What is Medicare?

Medicare is a federal health insurance program in the United States primarily for people aged 65 and older. It also provides coverage for some younger people with disabilities and those with end-stage renal disease (ESRD). Medicare has different parts that cover various aspects of healthcare:

• Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

• Part B (Medical Insurance): Covers outpatient services, doctor visits, preventive services, and some home health care.

• Part C (Medicare Advantage): Offers an alternative way to receive your Medicare benefits through private insurance companies that contract with Medicare. These plans often include additional benefits and coverage beyond what is offered by Parts A and B.

• Part D (Prescription Drug Coverage): Provides prescription drug coverage through private insurance companies. It helps with the cost of prescription medications.

Medicare is designed to help with healthcare costs, but it doesn’t cover everything. Beneficiaries often have to pay premiums, deductibles, and co-payments.

How do I get Medicare?/Am I eligible?

Determine Eligibility: Medicare is primarily for people who are 65 or older, but younger individuals with certain disabilities or specific conditions like end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) may also qualify. U.S. citizens and legal residents who have lived in the country for at least five years are eligible.

1. Sign Up:

   • Automatic Enrollment: If you're already receiving Social Security benefits when you turn 65, you’ll be automatically enrolled in Medicare Parts A and B. You’ll get your Medicare card in the mail three months before you turn 65.

   • Manual Enrollment: If you’re not automatically enrolled, you need to sign up through the Social Security Administration (SSA). You can do this online at the SSA website, by phone, or by visiting a local Social Security office.

Am I eligible for Obamacare?

Whether you’re eligible for health coverage through the Affordable Care Act (often referred to as Obamacare) in Wisconsin depends on several factors:

1. Income Level: Eligibility for subsidized coverage through the Health Insurance Marketplace is primarily based on your household income relative to the Federal Poverty Level (FPL). For 2024, you may qualify for a subsidy if your income is between 100% and 400% of the FPL.

2. Medicaid Expansion: Wisconsin has its own Medicaid program, known as BadgerCare Plus. The state opted for a partial Medicaid expansion, so eligibility for BadgerCare Plus is based on income and family size. As of 2024, if your income is below 100% of the FPL, you might qualify for BadgerCare Plus.

3. Employment Status: If you have employer-sponsored insurance that meets certain standards, you may not qualify for Marketplace subsidies.

4. Other Factors: Your eligibility can also depend on factors like citizenship status, age, and household size.

To get a precise answer, you can visit the Health Insurance Marketplace website or Wisconsin’s Medicaid website, where you can use their tools to check your eligibility based on your specific circumstances. We are also available to answer questions you may have about eligibility.