1. Part A : Hospital Insurance
You are automatically eligible for Medicare Part A free of charge if you are one of the following:
• You are 65 or older and are eligible for Social Security retiree benefits based on your own or your spouse’s employment
• You are a federal employee who retired after 1982 and have enough quarters of coverage
• You have been receiving Social Security Disability Income payments for 24 consecutive months
• You are age 50 or older and are a disabled widow or widower who has received Social Security through your spouse for at least 2 years
• You have end-stage kidney disease, or you have Lou Gehrig’s disease (in either case, you still must have worked enough quarters, however, even though you don’t need to be 65)
People who are not automatically eligible for Medicare Part A may enroll voluntarily if you meet all of the following three requirements:
• You are 65 or older and
• You are a U.S. citizen, or a legal alien who has resided in the U.S. continuously for at least five years and
• You purchase both Parts A and B of Medicare, or you purchase Part B only. You may not purchase Part A only.
If you meet these three requirements for voluntary Part A, your monthly premium depends on your work history.
2. Part B : Medical Insurance
If you meet the eligibility guidelines for Part A, you will be eligible for Part B. Most people pay the standard Part B monthly premium amount ($170.10 in 2022). The premium is higher for those with higher incomes. The Part B deductible is $233 per year
If you have a low income and low resources, the state may pay for your Medicare premiums under Medi-Cal or the Medicare Savings Program.
Medicare does not cover all types of health care needs, nor is it free of cost. It does NOT cover custodial care in a nursing home or at home, dental care, eyeglasses, and hearing aids. For the services that are covered by Medicare, you have to pay co-payments.
3. Part A Coverage
Medicare will pay for hospital care if a doctor has decided that you need inpatient care and the hospital participates in Medicare. You will pay a hospital deductible for the first 60 days in a hospital. If you remain in the hospital for days 61 to 90, you pay $389 per day and Medicare pays the balance. If you need hospital care after the 90th day you pay $778 each day and Medicare pays the balance, for up to 60 extra days. These amounts may be subject to change.
4. Skilled Nursing and Hospice Services
After a three day prior hospitalization, Medicare pays for daily (five to seven days per week) skilled nursing and therapy services in a Medicare certified skilled nursing facility for persons who are terminally ill. Medicare pays for the first 20 days in full. The rate is $194.50 per day for days 21–100 of each benefit period, and then Medicare pays for all costs after day 100.
Medicare pays for skilled nursing and therapy services in the home if you are homebound and meet other requirements. There are no copayments for home health services.
5. Part B Coverage
Part B pays 80% of “allowable” charges for a variety of outpatient care, medical equipment, and ambulance services. You pay the remaining 20%, an annual deductible and a 20% excess charge if the provider does not take ” Medicare assignment.” Ask your provider if he or she will accept assignment.
6. Part D Coverage
Part D pays for outpatient drug coverage. To obtain Part D coverage, you must enroll into a Medicare Part D drug plan. Not all Part D plans are the same. Each plan has its own drug formulary, cost sharing requirements and restrictions on coverage. Visit Medicare.gov/plan-compare to get plan premiums. You can also call1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. If you have questions, call Legal Services at (916) 551-2150.
7. Medicare Advantage HMOs
A Medicare Advantage HMO is a health plan that enrolls people who have both Medicare Parts A and B. Generally, persons who have end stage renal disease (kidney failure) cannot enroll into a Medicare HMO. If you join a Medicare HMO, you must use the HMO for all of your medical care, except for urgent care when you are out of the HMO’s service area.
8. Other Information
• Many people receive both Medicare and Medi-Cal. People who have both programs do not usually have to pay Medicare’s monthly premiums, deductibles, or co-payments. If you have both, only see health care providers that take Medicare and Medi-Cal. Show your insurance cards before you receive services.
• Always carry your Medicare card with you
• Contact the Social Security office immediately if you lose your card or don’t get one
• Appeal any incorrect or unfair decision about your Medicare benefits
• For help with Medicare: 1 (800) 434-0222 (Health Insurance Counseling & Advocacy Program.)