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    Medicare

    Frequently Asked Questions

    If you or your spouse works enough time while paying Medicare taxes, you qualify for Medicare:

    • When you turn 65
    • After you get Social Security Disability Insurance (SSDI) benefits for two years, or
    • If you have Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS) or end-stage kidney disease (ESRD).

    If your disability starts before you are 22 years old, you start getting Medicare if you get Disabled Adult Child (DAC) benefits for two years based on a parent’s work record.

    Note: For full Medicare coverage, you have to be a U.S. citizen or have been living in the U.S. for the last five years as a lawfully admitted permanent resident.

    You automatically get Original Medicare coverage if you get SSDI for two years or start getting Social Security retirement benefits before you turn 65. Otherwise, you may need to sign up.

    If you have government-run Original Medicare, you have the options of also getting a privately managed Part D prescription drug policy and a privately run Medicare supplement (Medigap) policy.

    Or, you may decide that you want a privately run Medicare Advantage or Medicare Cost plan that includes all the benefits you need. Note: Many Medicare Advantage and Medicare Cost plans include prescription drug coverage, but some allow you to sign up for a separate Part D plan instead.

    Important: Medicare Cost plans are not an option in most counties and are being phased out. If you have any questions about this, call the Senior LinkAge Line® at 1-800-333-2433.

    For all of these types of privately managed Medicare benefits, the signup process is basically the same:

    1. You decide which types of plans you want to sign up for.
    2. You research the private plans you are looking at. One way of comparing plans is by using the Medicare Plan Finder.
    3. You sign up:
      • On Medicare.gov
      • By calling Medicare at 1-800-633-4227 or 1-877-486-2048 (TTY)
      • By calling the Senior LinkAge Line® at 1-800-333-2433
      • By completing a paper application with the plan, or
      • By contacting the plan directly.

    For more help in understanding Medicare, you can:

    Original Medicare has three main parts:

    • Part A helps pay for medical care you get while you’re admitted in a hospital.
    • Part B helps pay for outpatient medical care.
    • Part D helps pay for prescription drugs.

    Medicare Advantage (also called "Part C") and Medicare Cost plans are ways to get a single combined plan including Parts A, B, and D through a private company. With Medicare Advantage plans, you may have less flexibility, but your costs could be lower. With Medicare Cost plans, you have more flexibility, because you can still use Original Medicare to pay for out-of-network providers.

    Whether Original Medicare, Medicare Advantage, or a Medicare Cost plan is right for you depends on your situation and preferences. There is no answer that is right for everyone. In Minnesota, 45% of Medicare beneficiaries choose Original Medicare and 55% choose Medicare Advantage or Medicare Cost plans.

    Learn more about the reasons one or the other might be right for you.

    No. Medicare only helps pay for care that it considers reasonable and necessary. If you need a service that Medicare doesn’t cover, you have to pay for it yourself, unless you have other coverage, such as Medical Assistance (MA) or employer-sponsored coverage.

    For some services, you pay a deductible, copayment, or co-insurance before Medicare begins to help pay for that service. For Medicare Part B or Part D, or for Medicare Advantage or Medicare Cost plans, you may have to pay a monthly premium, unless you qualify to get help paying for your Medicare premiums, copayments, and deductibles through MA, a Medicare Savings Program (MSP), or the Low Income Subsidy (LIS).

    If you have low income and low assets, you may qualify to get help paying for Medicare. There are two main types of help:

    • Medicare Savings Programs (MSPs) help with Medicare premiums. Depending on the MSP, it may also help with other expenses, such as copayments, co-insurance, and deductibles.
      • For people with Original Medicare, MSPs can help with Parts A and B.
      • MSPs can help with any Medicare Advantage plan.
    • The Low Income Subsidy (LIS), also known as Extra Help, helps pay premiums, copayments, co-insurance, and deductibles for prescription drug coverage.
      • For people with Original Medicare, the LIS can help with Part D plan expenses.
      • The LIS can help with Medicare Advantage plans that include prescription drug coverage, sometimes call MA-PD plans.

    Note: If you have both Medical Assistance (MA) and Medicare coverage, your MA coverage may also help pay for your Medicare expenses or you may automatically get help from an MSP and the LIS.

    If you have any questions about Medicare Savings Programs and the LIS, call the Senior LinkAge Line® at 1-800-333-2433.

    Learn more about getting help paying for Medicare and how to apply for it.

    A Medigap policy (also called Medicare Supplement Insurance) is a private insurance policy that helps cover some Original Medicare expenses, such as copayments and deductibles. Medigap policies do not cover prescription drugs; you have to enroll in a Part D plan for prescription drug coverage.

    Medicare.gov lists the most common levels of Medigap plan and shows the benefits they offer. The Minnesota Board on Aging's Health Care Choices for Minnesotans on Medicare also can help you understand your options.

    You should only opt out of Part B coverage if you:

    If you opt out of Part B coverage, you may have to pay monthly penalties if you want Part B later. If you qualify for MA or an MSP, they help pay for your Part B expenses and you are better off overall with Part B.

    Note: Retiree health coverage and COBRA are not considered employer-sponsored coverage. If you have one of these and sign up for Part B later, you'd have to pay monthly penalties.

    Important: If you also have MA or MA-EPD coverage, do not decline Part B coverage, because if you decline it, MA (or MA-EPD) won't pay for what Part B would have covered.

    If you have Original Medicare, you should sign up for Part D unless you both:

    If you do not have creditable prescription drug coverage, you have to pay a monthly penalty if you want Part D later. If you qualify for MA or the Low Income Subsidy, they help pay your Part D costs and you are better off overall with Part D.

    Note: If you have Medicare Advantage or a Medicare Cost Plan, it may already include prescription drug coverage. Check with your plan. (The Low Income Subsidy also helps pay for Medicare Advantage and Medicare Cost plans that cover prescription drugs.)

    Important: If you also have MA or MA-EPD coverage, you are automatically signed up for a Part D plan. Do not decline Part D coverage, because if you decline it, MA (or MA-EPD) won't pay for what Part D would have covered.

    Yes. Other types of coverage that you can have with Medicare include:

    You cannot get MinnesotaCare or tax subsidies for individual coverage if you qualify for Medicare.

    Learn more about how Medicare interacts with other types of coverage.

    No, Medicare does not generally pay for long-term care. Medical Assistance (MA) and MA-Waiver programs may help pay for some of these costs.

    If you need long-term care and have Medicare, you can:

    Learn more

    Social Security Disability Insurance (SSDI)

    SSDI helps people with disabilities who worked and paid Social Security taxes.

    Benefits and Work Estimator

    See how a work plan can help your situation.

    Disability-Based MA

    For people with disabilities who have low income.