What is Medicare? Why is it important for people age 65 and older?
Medicare is the U.S. federal health insurance program designed to ease the burden of medical expenses. It primarily serves people age 65 and older, but it also covers younger individuals with certain disabilities or serious conditions such as End-Stage Renal Disease (ESRD) or ALS. Medicare is an essential program that helps safeguard the health and quality of life for Americans in retirement.
You may be eligible for Medicare if you are 65 or older and are a U.S. citizen or a lawful permanent resident (Green Card holder) who has lived in the United States for at least five continuous years. People under 65 may also qualify if they have a disability and have received Social Security disability benefits for at least 24 months, or if they have ESRD requiring dialysis or a kidney transplant, or if they have been diagnosed with ALS (Lou Gehrig’s Disease).
Medicare is divided into several parts.
Part A – Hospital Insurance
Part A covers inpatient hospital services, including room, meals, and medical care received during a hospital stay. It helps reduce the financial burden of major medical events that require hospitalization.
Part B – Medical Insurance
Part B covers doctor visits, outpatient care, and clinical services such as lab tests and preventive screenings. Enrollment for both Part A and Part B is generally handled through the Social Security Administration.
Part C – Medicare Advantage
Also known as Medicare Advantage, Part C is offered by private companies approved by CMS. These plans combine the coverage of Parts A and B and often include extra benefits such as dental, vision, fitness memberships, transportation to appointments, allowances for over-the-counter items, healthy food cards, and even worldwide emergency coverage. Many Medicare Advantage plans also bundle in Part D prescription drug coverage.
Supplement Plan (Medigap)
For those who want more flexibility, especially the ability to see specialists without referrals, a Medicare Supplement Plan (Medigap) is available. These plans help cover out-of-pocket costs not fully paid by Parts A and B, offering greater financial protection and choice of providers.
A common question is whether Part A has a premium. If you or your spouse worked and paid Medicare taxes for 40 quarters (about 10 years), you are entitled to Part A with no monthly premium. If you have fewer than 40 credits, you can still enroll, but you will need to pay a monthly premium, with the cost increasing the fewer credits you have. However, individuals with Medi-Cal who qualify for QMB may have their Part A and Part B premiums covered by the government, depending on their situation.
Medicare coverage never expires, but you may change your plan once a year during the Annual Enrollment Period (AEP), which runs from October 15 to December 7. In some cases, you may qualify for a Special Enrollment Period (SEP) that allows you to make changes at other times of the year. Consulting with a Medicare Enrollment Agent can help you find a plan that fits your specific needs and budget.
The most important step is to enroll on time when you turn 65. Delaying enrollment can lead to lifetime penalties. For example, the Part B premium increases by 10% for each year you delay enrollment—up to 40%—and that penalty lasts for life. For Part D, going without prescription drug coverage for more than 63 days also results in a penalty. If you still have employer-sponsored health insurance, you can choose to start Part A at 65 and delay Part B until retirement without penalty.
In short, Medicare is not just another benefit—it’s a safeguard for your long-term health and financial security. By enrolling on time and choosing the right plan, you ensure the coverage you need and the peace of mind you deserve. Many people reach out to us for help when it’s already too late to fix their Medicare issues. Don’t wait until that happens—get guidance early. Our consultations are always free, so if you want to protect your Medicare benefits, call us today.
