Understanding Medicare benefits
Do I qualify for Medicare benefits?
Medicare is the federal health insurance program with a range of eligibility criteria. At a high level, you may qualify for Medicare if:
You're 65 or older
If you have worked and paid payroll taxes for at least 10 years, you qualify for Medicare at age 65.
You're under 65 with a disability
If you have certain
You're a U.S. person
You must also be a U.S. citizen or permanent legal resident (or married to one who has paid Social Security taxes for at least 10 years).
Medicare is primarily funded through payroll taxes paid by employees, employers, and self-employed taxpayers and has
What does Medicare cover?
Medicare coverage varies across the different types and includes different kinds of healthcare expenses.
Here are coverage summaries by category:
Hospital insurance
- Inpatient hospital care
- Skilled nursing facility care
- Hospice care
- Some home health services
Medical insurance
- Doctor visits
- Outpatient hospital services
- Preventive services like disease screenings and vaccines
- Ambulance services
- Durable medical equipment (DME)
- Some home health services
Medicare advantage
Medicare Advantage combines the coverage offered in Part A and Part B to make it available as an employer plan through private companies.
Prescription drug coverage
Primarily provided through Medicare-approved private insurance plans, Part D can help assist in prescription drug costs.
When can I claim Medicare benefits?
You're automatically enrolled at 65 if you've been collecting Social Security.
If not, or if you're under 65 and qualify, you’ll need to
You don't need to re-enroll every year, but you can check in during open enrollment, October 15 through December 7 each year, to review and make changes to your coverage.
How do I enroll in Medicare?
If you are not enrolled automatically by collecting Social Security, you may enroll in Medicare Parts A and B during the following time periods:
Initial Enrollment Period
You have a 6-month window to sign up starting 3 months before your 65th birthday and ending 3 months after.
General Enrollment Period
If you miss the Initial Enrollment Period, you can sign up from January 1 through March 31 each year with coverage starting July 1. Late enrollment may mean higher premiums.
Special Enrollment Period
If you or your spouse (or family member if you are disabled) is still working and covered by a health insurance through an employer or union, you can enroll when that coverage ends.
What if I keep working when I turn 65?
If you or your spouse (or family member if you are disabled) is currently working and had employer or union provided health insurance, you can use the Special Enrollment Period once that coverage ends.
Supplemental insurance (Medigap)
Medigap plans help cover costs that traditional Medicare doesn't. These plans are offered by private insurers to anyone enrolled in Parts A and B.
Enrollment tips
Medicare publishes a guide each year with detailed information. Review it as you are estimating your retirement expenses and doing income planning (and again when you are 64 and are preparing to enroll) to understand current costs and options.
By understanding these Medicare basics, you’ll be better prepared to meet your healthcare needs in retirement.
This material is for informational or educational purposes only and is not fiduciary investment advice, or a securities, investment strategy, or insurance product recommendation. This material does not consider an individual’s own objectives or circumstances which should be the basis of any investment decision.
Investment products may be subject to market and other risk factors. See the applicable product literature or visit TIAA.org for details.
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