10 Things to Know About Medicare

The information contained in this article applies to October 1, 2025 through September 30, 2026.

1. Benefit.  Medicare provides medical insurance and services.  Individual 65 years of age or older are eligible for Medicare, even though they may be working, not working, or retired.  An individual’s age counts, not their spouse’s age.

If the individual is younger than 65 but has a qualifying disability, Medicare begins 24 months after receiving Social Security Disability Insurance (SSDI).

2. Income Limit.  There is no income limit for Medicare.

3. Resource Limit.  There is no resource limit for individual receiving Medicare.

4. Deeming.  Because there is no income or resource limit, there is no deeming of assets or income.

5. Transfer of Asset Penalty.  There is no transfer of asset penalty, because there is no resource limit.

6. Special Need Trust.   There is no need for establishment of a Special Needs Trust.

7. Who Can Collect?   A non-disabled person over 65 or SSDI recipient after two years or an individual who has End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).

8. Who Determines Disability?  SSA determines disability, if applicant is under age 65.

9. Services.  Medicare is divided into four parts:

• Part A covers in-patient hospital care if admission is overnight or for a longer period of time.  It also covers short post-hospital rehabilitation stays in nursing homes and hospice care.  It does not pay for long-term care.

• Part B covers doctor visits and out-patient care including many preventive care services such as rehabilitation and therapy services.  The Medicare Part B premium is paid by the individual and the payment increases with the applicant’s income.

• Part C is known as Medicare Advantage.  It is private insurance to replace Medicare Parts A and B.

• Part D is prescription drug coverage through a private insurance company. 

10. Medicare Supplemental Plans.  Medicare covers about 80% of the beneficiary’s medical services for Medicare-approved services.

Medicare Supplemental Plans are private insurance that works with Medicare.  These Plans bridge the gap between the actual cost of care and the amount that Medicare will pay.  There is a separate premium for these Plans but they offer greater predictability.  Medicare Advantage Plans generally have lower premiums but coverage is also less.  Out-of-pocket costs related to co-insurance, copays and deductibles are generally higher with original Medicare and a Supplemental Plan.  If the covered individual develops serious or chronic health conditions, it is usually better to be covered by original Medicare.