Revised June 2015

What’s Medicare?

Medicare is health insurance for:

- People 65 or older

- People under 65 with certain disabilities

- People of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant)

What are the different parts of Medicare?

Part A (Hospital Insurance) helps cover:

- Inpatient care in hospitals

- Skilled nursing facility (SNF) care

- Hospice care

- Home health care

Usually, you don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working. This is sometimes called premium-free Part A. If you aren’t eligible for premium-free Part A, you may be able to buy Part A, and pay a premium. Part B (Medical Insurance) helps cover:

- Services from doctors and other health care providers

- Outpatient care

- Home health care

- Durable medical equipment (DME)

- Some preventive services

Most people pay the standard monthly Part B premium.

Note: You may want to get coverage that fills gaps in Original Medicare coverage. You can choose to buy a Medicare Supplement Insurance (Medigap) policy from a private company.

Part C (Medicare Advantage):

- Includes all benefits and services covered under Parts A and B

- Usually includes Medicare prescription drug coverage (Part D) as part of the plan

- Run by Medicare-approved private insurance companies

- May include extra benefits and services for an extra cost

Part D (Medicare prescription drug coverage):

- Helps cover the cost of prescription drugs

- Run by Medicare-approved private insurance companies

- May help lower your prescription drug costs and help protect against higher costs in the future

Note: If you have limited income and resources, you may qualify for help paying for your health care and prescription drug costs. For more information, visit socialsecurity.gov, call Social Security at 1-800-772-1213, or contact your local State Medical Assistance (Medicaid) office.

What’s Medicaid?

Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid may also cover services not normally covered by Medicare (like long term supports and services and personal care services). Each state has different rules about eligibility and applying for Medicaid. If you qualify for Medicaid in your state, you automatically qualify for Extra Help paying your Medicare prescription drug coverage (Part D).

You may be eligible for Medicaid if you have limited income and are any of these:

- 65 or older

- A child under 19

- Pregnant

- Living with a disability

- A parent or adult caring for a child

- An adult without dependent children (in certain states)

- An eligible immigrant

In many states, more parents and other adults can get coverage now. If you were turned down in the past, you can try again and may qualify now.

When you enroll, you can get the health care benefits you need, like:

- Doctor visits

- Hospital stays

- Long-term services and supports

- Preventive care, including immunizations, mammograms, colonoscopies, and other needed care

- Prenatal and maternity care

- Mental health care

- Necessary medications

- Vision and dental care (for children)

You should apply for Medicaid if you or someone in your family needs health care. If you aren’t sure whether you qualify, a qualified caseworker in your state can look at your situation. Contact your local or state Medicaid office to see if you qualify and to apply. To get information about your state’s Medicaid program, visit HealthCare.gov/do-i-qualify-for-medicaid.

Dual eligibility

Some people who are eligible for both Medicare and Medicaid are called “dual eligibles.” If you have Medicare and full Medicaid coverage, most of your health care costs are likely covered.

You can get your Medicare coverage through Original Medicare or a Medicare Advantage Plan (like an HMO or PPO). If you have Medicare and full Medicaid, Medicare covers your Part D prescription drugs. Medicaid may still cover some drugs and other care that Medicare doesn’t cover.

For more information on Medicaid, visit HealthCare.gov/do-i-qualify-for-medicaid. If you have questions about Medicare, visit Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

CMS Product No. 11306

Table of Contents

What’s Medicare?

What’s Medicaid?