Yes, Medicare is a federal program run by the Centers for Medicare & Medicaid Services

Medicare is a federal health insurance program operated by the U.S. Department of Health and Human Services through an agency called the Centers for Medicare & Medicaid Services (CMS). The federal government funds it, sets the rules for who can enroll, decides what services it covers, and determines how much doctors and hospitals are paid. You do not explore to a state office or a private company — you deal with the federal government.

Medicare began in 1965 as part of the Social Security Act. It is separate from Medicaid, which is a joint federal and state program with different rules in each state. Because Medicare is entirely federal, the coverage, may be able to access rules, and payment amounts are the same whether you live in California or Maine.

The program is divided into four parts: Part A covers hospital stays, Part B covers doctor visits and outpatient care, Part D covers prescription drugs, and Part C (Medicare Advantage) is an alternative way to receive Parts A and B through a private insurance company that contracts with Medicare.

Key Takeaways

  • Medicare is administered by the Centers for Medicare & Medicaid Services, a federal agency under the Department of Health and Human Services.
  • may be able to access and coverage rules are set by the federal government and are identical across all states.
  • Most people become may be able to access at age 65, but some younger people with disabilities or end-stage renal disease can enroll earlier.
  • You enroll through Medicare directly, not through your state, and you can contact Medicare at 1-800-MEDICARE to ask questions about your coverage.

Who is may be able to access for Medicare

You are generally may be able to access for Medicare at age 65 if you are a U.S. citizen or permanent resident who has lived in the country for at least five years. You do not have to be retired or have a certain income level — age 65 is the main threshold.

Some people under 65 can enroll if they have received Social Security Disability Insurance (SSDI) for 24 months, if they have end-stage renal disease (permanent kidney failure), or if they have amyotrophic lateral sclerosis (ALS). These groups can join Medicare before reaching 65.

You must be enrolled in Social Security to get Medicare. If you have not yet claimed Social Security benefits, you will need to do that first. The enrollment process happens through Social Security, not through a separate Medicare office.

How Medicare enrollment works

If you are turning 65, you have a seven-month window called your Initial Enrollment Period that begins three months before the month you turn 65 and ends three months after. During this window, you can enroll in Medicare Part A and Part B without a penalty.

You can enroll online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. You will need your Social Security number and information about your current health coverage.

If you miss your Initial Enrollment Period, you can still enroll during the General Enrollment Period (January 1 to March 31 each year), but you may face a permanent penalty on your Part B premium. This is why enrolling on time matters, even if you are still working.

What Medicare covers and what it does not

Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice, and some home health services. Part B covers doctor visits, outpatient surgery, diagnostic tests, and preventive care like screenings and vaccines. Part D covers prescription medications through a separate plan you choose.

Medicare does not cover dental care, vision care, hearing aids, or long-term custodial care in a nursing home. It also does not cover routine foot care, most cosmetic surgery, or acupuncture (with limited exceptions). Many people buy a supplemental policy called Medigap to cover costs that Medicare does not pay.

Part C, also called Medicare Advantage, is an alternative to Original Medicare (Parts A and B). Private insurance companies offer these plans, but they must follow federal rules set by CMS. Medicare Advantage plans often include prescription drug coverage and may cover some services that Original Medicare does not, but they typically have network restrictions.

How Medicare is funded

Medicare is funded through payroll taxes, premiums, and general federal revenue. If you worked and paid taxes, you contributed to Medicare through the Medicare tax on your paychecks (1.45 percent of your wages, plus an additional 0.9 percent if you earn over a certain threshold). Your employer also paid 1.45 percent on your behalf.

When you enroll in Medicare, you pay a monthly premium for Part B (the amount changes each year based on your income) and for Part D if you choose a prescription drug plan. Part A is usually free if you or your spouse paid Medicare taxes for at least 10 years while working.

The federal government also funds Medicare through general tax revenue when payroll taxes and premiums do not cover the full cost. This is why Medicare is sometimes described as a pay-as-you-go system — current workers' taxes help pay for current retirees' care.

Medicare versus Medicaid: the key differences

Medicare and Medicaid are often confused because their names are similar, but they are completely different programs. Medicare is federal and based on age or disability. Medicaid is jointly run by the federal government and each state, and it is based on income.

To be on Medicare, you must be 65 or older, disabled, or have end-stage renal disease — your income does not matter. To be on Medicaid, your income must be below a certain level set by your state. Some people are on both programs at the same time; they are called "dual may be able to access."

Medicaid rules, covered services, and income limits vary by state. Medicare rules are the same everywhere. If you move from one state to another, your Medicare coverage does not change, but your Medicaid coverage might.

How to contact Medicare with questions

The official Medicare phone line is 1-800-MEDICARE (1-800-633-4227). You can call to ask about enrollment, coverage, claims, or billing. The line is open 24 hours a day, seven days a week.

You can also visit Medicare.gov to find information about plans, coverage, costs, and how to enroll. The website has a plan finder tool that shows you what plans are available in your area and what they cost.

If you need help in person, you can visit your local Social Security office or find a State Health Insurance information Program (SHIP) counselor in your area. SHIP counselors are trained volunteers who answer Medicare questions for free.

Frequently Asked Questions

Can I delay enrolling in Medicare if I am still working at 65?

You can delay Part B enrollment if you are still working and covered by your employer's health plan, but you should still enroll in Part A at 65 because it is usually free and has no penalty for delaying. If you delay Part B, you must enroll within eight months of leaving your job or losing your employer coverage, or you will face a permanent penalty.

Does Medicare cover everything once I turn 65?

No. Medicare covers many services, but it has gaps. It does not cover dental, vision, hearing aids, or long-term nursing home care. Most people buy a Medigap policy to cover the costs that Medicare does not pay, such as copayments and deductibles.

What happens if I do not enroll in Medicare when I turn 65?

If you do not enroll during your Initial Enrollment Period and you do not have other may have access to coverage, you will pay a permanent penalty on your Part B and Part D premiums for as long as you have Medicare. The penalty is 10 percent per year you were late.

Can I change my Medicare plan after I enroll?

Yes, but only during certain times of year. The Annual Enrollment Period runs from October 15 to December 7 each year, and changes take effect January 1. If you have a life event like moving or losing other coverage, you may be able to change plans outside this window.

Is Medicare the same in every state?

Yes, the federal rules for Medicare coverage and may be able to access are the same everywhere. However, the cost of living and the number of available plans vary by state, so your out-of-pocket costs and plan options may differ depending on where you live.