| Medicare Primer | |
Program Purpose:
Medicare (Web site), created in 1965 as an amendment to the Social Security program, provides health insurance to persons age 65 and older, to qualifying persons under 65 with disabilities, and to persons of any age suffering from permanent kidney failure. Medicare should be considered as offering payment for the "basic" costs of health care. Not all medical expenses or the costs of long-term-care are covered. Medicare is the nation's largest health insurance program, currently covering over 39 million people.
Medicare or Medicaid?
These two programs are often confused. Medicaid is administered by state governments to assist persons with little or no income. The U.S. federal government helps support state Medicaid programs, but each state sets its own eligibility requirements and coverage details. Some persons may qualify for both federal Medicare and state Medicaid.
Medicare Eligibility:
U.S. citizens and non-citizens of lawful alien status may receive Medicare benefits. The following groups are currently entitled to Medicare benefits:
- Any person age 65 or older
- Any person, regardless of age, who has been entitled to Social Security or Railroad Retirement disability benefits for at least 24 months
- Any person, regardless of age, requiring continuing dialysis or kidney transplants
- Other elderly persons not covered by traditional health insurance who choose to buy into the Medicare program
[Complete eligibility details from the Centers for Medicare & Medicaid Services]
What Medicare Provides:
In its most simple form, Medicare provides two benefits - Hospital Insurance and Medical Insurance. Very brief descriptions of both are given here and you need to be aware that Medicare in an extremely complex program, with several options and costs depending on several factors. Persons with any questions about Medicare should be sure to call, toll-free, 1-800-MEDICARE (1-800-633-4227) to speak to a Medicare representative. People who are deaf or hard of hearing may call their toll-free TTY number, 1-800-325-0778.
- Hospital Insurance (Medicare Part A): Part A generally covers inpatient hospital care, care in critical access hospitals, skilled nursing facilities, hospice care, and some home health care. Most people get Part A automatically when they turn 65 and are not required to pay a monthly premium.
- Medical Insurance (Medicare Part B): Part B generally pays for doctors' fees and services, outpatient hospital care, and some medical costs not covered by Part A, like physical and occupational therapy. Part B will helps pay for some covered services only when they are declared medically necessary. Medicare Part B is not free. The current (2003) cost of Part B is $58.70 per month, but can be higher in some cases. Enrollment in Part B is completely optional. You can sign up for Part B anytime during a 7 month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-772-1213 to sign up.
Questions? Call 1-800-MEDICARE (1-800-633-4227) TTY number, 1-800-325-0778.
Also see: Your Medicare Benefits - Parts A and B (.pdf document - requires Adobe Acrobat Reader)
Enrolling in Medicare:
If you are already getting Social Security retirement or disability benefits, or Railroad Retirement checks, you should be contacted by Social Security shortly before you become eligible for Medicare. If not, contact your nearest Social Security office three months before your 65th birthday to sign up.
For more online Medicare information see: the Health Care Financing Administration site the Medicare site, and Social Security Online.
Important Medicare News:
About Medicare-approved Drug Discount Cards
As early as May 2004, almost anyone with Medicare will be eligible to enroll in the new Medicare-approved drug discount card program. The discount cards will be good until at least December 31, 2005.
Details of Medicare Prescription Drug Plan
This article presents the most current information regarding the Medicare Prescription Drug Improvement and Modernization Act of 2003 that you will need to help you make the best decisions regarding your Medicare coverage.
