Medicare Health Coverage

Authored By: Lagniappe Law Lab


About Medicare Health Coverage

Medicare is a federal health insurance program that primarily serves individuals who are 65 or older or people with certain disabilities, regardless of income. Medicare is funded through payroll taxes and premiums paid by beneficiaries. It has four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage, which is offered by private insurance companies), and Part D (prescription drug coverage). 

What You Need To Know

The different parts of Medicare are: 

  • Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and home health care.
  • Part B (Medical Insurance): Covers doctor visits, outpatient care, medical equipment, and preventive services.
  • Part C (Medicare Advantage): Offers an alternative to original Medicare by allowing beneficiaries to receive their Medicare benefits through a private insurance plan.

  • Part D (Prescription Drug Coverage): Covers the cost of prescription drugs and is offered through private insurance companies.

Beneficiaries can choose to enroll in Original Medicare (Part A and Part B) or a Medicare Advantage plan (Part C), which includes all of the benefits of Original Medicare as well as additional benefits such as vision, dental, and hearing coverage. Additionally, beneficiaries can choose to enroll in a stand-alone prescription drug plan (Part D) if they have Original Medicare or a Medicare Advantage plan that does not include prescription drug coverage.

Generally, you pay a monthly premium for Medicare coverage and part of the costs each time you get a covered service. There’s no yearly limit on what you pay out-of-pocket unless you have supplemental coverage, like a Medicare Supplement Insurance (Medigap) policy.

Learn more about Medicaid costs by visiting this resource here

Medicare coverage starts based on when you sign up and which sign-up period you’re in. 

Generally, there are three main enrollment periods for Medicare:

  1. Initial Enrollment Period (IEP): This is the first time you can enroll in Medicare. It starts three months before your 65th birthday and ends three months after your 65th birthday. If you enroll during this period, your coverage will start on the first day of the month you turn 65.

  2. General Enrollment Period (GEP): This period runs from January 1st to March 31st each year. If you missed your IEP, you can enroll in Medicare during this period, but your coverage won't start until July 1st of that year.

  3. Special Enrollment Period (SEP): If you have qualifying circumstances, you may be able to enroll in Medicare outside of the IEP or GEP. For example, if you have employer coverage and then lose that coverage, you may be eligible for a SEP.

It's important to note that if you don't enroll in Medicare during your IEP or SEP, you may have to pay a penalty when you do enroll. So it's important to understand your enrollment options and make sure you sign up for Medicare at the right time.

Medicare is available to U.S. citizens and noncitizens who are lawfully present in the United States. In addition to being lawfully present, noncitizens must meet certain residency requirements to be eligible for Medicare. Specifically, you must have lived in the United States continuously for at least five years before you apply for Medicare. Noncitizens who are eligible for Medicare receive the same benefits as U.S. citizens. This includes coverage for hospital stays, doctor visits, and other medical services. 


How To Enroll

How To Enroll In Medicare

This information covers the general steps that you may need to follow to enroll in Medicare. 

Steps To Enroll In Medicare

Medicare primarily covers people who are 65 or older, as well as people under 65 with certain disabilities, permanent kidney failure, or Amyotrophic Lateral Sclerosis (ALS).

To be eligible for Medicare, you generally need to meet one or more of the following criteria:

  • You are 65 years of age or older and either a U.S. citizen or a legal resident who has lived in the United States for at least five years.

  • You have received Social Security Disability Insurance (SSDI) for at least 24 months, or you have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).

  • You are the spouse or dependent child of someone who qualifies for Medicare based on their age or disability.

To apply for Medicare, you'll need to gather certain documents and information. Depending on your situation and the type of Medicare coverage you're applying for, the specific documents and information may vary. In general, you may need: 

  • Social Security number: You will need to provide your Social Security number (SSN) or the SSN of the person who qualifies for Medicare based on age or disability.

  • Proof of age: If you're applying for Medicare based on age, you will need to provide proof of your date of birth. This could include a birth certificate, passport, or other government-issued identification.

  • Proof of citizenship or legal residency: You will need to show that you are either a U.S. citizen or a legal resident who has lived in the United States for at least five years. You may need to provide a certificate of citizenship or naturalization, or other documentation.

  • Employment information: If you or your spouse have worked and paid Medicare taxes for at least 10 years, you may be eligible for premium-free Medicare Part A. You will need to provide information about your employment history and income.

  • Health insurance information: If you have other health insurance, such as through an employer or a private insurer, you will need to provide information about that coverage.

There are certain times of the year when you can enroll in Medicare, including the Initial Enrollment Period (IEP), the Annual Enrollment Period (AEP), and the Special Enrollment Period (SEP). Make sure you sign up during the appropriate enrollment period to avoid any penalties.

You can enroll in Medicare online by visiting the Social Security website, or you can call Social Security to enroll over the phone. If you are already receiving Social Security benefits, you will be automatically enrolled in Medicare.

There are several Medicare plans available, including Original Medicare (Part A and Part B), Medicare Advantage (Part C), and Medicare Prescription Drug (Part D) plans. You will need to choose a plan that best meets your healthcare needs and budget. Each Medicare plan has different costs associated with it, including premiums, deductibles, and co-payments. Make sure you understand the costs of each plan before you enroll.

Other Issues To Consider

Others Issues To Consider

This covers information about other issues to consider related to Medicare health coverage. 

Other Issues To Consider

You have a right to appeal a Medicare decision. An appeal is an action you can take if you disagree with a coverage or payment decision by Medicare or your Medicare plan. There are various reasons why you may need to appeal a Medicare decision. Depending on the type of Medicare - Original Medicare, Medicare health plans, medicare prescription drug plans, PACE, and Special Needs Plan, you may need to begin your appeal process differently. 

Learn more about how to file an appeal by visiting this resource here


You can be eligible for both Medicaid and Medicare. This is known as "dual eligibility." Dual eligibility is common among older adults and individuals with disabilities. 

Learn more about Medicaid by visiting this resource here

Last Review and Update: Apr 12, 2023
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