What is Medicare?

The Health Care Financing Administration (HCFA) administers Medicare, the Nations largest health insurance program, which covers 39 million Americans.

Medicare is a Health Insurance Program for people 65 years of age and older, some disabled people under 65 years of age, and people with End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant)

  • 65 years of age and older
  • Some people with disabilities, under 65 years of age
  • People with End-Stage renal Disease (permanent kidney failure requiring dialysis or a transplant)

Medicare has two parts:

  • Part A (Hospital Insurance)
    (Most people do not have to pay for Part A)
  • Part B (Medical Insurance)
    (Most people pay monthly for part B)

We deal with both types in the Nursing Home setting.

You have choices in how to get your health care

  • The Original Medicare Plan- Available almost everywhere in the U.S. This is the way most people get their Medicare Pat A and Part B benefits. You may go to any doctor, specialist, or hospital that accepts Medicare. Some things are not covered like prescription drugs.
  • Medicare Managed Care Plans- Like HMO’s, available in some areas of the country. You can go to doctors, specialists, or hospitals that are part of the plan. Some plans cover extras, like prescription drugs. Your out of pocket cost are lower than in the Original Medicare Plan.
  • Private Fee-for-Service Plans- This is a new Medicare health care choice in some areas. You may go to any doctor, specialist, or hospital. Plans must cover all Medicare Part A and B benefits. Some plans cover extras, like extra days in the hospital. The plan, not Medicare, decides how much you pay.

Who is eligible for Medicare?

Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are a younger person with a disability or with chronic kidney disease.

What do you have to pay to get Medicare?

You can get Part A at age 65 without having to pay premiums if:

  • You are already receiving retirement benefits from Social Security or the Railroad retirement board.
  • You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.
  • You or your spouse had Medicare-covered government employment

If you are under 65, you can get Part A without having to pay premiums if:

  • You have received Social Security or Railroad Retirement Board disability benefit for 24 months.
  • You are a kidney dialysis or kidney transplant patient.

While you do not have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it. The Part B monthly premium in 2000 is $45.50. It is deducted from your Social Security Check, railroad Retirement, or Civil Service Retirement check. If you do not get any of the above payments, Medicare sends you a bill for your part B premium every 3 months.

What Services are covered by Part A (Hospital Insurance)?

Pays for care in hospitals, skilled nursing facilities, hospice, and some home health care.

What Services are covered by Part B (Medical Insurance)?

Medicare Part B helps pay for doctors’ services, outpatient hospital care, blood, medical equipment and some home health services. It also pays for other medical services such as lab tests and physical and occupational therapy. Some preventative services such as mammograms and flu shots are also covered.

Medicare Part B does NOT cover routine physical exams; eye glasses; custodial care; dental care; dentures; routine foot care; hearing aides; orthopedic shoes; or cosmetic surgery. It does not cover most prescription drugs.

How do you Enroll in Medicare Part A & B?

Enrollment in Medicare is handled in two ways: either you are enrolled automatically or you have to apply.

How can I find out if I have Medicare Coverage?

Social Security information at 1-800-772-1213 or contact your local Social Security Office to verify your Medicare Part A and Part B coverage. This information can also be found on your red, white, and blue Medicare card.