Administered by the Centers for Medicare and Medicaid Services (CMS), Medicare is a health care benefit for qualified people 65 years of age and older and people with disabilities. In order to qualify for Medicare, people older than 65 must have worked and paid into Medicare for ten years (40 quarters) while working or have been married for ten years or more to a worker who paid into Medicare. People with disabilities may qualify for Medicare if they have specific medical conditions or if they have received Social Security Disability Insurance benefits due to their disability for 24 months.

Medicare has four parts or areas of coverage. Medicare beneficiaries choose which parts they want and pay different amounts for their coverage depending on which parts they choose. There is also cost sharing with Medicare, so beneficiaries pay a portion of the cost of their medical services.

Medicare Part A provides hospital benefits and nursing home benefits under certain circumstances. Part B provides out-patient medical benefits, such as provider appointments and lab fees. Part C, Medicare Advantage Plans, provides hospital and out-patient medical benefits through various health plans beneficiaries select. Part D provides prescription drug coverage. Generally, Medicare Parts A and B cover medically necessary medical services only, including mental health services. Dental services are not covered.

Medicare beneficiaries have certain rights in their receipt of benefits through the program, because Medicare is a government health insurance program. Beneficiaries may appeal adverse decisions like denials of payment or health plan referral denials. Medicare beneficiaries also have access to informational and advocacy resources through the Health Insurance Counseling and Advocacy Programs (HICAPs) that can assist with coverage questions, help resolve problems with Medicare and offer guidance on issues to consider when selecting health plans.

Some Medicare beneficiaries have other health care coverage in addition to Medicare, such as Medi-Cal, retiree health benefits, private health insurance or veterans’ health benefits.

The following resources provide additional information about the Medicare program and its rules:

• California Health Advocates
• Original Medicare: An Overview
• Appeals: When Your Part A or B Medicare Claim is Denied
• Medicare Enrollment Periods
• Supplementing Medicare: An Overview
• Medicare Advantage (Medicare Part C): An Overview
• If You Have Problems With Your Medicare Advantage Plan
• When Medicare Advantage Plans Terminate Coverage
• Medicare Part D: An Overview
• Prescription Drug Resources
• When Your Part D Prescription is Denied
• Low-Income Assistance: Medicare Savings Programs
• Medi-Cal (for people with Medicare)
• Extra Help for Part D Costs
• Medicare and People with Disabilities: An Overview
• Medicare and People with End Stage Renal Disease (ESRD)
• Employer Group, COBRA, Extended Continuation of Coverage, and Individual Health Insurance
• People with Medicare and TriCare for Life
• Medicare and Veterans Administration Medical Benefits Package