_________"MEDICARE 101"_________

People often confuse Medicare with Medicaid- two programs which sound very much alike, and which often serve the same people, but are different. So, WHAT IS MEDICARE?

  • Health insurance for people age 65 and older
  • Health insurance for people under age 65 with certain disabilities or health conditions


Medicare has FOUR main parts. Parts A, B, C, and D. Each part covers specific services and benefits, or provides different options for coverage:

  • Part A (Hospital Insurance): helps cover inpatient care in hospitals, skilled nursing facilities, hospice and home health care.
  • Part B (Medical Insurance): helps cover services from doctors and other providers, outpatient care, home health care, durable medical equipment and some preventative services. 
  • Part C (Medicare Advantage): run by Medicare-approved private insurers, and includes all benefits and services covered under Part A, and B, and usually Part D; may include extra benefits at additional cost. 
  • Part D (Prescription Drug Coverage): run by Medicare-approved private insurers and helps cover the cost or prescription drugs. 


As with most health insurance, there monthly premiums, annual deductibles and co-payments or co-insurance associated with Medicare:

  • Medicare Part A is premium-free if you have worked and paid taxes for at least 40 quarters (equivalent of 10 years), but you are responsible for meeting a deductible for each benefit period, $1,184 in 2013, and paying co-insurance for Medicarecovered care. A benefit period begins the day you are admitted as an inpatient and ends when you haven't received any inpatient care for 60 days in a row. or 
  • Medicare Part B: the monthly premium for 2013 for most beneficiaries is $104.90, the annual deductible is $147, and generaly pay 20% of Medicare-covered services.
  •  For Medicare Parts C and D: in addition to paying the monthly Part B premium , you also pay monthly premiums in additions to deducribles and con-insurance, all of which vary by plans. 


Medicare eligibility:

  • Upon reaching age 65 
  • If you are under 65 and disabled, you become eligible 24 months after you start receiving Social Security Disability Insurance (SSDI), or disability benefits from the Railroad Retirement Board (RRB).
  • If you have End State Renal Disease (ESRD) or ALS (Lou Gehrig's disease), you become eligible the month you disability benefits begin. 


I person who is eligable for Medicare may also by eligable for Medicaid based on income:

  • Medicaid helps pay medical costs for persons of any age who have limited income and resources
  • Medicaid is jointly funded by the federal and state governments, but is administered by the state, which determines eligibility based on the income and resources limits it sets. 


There is a lot to know and think about when it comes to Medicare, and how to make the most of its many benefits. Fortunately, there is a lot of good information and help available, at your fingertips and in your community. 


  • The "Medicare & You" handbook, mailed to all Medicare beneficiaries
  • The Medicare website: www.medicare.gov
  • Call for answers to your Medicare questions at:  1-800-MEDICARE (633-4227) TTY users call 1-877-486-2048
  • The Social Security Website: www.socialsecurity.gov
  • The Social Security toll-free number 1-800-772-1213/ TTY users call 1-800-325-0778
  • ELDERinfo, the Delaware State Health Insurance Program (SHIP) can provide you with personalized help in your community- call: 1-800-336-9500 to get the help you need.



*A special thanks to Nancy B. O'Connor, the Medicare Regional Administrator for the states of Delaware, Maryland, Pennsylvania, Virginia, West Virginia, and the District of Columbia, for providing us with this helpful information to share with our visitors. 

People with Medicare and the Health Insurance Marketplace


Frequently Asked Questions


  • How will the Health Insurance Marketplace that starts in 2014 affect my Medicare coverage?
    • The Health Insurance Insurance Marketplace is designed to help people who don't have any health insurance. You have health insurance through Medicare. The Marketplace won't have any effect on your Medicare coverage. 
    • Your Medicare benefits aren't changing. No matter how you get Medicare, whether through original Medicare or a Medicare Advantage Plan, you'll still have the same benefits and security you have now, and you won't have to make any changes. 
    • The Marketplace provides new health insurance options for many Americans. If you have family and friends who don't have health insruance, tell them to visit HealthCare.gov to learn more about their options. 



  • Do I need to do anything with Marketplace plans during Medicare open enrollment (October 15-December 7, 2013)?
    • Medicare's Open Enrollment isn't part of the new Health Insurance Marketplace. It's against the law for someone who knows that you have Medicare to sell you a Marketplace plans. 
    • Medicare Open Enrollment (October 15- December 7, 2013) is the time when all people with Medicare are encouraged to review their current health and prescription drug coverage, including any changes in costs, coverage and benefits that will take effect next year. If you want to change your coverage for next year, this is the time to do it. If you're satisfied that your current coverage will continue to meet your needs for next year, you don't need to do anything. For more information on Medicare Open Enrollment, visit Medicare.gov or call 1-800-MEDICARE. 
      • NOTE: The Health Insurance Marketplace Open Enrollment period (October 1, 2013 to March 31, 2014) overlaps with Medicare Open Enrollment period (October 15- December 7, 2013). Therefore, people with Medicare who are looking to make Medicare coverage changes should make sure that they are reviewing Medicare plans and not Marketplace options. 



  • What should I do it i'm contacted about signing up for a health plan?
    • The Medicare open enrollment period is a time when there's a higher risk for fraudulent acitivties. 
    • It's against the law for someone who knows that you have Medicare to see you a Marketplace plan.
    • DO NOT share your Medicare number or other personal information with anyone who knocks on your door or contacts you uninvited to sell you a health plan. 
    • Senior Medicare Patrol programs are teaching people with Medicare how to detect and report fraud, and protect themselves from fraudulent activity and identity theft. 
    • To learn more about health care fraud and ways to protect against it, visit StopMedicareFraud.gov or the Senior Medicare Patrol (SMP) program in your area (locate you SMP at SMPResource.org). 



This information is provided by the United States Department of Health and Human Services.

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