You can check the status of your Medicare application online or by phone:
After your application for Medicare has been processed, you will receive a letter regarding your Medicare eligibility and benefits. If you are approved for benefits, you will also receive a Medicare insurance card. If you are automatically enrolled into Medicare Part A and B, you will receive your Medicare card three months before your 65th birthday or three months before your enrollment date if you are eligible based on a disability.
If you would like to change your Medicare plan, you may only do so during the open enrollment period. You may change your Medicare plan from October 15th through December 7th each year. Your new coverage will begin on January 1st. However, if you currently have a Medicare Advantage Plan, and you would like to change your plan or switch to Original Medicare, you may do so from January 1st through March 31st each year.
Learn more about changing your Medicare plan here.
If you do not agree with an action or decision made about your Medicare eligibility, coverage, or payments, you have the right to file an appeal. You can also request an appeal if there is a health care service, item, or prescription drug that was previously covered or you believe should be covered by your Medicare plan.
To request an appeal for an Original Medicare plan, you must file your appeal by the date shown on your Medicare Summary Notice, unless you can show good cause for missing your deadline.
To submit an appeal, you will need to complete the Redetermination Request Form here and send it to the company’s address that handles claims for Medicare in your area. You can find this address on your Medicare Summary Notice under the “appeals information” section.
Once you submit your appeal, you will usually receive a decision within 60 days of your request.
To request an appeal for a Medicare Advantage Plan, you must request an appeal through your plan’s provider. Appeal processes may vary by provider.
Learn more about the Medicare appeals process here.
It’s important to report changes that may affect your Medicare coverage right away. You can report a change by contacting the Medicare Contact Center at 1 (800) 633-4227 or your Medicare Advantage Plan’s provider.
For help with a Medicare application or any further questions about the Medicare program, contact the Medicare Contact Center at 1 (800) 633-4227. For questions regarding your expenses, medical records, or claims, you can also log in to your MyMedicare.gov account here.
If you have questions regarding your Medicare Advantage Plan, you can also contact your provider.
While we are not affiliated with the government in any way, our private company engaged writers to research the Medicare program and compiled a guide and the following answers to frequently asked questions. Our goal is to help you get the benefits that you need by providing useful information on the process.
Our free Medicare Guide is filled with helpful information about how to apply, program eligibility, and how to get in touch with local offices. You can view or download our free guide here.