Medicare Info

What is Medicare?
Medicare is a federal government health care program enacted in 1965. Often referred to today as “Original Medicare,” the program is primarily set up to provide medical expense coverage to persons over 65. The Health Care Financing Administration (HCFA) administers the Medicare program, which is a division of the U.S. Department of Health and Human Services.

The Medicare program is divided into two parts: Part A, for hospital and skilled nursing facility expenses…and Part B, for medical expenses such as doctor, outpatient facility and home health care charges. Each part has its own set of deductibles, co-payments and preapproved charges, which normally change each year.

Does Medicare cover all medical costs?
No. There are certain co-payments and deductibles you must pay. Medicare pre-assigns allowable charges for all kinds of illnesses, surgeries and procedures, when the cost of a medical procedure is more than Medicare’s “approved” charge, you have to pay the difference. This is why there are private insurance options, like Medicare Supplement Insurance, to help pay for the expenses Medicare does not cover.

The Medicare Program
Medicare is a federal health insurance program funded by taxable wages and administered by the Health Care Financing Administration (HCFA) of the U.S. Department of Health and Human Services. You or your spouse have already paid of a part of your coverage through taxes you paid when you were employed. Medicare helps seniors and people with disabilities pay of medical, hospital, skilled nursing care and home health care.

When you enroll in Part B of Medicare, you will pay additional monthly premium that is usually automatically deducted each month from your Social Security benefits. Your local Social Security Administration office accepts applications for Medicare and can provide general information to you about the program. Ask for a Medicare Handbook.

What is Covered Under Medicare?
Medicare Part A (Hospital Insurance) helps pay for your care in hospitals and skilled nursing facilities, and for home health care and hospice services. Medicare Part A has deductibles and co-payments you must pay.

What is Not covered Under Medicare

• Outpatient prescription drugs
• Routine physical examinations
• Eye glasses (except after cataract surgery)
• Custodial nursing care
• Dental Care
• Routine foot care
• Hearing Aids

Who is Eligible for Medicare Coverage?
At age 65 (or younger if you are disabled), you are eligible for Medicare if any of the following apply:

• You are eligible for Social Security benefits upon completing 10 years of employment, and during which time Social Security taxes were withheld.
• You are the spouse of a qualified wage earner who completed 10 years of employment, and during which time Social Security taxes were withheld.
• You are a qualified Railroad Retirement beneficiary.
• You meet the requirements for a federal government eligible for Social Security benefits if your work qualified as “covered work under the Social Security Act.

When You Should Enroll in Medicare
If you are Medicare eligible, you are automatically enrolled in Medicare Part A when you turn age 65. Or, if you are under 65, you are enrolled if you have received Social Security Disability benefits for 24 months, or Railroad Retirement disability benefits for the prescribed time and meet the Social Security Act disability requirements.

For Medicare Part B coverage:

• You are given a 3 month initial election period for you to enroll that begins three months before the month you first become Medicare eligible.
• There is an annual open enrollment period from January 1 through March 31 each year for if you do not enroll at age 65.
  (Note your Medicare Part B monthly premium will increase by 10% for each 12-month period you delay your enrollment in Medicare Part B monthly premium will increase by 10% for each 12-month period you delay your enrollment in Medicare).
• You can delay your Medicare Part B enrollment without experiencing a rise in premium if you are age 65 or older and you have group health insurance coverage based upon your own or your spouse’s employment; or, if you are disabled and have group insurance based upon your employment or the employment of any family member.

If you under age 65 and are entitled to Social Security disability benefits for 24 consecutive months, you are eligible for Medicare. If you have End-Stage Renal Disease that requires a kidney transplant or dialysis, you are eligible for Medicare at any age.

References:
Judith A. Stein and Alfred J Chiplin, Jr., Medicare Handbook, Aspen Publishers (2000).
2000 Guide to Health Insurance for People with Medicare, Health Care Financing Administration, U.S. Department of Health and Human Services. Request Product Information