If you’re 65 years of age or older, Medicare is the federal government program that provides health care coverage. Medicare also offers health insurance if you’re under 65 years of age and receive Social Security Disability Insurance or SSDI for a certain amount of time, or if you’re under 65 years of age and have End-Stage Renal Disease (ESRD).

The Centers for Medicare & Medicaid Services known as CMS, is the federal agency that runs the Medicare program.

Medicare funding

Medicare is in part funded by Social Security and Medicare taxes you pay as withholding on your income, through premiums that people with Medicare pay, and through the federal budget.


Once you’ve become Medicare-eligible, you can enroll in Original Medicare, the traditional fee-for-service program offered directly through the federal government.  Alternatively, you can choose to enroll in a Medicare Advantage Plan, a type of private insurance offered by health insurance companies that contract with Medicare (the federal government).

Pick your Coverage Carefully

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 example, the Original Medicare covers your visit to nearly all doctors and hospitals in the country. However, Medicare Advantage Plans may have network restrictions, meaning that you will likely be more limited in your access to doctors and hospitals. But, in contrast to the Original Medicare, Medicare Advantage Plans may provide additional benefits that Original Medicare does not cover, such as routine vision or dental care.

Remember, you still have Medicare if you enroll in a Medicare Advantage Plan. This means that you must still pay your 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 offered by Original Medicare, but can do so with different rules, costs, and restrictions that can affect how and when you receive care.

Automatic Enrollment

Note that if you have health coverage from your trade 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. While you have the choice to stay with this plan, switch to the Original Medicare, or enroll in a different Medicare Advantage Plan, it is important to discuss these options with your trade union representative or (former) employer before doing so.

Medicare vs. Medicaid

Medicare is not the same as Medicaid.  Medicaid, which is funded and run by the federal government in partnership with states to cover people with limited income, is another government program that provides health insurance.  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.
Unlike Medicaid, Medicare eligibility does not depend on income.

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 have to show this card when you request a medical or pharmacy benefit.

If you choose to receive your Medicare benefits through a Medicare Advantage Plan, you will also receive an Original Medicare card. However, in addition to the original Medicare card, you’ll have to show your private plan card when you request a medical or pharmacy benefit.

Finally, please protect your ID. While it does not matter how your get your Medicare benefits, you should never share your Medicare number with anyone other than your to pharmacist or health care provider.

What does Medicare cover?

Different parts of Medicare cover different health related services, including

  • Medicare Part A (Hospital Insurance),
  • Medicare Part B (Medical Insurance),
  • Medicare Part C, and
  • Medicare Part D.

Original Medicare is administered directly by the federal government, and includes Part A and Part B.

  • Part A (Hospital Insurance) covers most medically necessary hospital, skilled nursing facility, home health, and hospice care. It is free if you have worked and paid Social Security taxes for at least 40 calendar quarters (10 years); you will pay a monthly premium if you have worked and paid taxes for less time.
  • Part B (Medical Insurance) covers most medically necessary doctors’ services, preventive care, durable medical equipment, hospital outpatient services, laboratory tests, x-rays, mental health care, and some home health and ambulance services. You pay a monthly premium for this coverage.
  • Medicare Part C Medicare Part C is not a separate benefit. It’s the part of Medicare policy that allows private health insurance companies to provide Medicare benefits. These Medicare private health plans, such as HMOs and PPOs, are known as Medicare Advantage Plans. If you can choose to get your Medicare coverage through a Medicare Advantage Plan instead of through Original Medicare.
  • Medicare Part D (outpatient Prescription Drug Insurance). Medi care Part Dis the part of Medicare that provides outpatient prescription drug coverage and is provided only through private insurance companies that have contracts with the government—it is never provided directly by the government (like Original Medicare is). To sign up, you must choose Part D coverage that works with your Medicare health benefits. If you have Original Medicare, choose a stand-alone Part D plan (PDP).

Medicare Advantage Plans must offer at least the same benefits as Original Medicare (those covered under Parts A and B) but can do so with different rules, costs, and coverage restrictions. You also typically get Part D as part of your Medicare Advantage benefits package. Many different kinds of Medicare Advantage Plans are available. In addition to a premium for you Medicare Part B coverage, you may have to pay a monthly premium for this (additional) coverage.

Next Steps…

For more information contact us today and ask for your free no-obligation quote.We will help you explore a variety of insurance options and discounts. Call us at +1 800 645 0297 or email us. Alternatively, have an insurance-licensed Sunvalley Insurance representative contact you.