_________"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. 

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Delaware Ecumenical Council on Children and Families
240 North James Street, Suite 111 Wilmington, DE 19804 (302) 225-1040 or (855) 613-2110