Medicare is a federal health insurance program that some people with cystic fibrosis may qualify for — especially adults who are receiving Social Security Disability Insurance (SSDI). If you are no longer able to work due to treatment demands or other health-related issues, SSDI might be an option for you.
After two years of receiving SSDI benefits, you will be eligible for Medicare. Most people who receive SSDI qualify for
Medicare may also be available to:
- People 65 years and older who qualify for benefits from the Social Security Administration (SSA) or the Railroad Retirement Board (RRB)
- People younger than 65 years who are receiving SSDI or people receiving certain disability benefits from the RRB
- People with end-stage renal disease, which is permanent kidney failure that requires dialysis or a transplant
Medicare is divided into four parts:
- Part A: Hospital insurance
- Part B: Medical insurance
- Part C: Medicare Advantage plans (offered by private companies)
- Part D: Prescription drug coverage (offered by private companies)
- Medicap: Supplemental plans (offered by private companies)
To see the full list of services covered under Medicare and their costs, visit medicare.gov.
Medicare Part A (Hospital Insurance)
Services typically covered under Medicare Part A include:
- Inpatient hospital care
- Skilled nursing facility care (not custodial or long-term care)
- Hospice care
- Home health care
Each Part A service comes with its own set of
Medicare Part B (Medical Insurance)
Medicare Part B helps pay for medical services received outside of the hospital, including doctor visits, outpatient services, some preventive care, and other medically necessary services, including some nebulized CF medications.
Medicare Part B typically covers:
- Services from doctors and other health care providers
- Outpatient care
- Diagnostic tests (blood work) and imaging (X-rays, CT, PET scans, MRIs)
- Home health care when homebound
- Durable medical equipment
- Some preventive services
- Ambulance services
- Emergency department services
- Many essential diabetic supplies
- Some prescription drugs (some nebulized CF medications are covered under Part B)
To receive Medicare Part B, you are required to pay a monthly insurance premium. Most people pay the standard premium amount, which is automatically deducted from your Social Security check each month. If you don’t sign up for Part B when first eligible for Medicare, you may be subject to financial penalties.
You can wait to sign up for Medicare Part B without a penalty if you or your spouse are still working and have health insurance through that job (if the employer has 20 or more employees). This gives you a
Out-of-pocket costs for Medicare Part B services vary. Generally, you will pay a
Medicare Advantage Plan (Part C)
Medicare Part C, also known as Medicare Advantage, is provided by Medicare-approved private insurance companies. The companies offering Advantage plans vary by geographical area (zip code and county). Medicare Advantage plans:
- Include all benefits and services covered under Medicare Parts A and B
- Cap Medicare Part A and B out-of-pocket costs, determined by the Centers for Medicare and
Medicaid Services (CMS), in the calendar year - Usually include prescription drug coverage under Medicare Part D
- May include additional benefits and services, such as dental, vision, food, wellness programs, non-emergency transportation, or home modification
- Cap
insulin products at $35 for a month's supply
While Medicare Advantage plans are required to follow Medicare guidelines, the amount paid for deductibles, co-payments, and/or coinsurance varies by plan. These plans usually have network restrictions, limiting which doctors and hospitals you can use.
If you choose to enroll in Medicare Advantage plans, you’ll usually pay a monthly premium depending on your plan, income, or where you live.
These rules can change each year, and the Medicare Advantage plan must notify the enrollee about any changes before the start of the next enrollment year.
Medicare Part D (Medicare Prescription Drug Plan)
Medicare Part D, also called Medicare Prescription Drug Plan, helps cover the cost of prescription drugs. It is an optional benefit offered by Medicare-approved private insurance companies. People with Medicare Parts A and B can choose to add Part D to their coverage. Medicare Part D plans:
- Cap annual out-of-pocket costs to limit cost sharing for the patient
- Offer a prescription payment plan
- Cap insulin products at $35 for a month's supply
If you choose to enroll in Part D, you’ll usually pay a monthly premium depending on your plan, income, and where you live. Each Part D plan has its own rules about deductibles. Some don’t have deductibles while others may cover certain drugs before the deductible is met.
Open enrollment occurs between Oct. 15 and Dec. 8.
Medicare Extra Help
Medicare Extra Help is a program from the Social Security Administration that helps people with limited income or resources pay for costs related to a Medicare prescription drug plan. To qualify, your income and savings must be below certain limits.
If you get Extra Help:
- Your monthly premiums and deductibles are set at $0
- You will pay reduced costs for generic and brand name drugs copays, which is changed annually by CMS
- You won't have to pay a late enrollment fee for Part D
- You may be allowed to change your Part D plan outside of the usual enrollment period
You automatically qualify for Medicare Extra Help if you:
- Have both Medicare and Medicaid (called full dual eligibility)
- Are in a Medicare Savings Program that helps with premiums and other costs
- Receive Supplemental Security Income (SSI) benefits, even if you don’t have Medicaid
Medicare Supplemental Plans (Medigap)
Medigap is a type of insurance that helps pay for costs not fully covered by Medicare Parts A and B, like deductibles and coinsurance. Medigap plans are offered by Medicare-approved private insurance companies.
To get a Medigap plan:
- You must have Medicare Part A and Part B
- You cannot have a Medicare Advantage and a Medigap plan at the same time
- You must pay a separate premium for a Medigap plan, in addition to your monthly Part B and Part D premiums
- Medigap plans cover only one person. Your spouse must have a separate individual policy, though you may be eligible for household discounts.
Because there is no annual enrollment period for these plans, you can drop Medigap at any time.
Medigap plans follow Medicare rules and only help pay for services covered by Parts A and B. They pay after Medicare pays its share.
Important things to remember:
- If you already have a Medicare Advantage Plan (Part C), you will not be able to purchase a Medigap plan unless you switch back to Medicare Parts A and B.
- Medigap plans do not cover prescription drugs, so you’ll need a separate Part D plan.
- Medigap plans are available in all states, but costs may be higher or limited for people under 65 in some areas.
Medigap plans are labeled A through N, and each lettered plan offers different levels of coverage. While many private insurance companies may offer coverage for the same lettered plan, they may charge different rates. However, it's important to know that the coverage offered will be the same, regardless of the company selling it.
Policies automatically renew, and you cannot be dropped unless premium payments are missed or your application includes misinformation
During the six-month open enrollment period, insurers cannot deny coverage or charge more due to pre-existing conditions, such as cystic fibrosis. However, insurers can impose a waiting period of up to six months for coverage of a pre-existing condition.
If you apply outside your open enrollment window, you may be denied or charged more due to health history
To compare plans and get a quote, visit medicare.gov.
Comparing Medicare Options
To explore specific Medicare Advantage plans or Medicare prescription drug plans available in your area, visit the Medicare Plan Finder. For more information about Medicare, download the Medicare & You official handbook.