If you are new to Medicare or about to become eligible, the Frequently Asked Questions below may provide you with the information you need. We have also compiled a list of online resources to point you in the right direction.
You can also contact the Health Insurance Counseling & Advocacy Program (HICAP) for free, individual counseling on Medicare coverage questions, your rights and health care options. Call 1-800-434-0222 to schedule an appointment at a HICAP office near you.
Topics on this page:
- What is Medicare?
- If I am eligible for Medicare, how do I enroll?
- What does Medicare cover?
- How much does Medicare cost?
- Why do some people delay enrollment in Medicare Part B?
- Why do some people delay enrollment in a Medicare Part D plan?
- Since Medicare doesn’t cover all my health care costs, what are some ways to supplement Medicare?
1. What is Medicare?
Medicare is the federal health insurance program for:
- Most people age 65 and over
- Certain people younger than 65 with disabilities
- People with amyotrophic lateral sclerosis (ALS) , also known as Lou Gehrig’s disease
- People with end-stage renal disease (ESRD) , also known as permanent kidney failure
For more information, see our Eligibility section.
2. If I am eligible for Medicare, how do I enroll?
If you are receiving Social Security or Railroad Retirement benefits, you may be automatically enrolled. If you are automatically enrolled, you don’t need to pay a premium for Part A. For more information about automatic enrollment, see Medicare Enrollment or call Social Security at 1-800-772-1213.
If you are not automatically enrolled, you can enroll by calling Social Security.
3. What does Medicare cover?
Medicare covers health care services and items that are medically necessary and reasonable as follows:
- Medicare Part A covers inpatient hospital stays, inpatient skilled nursing facility stays, home health care and hospice care.
- Medicare Part B covers outpatient medical services such as doctor visits, diagnostic lab tests and preventive care.
- Medicare Part D covers most prescription drugs.
For more information, see Medicare Basics.
Note: Medicare Part C refers to Medicare Advantage (MA) plans. An MA plan is an alternative to Original fee-for-service Medicare. MA plans are sponsored by Medicare, which pays private insurance companies to provide health services to beneficiaries who enroll in these plans. For more information, see Medicare Advantage.
4. How much does Medicare cost?
Medicare requires premiums, deductibles and other cost-sharing for certain services. For specific amounts, see our Medicare cost-sharing chart summary. Several assistance programs can help cover some or all of these costs for beneficiaries with limited income and assets. For more information, see Low-Income Help.
5. Why do some people delay enrollment in Medicare Part B?
If you are covered by an employer group health plan due to active employment (i.e., not a retiree plan), you may delay enrolling in Part B. For more information, see Coverage While You and/or Your Spouse Works.
6. Why do some people delay enrollment in a Medicare Part D plan?
If you have creditable prescription drug coverage (meaning it is as good as or better than the standard Medicare Part D drug benefit), you may decide not to enroll in a Medicare Part D plan or to enroll later. For example, if you have the Veterans Affairs (VA) health care benefits or TRICARE for Life, you have creditable prescription drug coverage. To find out more about Medicare Part D and enrollment options, see Prescription Drugs (Medicare Part D).
7. Since Medicare doesn’t cover all my health care costs, how can I supplement Medicare?
Most people supplement Medicare with some other form of coverage, such as a Medigap plan, retiree plan, Medi-Cal (if they have low income and assets), or Veterans Affairs (VA) benefits (if they qualify). Others receive Medicare through private health plans called Medicare Advantage (MA) plans. To learn about the different ways to supplement Medicare, see our sections on Medicare & Other Health Insurance, Low-Income Help, Medigap and Medicare Advantage.
Additional Resources
California Health Advocates’ Website & Consultation/Training Services
For Medicare beneficiaries: Provides comprehensive information and resources on Medicare, prescription drugs, low-income assistance, Medigap plans, Medicare Advantage, Medicare appeals, long-term care and more. Offers Medicare podcasts in English and Spanish; and Medicare fact sheets in multiple languages.
For Professionals: Provides timely issue briefs on Medicare policies and advocacy updates, bimonthly California Medicare Coalition meetings, California Medicare News electronic newsletter, Medicare fact sheets in multiple languages, posted webinars and training materials, and Congressional testimonies.
We also offer consultation services and custom designed trainings on Medicare coverage, ways to supplement it, options for employers and unions who provide health care coverage for employees and/or retirees, and more. Contact us at 916-231-5110. See Education.
Websites
Medicare.gov – The Official U.S. Government Site for People with Medicare
1-800-MEDICARE (633-4227)
Information on Medicare, Medigap policies, Medicare Advantage (formerly known as Medicare+Choice) plan options, prescription drug assistance programs, nursing homes and home health care, and other Medicare-related issues.
Social Security Administration (SSA)
1-800-772-1213
Information on Medicare eligibility and enrollment, eligibility and application for Extra Help, Social Security benefits, change of address for Medicare or Social Security, and lost Medicare card replacements.
