Medicare Resources

Medicare is the federal health insurance program for people aged 65 or older. People younger than 65 with certain disabilities, permanent kidney failure, or amyotrophic lateral sclerosis (Lou Gehrig’s disease), can also qualify for Medicare. The program helps with the cost of health care, but it doesn’t cover all medical expenses or the cost of most long-term care.

You can sign up for Original Medicare (Parts A & B) through Social Security’s online Medicare application at www.ssa.gov. You can also schedule an appointment at one of the Social Security offices or enroll by phone. Their main number is 800-772-1213. Signing up online is fairly simple and less stressful or time consuming. The folks at MedicareJourney.org can provide some assistance, insight, and tips about how to enroll online.

You can also visit Medicare’s website, www.Medicare.gov, to get more information about Original Medicare, Medicare Advantage, or Part D coverage; or to download a copy of the publication Medicare & You (Publication No. CMS-10050). You can also call the Medicare toll-free number at 1-800-633-4227; TTY users can call 1-877-486-2048.

You are eligible for Medicare Part A at no cost at age 65 if one of the following applies:

• You receive or are eligible to receive benefits from Social Security. 40 work credits (10 years) of work qualifies you to receive Medicare Part A at no cost. You can also qualify based on the Railroad Retirement Board (RRB).


• Your spouse (living or deceased, including divorced spouses) receives or is eligible to receive Social Security or RRB benefits. If you have no work history, you could use your spouse’s work record (provided they accumulated 40 work credits or10 years of work) and this qualifies you to receive Medicare Part A at no cost.


• You or your spouse worked long enough in a government job through which you paid Medicare taxes


• You are the dependent parent of a fully insured deceased child

You should start thinking about Medicare when you’re 63, especially if you are a high-income earner and face IRMAA (Income-Related Monthly Adjustment Amount) surcharges. Social Security uses your income from 2 years prior to your Medicare enrollment to determine your Part B premium. When you’re 64 ½ years old, you are going to start getting inundated with phone calls, emails, junk mail, and even possibly a door-knock or two! You want to start working with an independent agent specializing in Medicare to get educated and determine what’s a good plan for you. If you’re turning 65, you have a 7-month eligibility period to enroll in Medicare (if not staying on group coverage): 3 months before, the month of, and 3 months after your birthday.

Medicaid and Medicare are two different programs. Medicaid is a state-run program that provides hospital and medical coverage for people with low income. Each state has its own rules about who’s eligible and what Medicaid covers. Some people qualify for both Medicare and Medicaid. For more information about the Medicaid program, contact your local medical assistance agency, social services office, or get state contact information at www.Medicaid.gov. If you do have both Medicaid and Medicare, you would most likely qualify for a no-cost Dual-Eligible Special Needs (DSNP) Medicare Advantage Plan with little to no cost, depending on your Medicaid eligibility.

Nope, it’s not the little munchkins you get at Dunkin Donuts but hey, they are delicious albeit not so healthy! The Medicare donut hole is a bit more menacing.

Most Medicare drug plans have a coverage gap (also called the “donut hole”). This means there’s a temporary limit on what the drug plan will cover for drugs.

Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. Once you and your plan have spent $4,130 on covered drugs in 2021, you’re in the coverage gap. This amount may change yearly. Also, people with Medicare who get Extra Help paying Part D costs won’t enter or have to worry about the coverage gap.

BRAND-NAME Prescription Drugs

Once you reach the coverage gap, you’ll pay no more than 25% of the cost for your plan’s covered brand-name prescription drugs. You’ll pay this discounted rate if you buy your prescriptions at a pharmacy or mail-order. Some plans may offer you even lower costs in the coverage gap. The discount will come off the price that your plan has set with the pharmacy for that specific drug.

Although you’ll pay no more than 25% of the price for the brand-name drug, almost the full price of the drug will count as out-of-pocket costs to help you get out of the coverage gap. What you pay and what the manufacturer pays (95% of the cost of the drug) will count toward your out-out-pocket spending.