Medicare is the federal government program that provides health care coverage (health  insurance) if you are 65+, under 65 and receiving Social Security Disability Insurance (SSDI) for  a certain amount of time, or under 65 and with End-Stage Renal Disease (ESRD). The Centers  for Medicare & Medicaid Services (CMS) is the federal agency that runs Medicare. The program  is funded in part by Social Security and Medicare taxes you pay on your income, in part through  premiums that people with Medicare pay, and in part by the federal budget. 

Once you have become Medicare-eligible and enroll, you can choose to get your Medicare  benefits from Original Medicare, the traditional fee-for-service program offered directly through  the federal government, or from a Medicare Advantage Plan, a type of private insurance offered  by companies that contract with Medicare (the federal government). Original Medicare includes: 

  • Part A (Inpatient/hospital coverage) 
  • Part B (Outpatient/medical coverage) 

If you want Medicare prescription drug coverage (Part D) with Original Medicare, in most cases  you will need to actively choose and join a stand-alone Medicare private drug plan (PDP). 

You still have Medicare if you enroll in a Medicare Advantage Plan. This means that you will  still owe a monthly Part B premium (and your Part A premium, if you have one). Each Medicare  Advantage Plan must provide all Part A and Part B services covered by Original Medicare, but  can do so with different rules, costs, and restrictions that can affect how and when you receive  care. Medicare Advantage Plans can also provide Part D coverage. Note that if you have health  coverage from a union or current or former employer when you become eligible for Medicare,  you may automatically be enrolled in a Medicare Advantage Plan that they sponsor. You have  the choice to stay with this plan, switch to Original Medicare, or enroll in a different Medicare  Advantage Plan, but you should speak with your employer/union before making any change. 

It is important to understand your Medicare coverage choices and to pick your coverage  carefully. How you choose to get your benefits and who you get them from can affect your out of-pocket costs and where you can get your care. For instance, in Original Medicare, you are  covered to go to nearly all doctors and hospitals in the country. Medicare Advantage Plans, on  the other hand, usually have network restrictions, meaning that you will be more limited in your  access to doctors and hospitals. However, Medicare Advantage Plans can also provide additional  benefits that Original Medicare does not cover, such as routine vision or dental care. 

Medicare is different from Medicaid, which is another government program that provides health  insurance. Medicaid is funded and run by the federal government in partnership with states to  cover people with limited incomes. Depending on the state, Medicaid can be available to people  below a certain income level who meet other criteria (e.g., age, disability status, pregnancy) or be  available to all people below a certain income level. Remember, unlike Medicaid, Medicare  eligibility does not depend on income. Also, eligible individuals can have both Medicare and  Medicaid and are known as dual-eligibles.

Everyone who has Medicare receives a red, white, and blue Original Medicare card. If you  choose to receive your coverage through Original Medicare, you will show this card when you  get services. If you choose to receive your Medicare benefits through a Medicare Advantage  Plan, you will still get an Original Medicare card but you will show your Medicare Advantage  Plan card when you get services. No matter how you get your Medicare health benefits, only  give your Medicare number to your doctors and health care providers. 

© Medicare Rights Center. Used with permission. 

The content is developed from sources believed to be providing accurate information. The  information in this material is not intended as tax or legal advice. It may not be used for the  purpose of avoiding any federal tax penalties. Please consult legal or tax professionals for  specific information regarding your individual situation. This material was developed and  produced by FMG Suite to provide information on a topic that may be of interest. FMG, LLC, is  not affiliated with the named broker-dealer, state- or SEC-registered investment advisory  firm. The opinions expressed and material provided are for general information, and should not  be considered a solicitation for the purchase or sale of any security. Copyright FMG Suite.

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