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Medicare for Family Members with Special Needs


Medicare is the nation's largest health insurance program, covering forty million Americans. Medicare provides coverage for individuals sixty-five years of age and older, some disabled individuals under sixty-five years of age, and individuals with end-stage renal disease (permanent kidney failure treated with dialysis or a transplant).

What services does Medicare provide?

People qualify for Medicare based on the Medicare tax they paid through their work. Workers' spouses, minor children, and adult children with disabilities may also be covered. The different parts of Medicare help cover specific services:

  • Medicare Part A (hospital insurance). Part A helps pay for care in hospitals for inpatient services, critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas), skilled nursing facilities, hospice care, and some home health care services.
  • Medicare Part B (medical insurance). Part B helps cover doctors' and other health care providers' services, outpatient care, durable medical equipment, and home health care; and helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse.
  • Medicare Part C (also known as Medicare Advantage).Part C offers health plan options run by Medicare-approved private insurance companies. Medicare Advantage Plans provide similar benefits and services covered under Part A and Part B and typically cover Medicare prescription drug coverage (Part D).
  • Medicare Part D (Medicare Prescription Drug Coverage). Part D helps cover the cost of prescription drugs, may help lower your prescription drug costs, and help protect against higher costs in the future.

Who is eligible for Medicare?

Generally, a person is eligible for Medicare if he or she or their spouse worked for at least ten years in Medicare-covered employment, is sixty-five years old, and is a citizen or permanent resident of the United States. A younger person who has a disability or chronic kidney disease may also qualify.

Service members' children with special needs qualify for Medicare Parts A and B automatically after receiving disability benefits from Social Security for twenty-four months. A Medicare card will be mailed approximately three months before the twenty-fifth month of disability benefits. Note that Part B is optional. If you do not want Part B, you must follow the instructions that come with the Medicare card, and send the card back. If you keep the card, you keep Part B coverage and may have to pay Part B premiums.

When TRICARE beneficiaries are entitled to Medicare Part A and B, they are also eligible for TRICARE for Life. If you decline Medicare Part B coverage for your child, your child will lose his or her TRICARE eligibility, unless you are on active duty. To maintain eligibility for TRICARE for Life for your child, you must enroll in Medicare Part B prior to your retirement to keep TRICARE without a break in coverage. More information on the TRICARE for Life program is available on the TRICARE for Life and Medicare Fact Sheet.

How much does Medicare cost?

Typically, beneficiaries do not pay a monthly premium for Part A coverage. Disabled children who have received Social Security benefits for twenty-four months qualify for "premium-free Part A" coverage.

If Medicare does not cover all your child's medical needs, you can look into purchasing a Medigap policy. A Medigap policy is a health insurance policy sold by private insurance companies to fill gaps in Medicare coverage. For example, if Medicare pays eighty percent of allowable medical charges, a Medigap policy might pay the other twenty percent, depending on the policy. In most states (excluding Massachusetts, Minnesota, and Wisconsin), a Medigap policy must be one of ten standardized policies so people can compare them easily. The Medicare website provides an online Medigap Policy Search to help identify potential policies in your area.

Where can I find more information on Medicare?

More information on Medicare is available through numerous sources:

  • Ask Medicare. "Ask Medicare" is Medicare's website for caregivers. This site can provide you assistance in choosing a drug plan, comparing nursing homes, getting help with billing, finding local care resources, and more. More information is available on the Ask Medicare website.
  • State Health Insurance Assistance Programs (SHIP). The SHIP provides free, personalized counseling and assistance about Medicare and insurance-related issues. The SHIP can help people with Medicare, or family and friends who have authorization to help someone with Medicare. The SHIP provides face-to-face or telephone counseling to answer general questions about enrollment in Medicare plans, long-term care insurance, claims and billing problems, information and referrals on public benefit programs for those with limited income and resources, and other health insurance benefit information. You can find contact information for SHIP by calling 1 (800) MEDICARE or by visiting the Medicare contacts website. TTY users should call 1 (877) 486-2048.
  • Medicare.gov and MyMedicare.gov. Medicare.gov is the official United States Government website for people with Medicare. Medicare's secure online service for accessing your personal Medicare information, MyMedicare.gov, is available twenty-four hours a day, every day. Through MyMedicare.gov, you can help the person you are caring for register on the site. More information is available on the Medicare.gov and MyMedicare websites.
  • 1-800-MEDICARE. Call 1 (800) 633-4227 to talk with a Medicare customer service representative twenty-four hours a day. TTY users should call 1 (877) 486-2048. You can get answers to questions about what Medicare Part A and Part B cover; get information about claims; ask for information about Medicare health coverage choices including cost, benefits, quality; and more.

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