What is Medicare?
Medicare is a federal health insurance program in the United States primarily for:
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People age 65 and older
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Certain younger individuals with disabilities
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People with End-Stage Renal Disease (ESRD) or ALS
It is administered by the Centers for Medicare & Medicaid Services (CMS).
Hours of Operation
Monday - Friday: 9 AM to 5 PM
Closed Saturday and Sunday
Location
408 South Main Street
Somerset, KY 42501
Telephone:
(606) 677-1759
Medicare Elgibility
1. Age-Based Eligibility
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You qualify at age 65 if you are a U.S. citizen or permanent legal resident.
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You can enroll 3 months before your 65th birthday, the month you turn 65, and 3 months after — this 7-month window is called your Initial Enrollment Period (IEP).
2. Early Eligibility (Under 65)
You can qualify before 65 if you meet certain criteria:
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You’ve received Social Security Disability Insurance (SSDI) for 24 months.
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You have End-Stage Renal Disease (ESRD) requiring dialysis or a kidney transplant.
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You have Amyotrophic Lateral Sclerosis (ALS/Lou Gehrig’s disease), which qualifies you immediately.
The Four Parts of Medicare
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What Medicare Part A Covers
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Inpatient Hospital Care
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Semi-private room
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Meals
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Nursing services
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Medications received during your stay
Skilled Nursing Facility (SNF) Care
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Short-term rehabilitation following a qualifying hospital stay
Hospice Care
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For individuals with a terminal illness who choose comfort-focused care
Limited Home Health Care
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Part-time skilled nursing or therapy services (when medically necessary)
What Part A Does Not Cover
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Long-term custodial care (help with bathing, dressing, etc. if that’s the only care needed)
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Private-duty nursing
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Most long-term nursing home stays
Cost of Medicare Part A
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Most people do not pay a monthly premium if they or their spouse worked and paid Medicare taxes for at least 10 years.
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There is a deductible per benefit period and daily coinsurance costs for longer hospital or skilled nursing stays.
What is Medicare Part C
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Medicare Part C, also known as Medicare Advantage, is an alternative way to receive your Medicare benefits through a private insurance company approved by Medicare.
Medicare is overseen by the Centers for Medicare & Medicaid Services (CMS), but Part C plans are offered by private insurers that contract with Medicare.
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Medicare Part C Includes​
Medicare Advantage plans must cover everything included in:
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Part A (Hospital Insurance)
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Part B (Medical Insurance)
Most plans also include:
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Part D (Prescription Drug Coverage)
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Dental, vision, and hearing benefits
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Fitness programs
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Additional wellness benefits
How Medicare Advantage Works
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You must be enrolled in Part A and Part B.
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You continue to pay your Part B premium.
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Plans often have provider networks (such as HMO or PPO).
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You typically have set copays or coinsurance instead of the 20% open-ended cost under Original Medicare.
Key Difference from Original Medicare
With Original Medicare (Parts A & B), you can see any provider that accepts Medicare, and you may add a supplement plan for extra coverage.
With Medicare Advantage (Part C), your coverage is bundled into one plan that may include additional benefits but often requires using network providers.
What Medicare Part B Covers
Doctor Services
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Primary care and specialist visits
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Outpatient services
Preventive Services
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Annual wellness visits
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Screenings (such as cancer screenings)
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Vaccines (including flu and other covered immunizations)
Outpatient Care
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Emergency room visits
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Same-day surgeries
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Diagnostic tests (X-rays, MRIs, lab work)
Durable Medical Equipment (DME)
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Wheelchairs
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Walkers
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Oxygen equipment
Some Home Health Services
What Part B Does Not Typically Cover
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Routine dental, vision, and hearing care
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Cosmetic procedures
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Most prescription drugs (covered under Part D)
Cost of Medicare Part B
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Most beneficiaries pay a monthly premium (which may vary based on income).
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There is an annual deductible.
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After the deductible, Part B generally pays 80% of approved services, and you are responsible for the remaining 20% unless you have supplemental coverage.
What Medicare Part D Covers
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Most prescription medications prescribed by your doctor
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Some vaccines not covered under Part B
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Certain specialty medications
Important: Coverage and costs can vary depending on the plan, including which pharmacies you use and whether your medications are on the plan’s formulary (approved drug list).
How Part D Works
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You must be enrolled in Part A or Part B to join a Part D plan.
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You pay a monthly premium in addition to your Medicare Part B premium.
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There is an annual deductible (plan-dependent).
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After the deductible, you pay copays or coinsurance based on your medication tier.
Key Points
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Part D is optional, but if you don’t enroll when first eligible and don’t have other credible prescription coverage, you may face a late enrollment penalty.
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Many Medicare Advantage (Part C) plans include Part D prescription coverage, so separate enrollment may not be needed if you choose a Medicare Advantage plan.