Medicare Basics

What is Medicare?

Medicare is a federal program - administered through Centers for Medicare and Medicaid Services (CMS) - that provides health insurance coverage to eligible elderly and disabled individuals no matter what their income is. Coverage benefits vary based on the site of service (i.e., doctors office, hospital inpatient, hospital outpatient, or home health treatments). 

stethoscopeHow Do I Know If I Qualify for Medicare?

You qualify for Medicare if you are a U.S. citizen or permanent resident and you:*

  • Are 65 years or older
  • Are under 65 and have a disability and have been receiving Social Security Disability Insurance for 24 months
  • Have End-Stage Renal Disease, a permanent kidney failure requiring dialysis or a kidney transplant

*The above requirements are only general guidelines; please visit Medicare Rights Center and Medicare.gov for more detailed guidelines.

How Does Medicare Work?

View a more detailed chart of Medicare benefitsMedicare is divided into four parts. Part A covers inpatient services, Part B covers outpatient services, and Part D covers prescription drugs. Part C refers to Medicare private plans. These four parts, combined with the Medigap option, allow you to customize your Medicare coverage for your situation.

However, it is important to note that you will be automatically enrolled into Original Medicare unless you actively choose another plan.

Contact us with insurance questions, success stories, suggestions, or requests to volunteer.


HELPFUL MEDICARE RESOURCES

Medicare.gov is the official U.S. Government site for people with Medicare.

Medicare & You 2012 is the official Medicare handbook.

Social Security Administration houses the Medicare application and can help you through the application process.

State Health Insurance Assistance Programs are state programs that offer one-on-one counseling and assistance to people with Medicare and their families.

Medicare Rights Center works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives.

Caring Voice Coalition has programs to help patients with insurance reimbursement, financial assistance, patient support services, public advocacy and some legal assistance.

The information provided on the PHA website is provided for general information only. It is not intended as legal, medical or other professional advice, and should not be relied upon as a substitute for consultations with qualified professionals who are familiar with your individual needs.

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NORD

The National Organization for Rare Disorders (NORD) awarded PHA the Abbey S. Meyers Leadership Award in 2012 for outstanding service to PHA members in advocacy, education and other key areas.