Medicare 101: Understanding the basics

Medicare is a valuable medical program for many Americans. It falls under Title XVIII of the Social Security Act. Medicare is a federal health insurance program for Americans age 65 and over, for disabled Americans under age 65, and for individuals who are in end-stage renal disease. Over 41,000,000 persons were on Medicare in 2003. That number has climbed to over 43,000,000 currently. If a Medicare recipient chooses wisely, they can rest secure knowing that they have a healthcare plan, or combination of plans, that works the best for them.


Enrolling in Medicare is easy, and is done through the Social Security Administration. If an individual is already receiving SSA benefits, such as Social Security Disability or early retirement, they will receive Medicare automatically when they become eligible. It can take two years from their disability onset date for a disabled person to begin receiving Medicare. Other eligible persons, such as those turning 65, can either visit a local office or call 1-800-772-1213 to enroll. For those turning age 65, SSA encourages applying three months before the 65th birthday.


There are four components to Medicare. These components are referred to as Part A, Part B, Part C, and Part D. Part A is hospital insurance, and includes hospice and some home health care. If the recipient and/or spouse has 40 work quarters, Part A is free. Otherwise, there may be a monthly premium.

Part B covers doctor visits, outpatient care, therapy, preventative care, and some medical supplies. Currently, the Part B monthly premium is $96.40. It may be wise to purchase Part B when first eligible – the monthly premium amount increases the longer an individual waits, after they are first eligible, to apply for it.

Part C refers to the Medicare Advantage Plans (like Health Maintenance Organizations and PPOs). These plans may be a combination of what a person could get through Medicare Part A, B, and D and are run by Medicare-approved private insurance companies.

Part D helps with medication costs after an individual enrolls in a Prescription Drug Plan. An individual must be eligible for Part A or Part B to get Part D. Medicare-approved private companies run Part D plans, and there may be dozens of plans from which to choose.


Certainly these plans appear to be fairly conclusive. The neediest individuals should be able to receive health coverage through Medicare. But are Medicare customers satisfied with the quality of care they receive from their providers, and the costs they are having to pay for their medications under Medicare Part D?

Teresa A Keenan of AARP conducted a research survey of Medicare recipients aged 50 and over. Her February 2007 report indicates that 79 percent were highly satisfied with the level of their health care and access to their physicians. Consumers were also satisfied with office visit wait times and with access to medical professionals.

As far as costs for medications, according to the August 14, 2008 CMS Office of Public Affairs press release, “Lower Medicare Part D Costs than Expected in 2009”, beneficiary satisfaction remains high. CMS estimates that the average amount Medicare recipients will have to pay for the Part D premium is $28/month, 37 percent lower than initially anticipated at the start of the Part D program almost 4 years ago.


Since many Medicare recipients have to pay co-payments and deductibles, as well as some prescription costs, many choose to also purchase a Medicare Supplemental (Medigap) plan. These plans are sold by private companies and ideally will cover what the Medicare plans do not, for a monthly premium. The key is to wisely examine the costs and coverage of the Supplemental plans, as not all plans are created equal.

Sources:,,, Centers for Medicare and Medicaid Services,