What Is Medicare?

Medicare is our country's health insurance program for people age 65 or older, certain people with disabilities who are under 65, and people of any age who have permanent kidney failure. It provides basic protection against the cost of health care, but it doesn't cover all your medical expenses nor the cost of most long-term care. You can choose one of two ways to get benefits under Medicare: the traditional fee-for-service system or the managed care program.

The Health Care Financing Administration is the agency in charge of the Medicare program. But the people at the Social Security offices help you enroll in the program and give you general Medicare information.

Medicare Has Two Parts

There are two parts of Medicare. They are:

Hospital Insurance (also called Part A Medicare)--which is financed by a portion of your payroll (FICA) tax that also pays for Social Security; and

Medical Insurance (also called Part B Medicare)--which is partly financed by monthly premiums paid by people who choose to enroll.

You are automatically enrolled in Part B when you become entitled to Part A. However, because you must pay a monthly premium for Part B coverage, you have the option of paying for the coverage or turning it down.

Each part of Medicare covers different kinds of medical costs, has different rules about enrolling, and so on.

About Medicaid

Many people think that Medicaid and Medicare are two different names for the same program. Actually, they are two different programs. Medicaid is a state-run program designed primarily to help those with low income and little or no resources. The federal government helps pay for Medicaid, but each state has its own rules about who is eligible and what is covered under Medicaid. Some people qualify for both Medicare and Medicaid.

Eligibility for Medi-Cal

You may be eligible for Medi-Cal benefits if you are 65 years or older, or you are blind, or you are younger than 65 and have a disability. If you receive Supplemental Security Income (SSI), you will get Medi-Cal benefits automatically. If you don’t receive SSI, you can still qualify for Medi-Cal as long as your income and assets are under certain amounts (see below). You can also find detailed information on Medi-Cal eligibility at

Eligiblity for Medi-Cal through SSI

Help For Low-Income Medicare Beneficiaries If your income and assets are very limited, you should know about programs that can help save you money. One is the Qualified Medicare Beneficiary or QMB program. The other is the Specified Low-Income Medicare Beneficiary or SLMB program. Both programs are run by the Health Care Financing Administration and the state agency that provides medical assistance under the Medicaid program. They differ in the amount of income that qualifies you for help.

If you qualify for the QMB program, your state will pay your monthly Medicare premiums. You will not have to pay the Medicare deductibles and coinsurance, which can save you a lot more money. If you qualify for the SLMB program, your state will pay only your medical insurance (Part B) monthly premium.

The rules vary from state to state. In general, you may qualify for help from the QMB or SLMB program if:

your income is limited; and your resources do not exceed certain limitations. (Resources are things you own. But some things don't count. For example, the house you live in and some other things, such as a car, may not count.)

Section 2--Who Can Get Medicare And How To Sign Up Hospital Insurance If You Are 65 or Older Most people 65 or older are eligible for Medicare hospital insurance (Part A) based on their own--or their spouse's-- employment.

You are eligible at 65 if you:

receive Social Security or railroad retirement benefits, or

are not getting Social Security or railroad retirement benefits, but you have worked long enough to be eligible for them, or

would be entitled to Social Security benefits based on your spouse's (or divorced spouse's) work record, and that spouse is at least 62 (your spouse does not have to apply for benefits in order for you to be eligible based on your spouse's work) or,

worked long enough in a federal, state, or local government job to be insured for Medicare.

If You Are Under 65
Before age 65, you are only eligible for Medicare hospital insurance when you:

have been a Social Security disability beneficiary for 24 months, or

have worked long enough in a federal, state, or local government job and you meet the requirements of the Social Security disability program.

If you receive a disability annuity from the Railroad Retirement Board, you will be eligible for hospital insurance after a waiting period. (Contact your railroad retirement office for details.)

Eligibility For Family Members Under certain conditions, your spouse, divorced spouse, widow or widower, or a dependent parent may be eligible for hospital insurance when he or she turns 65, based on your work record.

Also, disabled widows and widowers under age 65, disabled divorced widows and widowers under 65, and disabled children may be eligible for Medicare, usually after a 24-month qualifying period.

(For disabled widows/widowers, previous months of eligibility for Supplemental Security Income (SSI) based on disability may count toward the qualifying period.)

If You Have Kidney Failure There are special rules for people with permanent kidney failure. Under these rules, you are eligible for hospital insurance at any age if you receive maintenance dialysis or a kidney transplant and:

you are insured or are getting monthly benefits under Social Security or the railroad retirement system, or

you have worked long enough in government to be insured for Medicare.

In addition, your spouse or child may be eligible, based on your work record, if she or he receives continuing dialysis for permanent kidney failure or had a kidney transplant, even if no one else in the family is getting Medicare.

If You Do Not Qualify Under These Rules Certain aged or disabled people who do not qualify for Medicare hospital insurance under these rules may be able to get it by paying a monthly premium.

Medicare Medical Insurance Almost anyone who is 65 or older or who is under 65 but eligible for hospital insurance can enroll for Medicare medical insurance by paying a monthly premium. You don't need any Social Security or government work credits for this part of Medicare.

Medicare Medical Insurance Almost anyone who is 65 or older or who is under 65 but eligible for hospital insurance can enroll for Medicare medical insurance by paying a monthly premium. You don't need any Social Security or government work credits for this part of Medicare.