Medicare is our country's basic health insurance program for people age 65 or older and many people with disabilities. You should not confuse Medicare and Medicaid. Medicaid is a health care program for people with low income and limited resources. It is usually run by state welfare or social services agencies. Some people qualify for one or the other, while some people qualify for both Medicare and Medicaid.
Medicare is a health insurance program for:
1. people age 65 or older,
2. people under age 65 with certain disabilities, and
3. people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
Four parts of Medicare
1. Part A: Hospital Insurance
Hospital insurance (Part A) helps pay for inpatient hospital care and certain follow-up services. Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.
Most people get hospital insurance when they turn 65. You qualify for it automatically if you are eligible for Social Security or Railroad Retirement benefits. Or you may qualify based on a spouse's (including a divorced spouse's) work. Others qualify because they are government employees not covered by Social Security who paid the Medicare tax. If you get Social Security disability benefits for 24 months, you will qualify for hospital insurance. If you get Social Security disability benefits because you have amyotrophic lateral sclerosis (Lou Gehrig's disease), you do not have to wait 24 months to qualify. Also, people who have permanent kidney failure that requires maintenance dialysis or a kidney replacement qualify for hospital insurance if they have worked long enough or if they are the spouse or child of a worker who qualifies.
2. Part B: Medical Insurance
Medical insurance (Part B) helps pay for doctors' services, outpatient hospital care and other
medical services. Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.
Almost anyone who is eligible for hospital insurance can sign up for medical insurance. Part B is an optional program. It is not free. In 2009, the standard monthly premium is $96.40. Some people with higher incomes pay higher premiums.
3. Part C: Medicare Advantage Plan
Medicare Advantage plans (Part C) are available in many areas. People with Medicare Parts A and B can choose to receive all of their health care services through a provider organization under Part C. You might have to pay a monthly premium because of the extra benefits the Medicare Advantage plan offers. Types of plans are: Medicare managed care plans, Medicare preferred provider organization (PPO) plans, Medicare private fee-for-service plans, and Medicare specialty plans.
Anyone who has Medicare hospital insurance (Part A) and medical insurance (Part B) can join a Medicare Advantage plan.
4. Part D: Prescription Drug Coverage
Prescription drug coverage (Part D) helps pay for medications doctors prescribe for medical treatment. Most people will pay a monthly premium for this coverage. Starting January 1, 2006, new Medicare prescription drug coverage will be available to everyone with Medicare. Everyone with Medicare can get this coverage that may help lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.
Anyone who has Medicare hospital insurance (Part A) or medical insurance (Part B) or a Medicare Advantage plan (Part C) is eligible for prescription drug coverage (Part D). Prescription insurance is optional, and you pay an additional monthly premium for the coverage.
The Medicare & You Handbook
The Medicare & You Handbook is mailed to you each autumn, via Standard U.S. Mail. This handbook contains important information about health plans, prescription drug plans, and rights and protections and it helps you review your coverage options and prepare to enroll in a new plan. It is available in both English and Spanish.
When you choose to get the Medicare & You Handbook electronically, an email will be sent to you each year, which contains a link to the most current version of the Medicare & You Handbook. By getting the handbook electronically, you will help save millions of tax dollars in paper, printing and postage costs, you will have links to the most recent information to help you compare plans in your area, and you can bookmark your electronic Handbook as a 'Favorite' for easy access.
Medicare expenses for people with low income. If you have a low income and few resources, your state may pay your Medicare premiums and, in some cases, other "out-of-pocket" medical expenses, such as deductibles and coinsurance. Only your state can decide whether you qualify for help under this program. If you think you qualify, contact your state or local medical assistance (Medicaid) agency, social services or welfare office. You can go online to get more information about this program from the Centers for Medicare & Medicaid Services (CMS) website. Visit www.medicare.gov and request If you need help paying Medicare costs, there are programs that can help you save money. If you have limited income and resources, you may qualify for extra help to pay for your prescription drugs under Medicare Part D. To see if you qualify or to apply, call Social Security or visit their website. 1-800-772-1213 [ Link ]
For more information, visit [ Link ] or call 1-800-MEDICARE (1-800-633-4227)