Medicare is a Federal Government Health Insurance Program

• People age 65 or older, people under age 65 with certain disabilities, and people at any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant) are eligible for coverage.
• Coverage begins either the month the person turns age 65, the month after a beneficiary leaves an employer health plan, the month a person receives their 25th Social Security Disability payment, or the eligibility month after a person is diagnosed with End-Stage Renal Disease.
• All beneficiaries must enroll in Medicare through Social Security Administration to receive their Medicare eligibility.  A card with their random Medicare Health number will be sent to them indicating the effective dates of their eligibility. 
• U.S. Citizens and Legal residents must live in the US for at least 5 years in a row including the 5 years just before applying for Medicare to enroll.
• Medicare health plans do not work outside the United States. 

Part A

Most people become “eligible” for Part A by virtue of having worked and paid Medicare/Social Security taxes for a period of 40 quarters (ten years).  There is no additional monthly cost for Part A.  Part A covers:

Semiprivate room, meals, general nursing, and other hospital services and supplies. This includes inpatient care you get in critical access hospitals and mental health care. This doesn’t include private duty nursing, or a television or telephone in your room. It also doesn’t include a private room, unless medically necessary. Inpatient mental health care in a psychiatric facility is limited to 190 days in a lifetime costs. 

• Skilled Nursing Facility Care Semiprivate room, meals, skilled nursing and rehabilitative services, and other services and supplies (after a related 3-day inpatient hospital stay).
• Home Health Care Part-time or intermittent skilled nursing care and home health aide services, physical therapy, occupational therapy, speech-language therapy, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers), medical supplies, and other services.
• Hospice Care For people with a terminal illness, includes drugs for symptom control and pain relief, medical and support services from a Medicare-approved hospice, and other services not otherwise covered by Medicare. Hospice care is usually given in your home. However, Medicare covers some short-term hospital and inpatient respite care (care given to a hospice patient so that the usual caregiver can rest).
• Blood Pints of blood you get at a hospital or skilled nursing facility during a covered stay.

Part B

You will be enrolled in Part B unless you opt out when you become eligible for Medicare.  There is a monthly premium for this portion of coverage.  Part B covers doctor visits and all outpatient care.

• Medical and Other Services Doctors’ services (not routine physical exams), outpatient medical and surgical services and supplies, diagnostic tests, ambulatory surgery center facility fees for approved procedures, and durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers). Also covers second surgical opinions, outpatient mental health care, and outpatient occupational and physical therapy including speech-language therapy. (These services are also covered for long-term nursing home residents).
• Clinical Laboratory Services Blood tests, urinalysis, some screening tests, and more.

Most people pay for Part B as an automatic deduction if they are receiving Social Security benefits.  Those not receiving Social Security benefits make quarterly payments the first month of each quarter.  Each year Part B costs are reviewed by Medicare.  Unless there is a cost of living adjustment in Social Security, Part B costs cannot rise.  Costs are based on income and those with higher incomes pay more than the Standard deduction level.  Standard deduction varies for individuals who file taxes separately and for married couples who file jointly. Each year Medicare publishes the income/cost levels for that year. 

OPTION 1 –  ORIGINAL MEDICARE, A MEDIGAP SUPPLEMENT PLAN AND A PART D PLAN 

OPTION 1 –  ORIGINAL MEDICARE, A MEDIGAP SUPPLEMENT PLAN AND A PART D PLAN 

Original Medicare will cover 80% of your medical costs for everything that is covered by Medicare.  Medicare does not cover everything.  It is important to know this before your have any medical procedure done.  Ask your physician if the procedure they recommend is covered by Medicare.  You are responsible for the 20% Original Medicare does not cover.

OPTION 2 – MEDICARE ADVANTAGE PLANS

Today’s Medicare Advantage Plans (Part C) are about choices. Your health plan choices are:

• Medicare Managed Care Plans
• Medicare Private Fee-for-Service Plans
• Medicare Preferred Provider Organization Plans

The Medicare health plan that you choose affects many things such as: copay costs,  prescription drug coverage, choice of providers for primary care doctors, specialists, hospitals, rehab services, labs, outpatient care and other benefits, convenience, and quality of service. 

The Medicare health plan that you choose affects many things such as: copay costs,  prescription drug coverage, choice of providers for primary care doctors, specialists, hospitals, rehab services, labs, outpatient care and other benefits, convenience, and quality of service. 

Medicare Advantage Plans have a contract with Medicare but are offered and managed by private insurance companies. They are part of the Medicare Program and called “Part C.” When you join a Medicare Advantage Plan, you are still in Medicare. 

You must be enrolled in Part A and Part B to enroll in a Medicare Advantage Plans.  Many plans include prescription drug coverage. Plan benefits are contracted for one calendar year between the company and Medicare.   Every year during Annual Enrollment Period, beneficiaries have the option of choosing any Medicare Advantage plan offered in their service area.  Service areas are the counties and zip codes covered by plans.  Plans vary by county and zip code.