CARD T249
Medicare
Federal health insurance primarily for people age 65 or older and certain younger eligible people. Eligibility also includes specified disability and disease pathways.
How it works
Medicare is federal health insurance mainly for people 65 or older and certain younger eligible people. Disability-based eligibility generally follows 24 months of qualifying Social Security or Railroad Retirement disability benefits. Amyotrophic lateral sclerosis (ALS, also called Lou Gehrig’s disease) and end-stage renal disease (ESRD, permanent kidney failure requiring dialysis or a transplant) have special eligibility rules. Part A mainly covers hospital-related benefits; Part B covers medical and outpatient services; Part C is Medicare Advantage through private plans; Part D covers prescriptions. Original Medicare is Parts A and B. It has cost sharing and does not pay for unlimited long-term personal care. The usual age-65 enrollment window covers three months before the birthday month, that month, and three months afterward, with special timing exceptions. [32] [33]
An individual approaching 65 reviews enrollment during the three months before the birthday month, that month, and the three months afterward, applying the specific eligibility rules.
Medicare is not Medicaid, and eligibility does not mean all coverage is free or automatic for everyone.
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Practice questions
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T249 · Medicare
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Sources & further reading
Original explanations and practice scenarios informed by the following regulatory, legal, and product resources. State examples are not presented as nationwide deadlines or requirements.