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[edit] At Age 65
US Citizens become eligible for Medicare at age 65, but you have to enroll and make some choices. Hospitalization coverage, Part A is automatic. The doctor coverage, Part B is optional and comes as a cost and a deduction from your monthly check. Depending on where you live, there are the traditional as well as HMO policies, at different costs. It is important to make an informed decision as to whether you accept part B immediately or not. There is a monthly % penalty for each month that you are eligible, that you do not accept and pay for it. Many people think that if they have other coverage now, that they do not need Medicare at this time, so they want to turn down part B to save the cost. When they finally need it, (spouse retires or other insurance ends, etc) they find that the monthly cost is astromonical!!! Also, you need to make a decision on Part D, the prescription coverage. Again, depending on where you live, different policies are offered by different companies and they coverage can be VERY different, too. You need to check out the specific medicines that you take and make an informed decision based you your specific needs.
[edit] When Accepted for Social Security Disability
There are 2 types of disability.. SSI and SSDI. One is needs based *(financial circumstances), the other is based on what you actually contributed into social security through your employment. If you are approved for disability due to your medical condition, then you become eligible for Medicare even though you are not yet age 65. There is a 2 year waiting period for you to become Medicare eligible once you are on disability. Depending on your financial circumstances, you may be eligible for your state's Medicaid coverage once you are on disability, also.
[edit] Supplemental or Medigap Coverage
Medicare will not pay for everything, so you need supplement or medigap insurance. Medicare has a 20% copay plus a yearly deductible. Also, you MUST go to a participating provider, who has an agreement with Medicare to "accept" what Medicare says as the "allowable" charge for COVERED services that they deem medically necessary. You are then responsible for your yearly deductible and 20% copay, or HMO copay, depending on your policy.
If you are retired, then you may be eligible for secondary coverage from your former employer. If a spouse is still working and has insurance coverage, this policy can also become the secondary to Medicare for the retired spouse. There is a gray area as to which policy is primary ehen one person is still working, but can be worked out between the insurance companies and Medicare. This coverage is a type of supplemental insurance. In some cases, this insurance MAY pay if Medicare denies something, or you elect to go to a doctor that is not participating in Medicare.
Most people, however, have to pay for their secondary coverage known as "Medigap" insurance. This policy ONLY fills in the GAP between what medicare allows and the 80% that they pay. If medicare denies something, the Medigap does NOT pay.
AARP OR OTHERS OFFER MEDIGAP POLICIES. IT PAYS THE 20% COINSURANCE. IT IS NOT A SUPPLEMENT, AS IT DOES NOT PAY IF MEDICARE DENIES OR DOES NOT COVER SOMETHING.
ALSO, CHECK WITH YOUR LOCAL HOSPITALS. THERE ARE SOME HOSPITALS THAT OFFER THEIR OWN MEDIGAP INSURANCE. MY MOTHER IN LAW HAS HER MEDIGAP THROUGH HER LOCAL HOSPITAL IN GA. THE ONLY DRAWBACK IS THAT SHE HAS TO GO TO THAT HOSPITAL AND SEE THEIR DOCTORS. SHE DOES NOT MIND THE RESTRICTION AND SAYS IT IS REASONABLE.