Medicare Questions?

Medicare generally refers to traditional Medicare and is better known as “Original Medicare.” Original Medicare is a national health insurance program established by the United States government to provide older American individuals with affordable health care coverage as part of the Medicare and Medicaid Act (Social Security Amendment, 1965).

Medicaid is a public health insurance program strictly based on low income and assets for people of all ages, such as individuals with or without disabilities, families, including children with or without their parents, and pregnant women. The California Medicaid program is better known as Medi-Cal.

While the Original Medicare program was established for older adults, it has since been changed to include health coverage for younger disabled individuals of all ages. Additionally, Original Medicare is not based on income or assets, but some disabled individuals that qualify for Medicare before age 65 are generally eligible for Social Security disability benefits based on their low income.

Currently, eligibility for Medicare coverage could be at any age, including individuals 65 years of age or older who are eligible to receive Social Security retirement or Railroad Retirement Board (RRB) benefits; or disabled individuals under age 65 who receive Social Security disability benefits after a 24-month waiting period; or individuals diagnosed with End-Stage Renal Disease (ERSD) or Amyotrophic Lateral Sclerosis (ALS).

The actual enrollment into original Medicare Parts A & B is handled by the Social Security Administration (SSA) office. You will automatically get enrolled in Medicare Part A at age 65 if you already receive Social Security retirement or Railroad Retirement Board (RRB) benefits; Medicare Part B is optional. Otherwise, you can apply for your original Medicare card when you are eligible by contacting the Social Security office at 1-800-772-1213 (TTY 1-800-325-0778).

No. You can apply online for Medicare only.

Medicare Part A covers care for inpatient hospital, skilled nursing facility, hospice, and some home health care. 

*  Inpatient hospital care is covered when you are “admitted” to the hospital by doctor’s order at a hospital that accepts Original Medicare. In some cases, the Utilization Review Committee of the hospital must approve your stay.

*  Skilled Nursing Facility (SNF) care is covered by Part A in certain conditions for a limited time (on a short-term basis) if certain conditions are met.

*  The cost of care in a long-term care hospital facility is also covered by Part A. Services provided in a long-term hospital include comprehensive rehabilitation, respiratory therapy, head trauma treatment, and pain management. 

Part B covers the following two types of outpatient medical services:

• Medically necessary services:Services or supplies needed to diagnose or treat your medical condition that also meet accepted standards of medical practice.
• Preventive Services: Medical Services to prevent illnesses or detect illnesses at an early stage, when treatment is most likely to work best.

There is usually no monthly premium for Medicare Part A because most people pre-pay for this part of Medicare with the required payroll Medicare Tax.

The 2023 standard monthly premium for Original Medicare Part B is $164.90 dollars.

Cataract surgery is covered by original Medicare and so are eyeglasses prescribed as a result of Cataract surgery.

Routine eye exams, eyeglasses (not associated with Cataract Surgery), and contact lenses are not covered by original Medicare. Medicare Advantage plans usually include extra benefit coverage such as routine eye exams, eyeglasses, and contact lenses

You can apply for a different Medicare Supplement plan at any time throughout the year, but your approval and cost will depend on your answers to certain medical underwriting questions if you do not qualify for a Guarantee Issue right to enroll. In California there is the Birthday Open Enrollment period for Medicare Supplement plan changes with no medical underwriting questions: within 30 Days before your birthday and 60 Days after your birthday. Note that there are other Guaranteed Issue Open Enrollment opportunities as well.