Medicare

What is Medicare?

Medicare is an insurance program that has been around for more than 40 years.  Medicare was created as part of the Great Society programs started by Presidents Kennedy and Johnson.  It falls under Title XVIII of the Social Security Act and was created to protect the elderly and disabled citizens against the rising costs of medical and hospital care.  The program will continue to exist in one form or another even if healthcare reform bills pass over the next few years.

Medicare has Two Parts:

• Part A (Hospital Insurance) – Most people don’t have to pay for Part A.
• Part B (Medical Insurance) – Most people pay monthly for Part B.

Who is Eligible?

To be eligible for Medicare you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years or older and a citizen or permanent resident of the United States. If you aren’t yet 65, you might also qualify for coverage if you have a disability or with End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant).

Generally, to be eligible for Medicare you must be:

• an American citizen, either by birth or naturalization.
• age 65 or older.
• under the age of 65 with certain disabilities.
• diagnosed with end stage renal disease.

One common myth is that people are eligible for Medicare if they are receiving Social Security Benifits.  This is not accurate unless the person meets the eligibility requirements above.

Medicare Part A (Hospital Insurance)

Medicare Part A provides insurance assistance for care in hospitals as an inpatient, critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas), skilled nursing facilities (not custodial or long-term care), hospice care, and some home health care.

Most individuals get Part A automatically when they turn age 65.  Individuals normally don’t have to pay a monthly premium for Part A because they or a spouse paid Medicare taxes while they were working.

Individuals that don’t automatically get premium-free Part A may be able to buy it if:

• They (or their spouse) aren’t entitled to Social Security because they didn’t work or didn’t pay enough Medicare taxes while they worked.  The individual must be age 65 or older.
• They are disabled but no longer get premium-free Part A because they returned to work.

Medicare Part B (Medical Insurance)

Medicare Part B provides insurance assistance for doctors’ services, outpatient hospital care, and some other medical services that Medicare Part A doesn’t cover, such as the services of physical and occupational therapists, and some home health care. Medicare Part B helps pay for these covered services and supplies when they are medically necessary.

Most individuals pay the Medicare Part B premium of $96.40 per month in 2009.  This amount may change January 1, 2010.  In some cases this amount may be higher if you didn’t choose Part B when you first became eligible at age 65. Individuals should apply for Medicare Part B during their initial enrollment period.  The initial enrollment period is a seven month period surrounding their 65th birthday.   The cost of Part B may go up 10% for each 12-month period that you could have had Part B but did not sign up for it, except in special cases.  You will have to pay this extra 10% as long as you have Medicare Part B.

Need Help with a Medicare Problem?

Click here to find a Claims Assistance Professional near you.