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Medicare is
a federal program that provides health insurance to retired
individuals, regardless of their medical condition. Here are
some basic facts about Medicare that
you should know.
What
does Medicare cover?
Medicare coverage
consists of two main parts: Medicare Part
A (hospital insurance) and
Medicare Part
B (medical insurance). A third part, Medicare Part
C (Medicare Advantage),
is a program that allows you to choose among several types of
health-care plans. A fourth part,
Medicare Part
D, offers prescription drug coverage that can help you handle
the rising costs of prescriptions.
Medicare Part
A (hospital insurance)
Generally
known as hospital insurance, Part A covers services associated
with inpatient hospital care. These are the costs associated
with an overnight stay in a hospital, skilled nursing facility,
or psychiatric hospital, including charges for the hospital
room, meals, and nursing services. Part A also covers hospice
care and home health care.
Medicare Part
B (medical insurance)
Generally
known as medical insurance, Part B covers other medical care.
Physician care--whether you received it as an inpatient at a
hospital, as an outpatient at a hospital or other health-care
facility, or at a doctor's office--is covered under Part B.
Laboratory tests, physical therapy or rehabilitation services,
and ambulance service are also covered.
Medicare Part
C (Medicare Advantage)
The 1997
Balanced Budget Act expanded the kinds of private health-care
plans that may offer
Medicare benefits
to include managed care plans and private fee-for-service plans. Medicare
Part C
programs are in addition to the fee-for-service options
available under Medicare Parts
A and B. Medicare Part
C programs vary, but generally provide all Medicare-covered
benefits. Many also offer extra benefits, including prescription
drug coverage, and coverage for additional days in the hospital.
Medicare Part
D (prescription drug coverage)
All Medicare beneficiaries
are eligible to join a Medicare prescription
drug plan offered by private companies or insurers that have
been approved by Medicare.
Although these plans vary in price and benefits, they all cover
a broad number of brand name and generic drugs available at
local pharmacies or through the mail. Medicare prescription
drug coverage is voluntary, but if you decide to join a plan,
keep in mind that some plans cover more drugs or offer a wider
selection of pharmacies (for a higher premium) than others. You
can get information and help with comparing plans on the Medicare website,
www.medicare.gov,
or by calling a Medicarecounselor
at 1-800-Medicare.
What is
not covered by Medicare Parts
A and B?
Some
medical expenses are not covered by either Part A or B. These
expenses include:
-
Your Part B premium
-
Deductibles,
coinsurance, or co-payments that apply
- Most
prescription drugs
- Dental care
- Hearing aids
- Eye care
-
Custodial care at home or in a
nursing home
Medicare Part
C may cover some of these expenses, or you can purchase a
supplemental Medigap insurance policy that will help cover what Medicare does
not.
Are you
eligible for Medicare?
Most
people age 65 or older who are citizens or permanent residents
of the United States are eligible for Medicare Part
A (hospital insurance) without paying a monthly premium. You are
eligible at age 65 if:
-
You receive or are eligible to
receive Social Security or Railroad Retirement Board
benefits based on your own work record or on someone else's
work record (as a spouse, divorced spouse, widow, widower,
divorced widow, divorced widower, or parent), or
-
You or your spouse
worked long enough in a government job where Medicare taxes
were paid
In
addition, if you are under age 65, you can get Part A without
paying a monthly premium if you have received Social Security or
Railroad Retirement Board disability benefits for 24 months, or
if you are on kidney dialysis or are a kidney transplant
patient.
Even if
you're not eligible for free Part A coverage, you may still be
able to purchase it by paying a premium. Call the Social
Security Administration (SSA) at (800) 772-1213 for more
information.
Although Medicare Part
B (medical insurance) is optional, most people sign up for it.
If you want to join a Medicare managed
care plan or a Medicare private
fee-for-service plan, you'll need to enroll in both Parts A and
B. And Medicare Part
B is never free--you'll pay a monthly premium for it, even if
you are eligible for premium-free Medicare Part
A.
How much
does Medicare cost?
Medicare deductible
amounts and premiums change annually. Here's what you'll pay for
Medicare in
2010:
| |
Premium |
Deductible |
Coinsurance |
|
Part A (hospital) |
None for most people, but noneligible individuals pay
either $254 per month (if they have 30 to 39 quarters of Medicare-covered
employment) or $461 per month (if they have 29 or fewer
quarters of Medicare-covered
employment) |
$1,100 per benefit period |
$275 a day for the 61st to 90th day each benefit period;
$550 a day for the 91st to 150th day for each lifetime
reserve day (total of 60 lifetime reserve days); up to
$137.50 a day for the 21st to 100th day each benefit
period for skilled nursing facility care |
|
Part B (medical) |
$96.40 per month (Most people will pay this premium, but
certain beneficiaries will pay more--see note below) |
$155 per year |
After satisfying a deductible, you normally pay 20
percent of the approved amount for medical expenses (50
percent for outpatient mental health services, 20
percent for hospital charges for outpatient hospital
services, nothing for laboratory services) |
Note:
Your monthly Medicare Part
B premium will be $110.50 if you did not have the Social
Security Administration withhold your premium in 2009. You will
pay an even higher premium if you file an individual income tax
return and your annual modified adjusted gross income is more
than $85,000, or if you file a joint income tax return and your
annual modified adjusted gross income is more than $170,000 (in
2010). For more information, visit www.medicare.gov.
Since Medicare doesn't
cover every type of medical care, and you'll have to pay
deductibles and coinsurance, you may want to buy a Medicare supplemental
insurance (Medigap) policy.
Who
administers the Medicare program?
The
Centers for Medicare &
Medicaid Services (formerly known as the Health Care Financing
Administration), a division of the U.S. Department of Health and
Human Services, has overall responsibility for administering the Medicare program
and sets standards and policies. But it's the SSA that processes Medicare applications
and answers questions about eligibility.
However,
as a beneficiary, you deal mostly with the private insurance
companies that actually handle the claims on the local level for
individuals with Medicare coverage.
Insurance companies that handle Medicare Part
A claims are known as Medicare intermediaries,
and insurance companies that handle Part B claims are known as Medicare carriers.
Managed care plans handle Part C claims. Although the same
private insurance company may handle both Part A and Part B
claims, Part A and Part B are very different in regard to
administration (e.g., different deductibles and co-payment
requirements). There is virtually no overlap; it is as if you
have two separate health insurance policies.
How do
you sign up for Medicare?
Any
individual who is receiving Social Security benefits will
automatically be enrolled in MedicareParts
A and B at age 65 when he or she becomes eligible. If you are
not receiving Social Security benefits before age 65, you will
be automatically enrolled when you apply for benefits at age 65.
But if you decide to delay retirement until after age 65,
remember to enroll in Medicare Parts
A and B at age 65 anyway, because your enrollment won't be
automatic. If you're going to be automatically enrolled in Medicare,
you'll receive an initial enrollment package by mail from the
SSA, usually three months before your 65th birthday.
Of
course, even if you sign up for Part A, you don't have to enroll
in Part B, or you can decide to delay enrolling. But first,
carefully read the information contained in your initial
enrollment package. It explains the consequences of not
enrolling at age 65 (e.g., you may have to pay a higher premium
later) and will help you learn more about the Medicare program.
For more
information about enrolling in Medicare,
call the SSA at (800) 772-1213.
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