An Introduction To Medicare

Some basic facts about Medicare health care coverage.

Medicare is a form of federally funded health insurance provided to individuals who have permanent kidney failure, are disabled, or who are over 65 years old.

Any individual who applies for Social Security retirement or survivors’ benefits before he or she is 65 years old does not need to submit a separate application for Medicare; he or she will receive an Initial Enrollment Package in the mail three months before he or she turns 65. At this time, all individuals receive this packet, which includes coverage information, a Medicare card, and a questionnaire. Medicare automatically begins at age 65 if an individual is receiving disability, Railroad Replacement, Social Security, or other benefits regardless of whether or not an individual has his or her Medicare card. Individuals who are younger than 65 and who have received Railroad Retirement Disability or Social Security checks for 24 months are also eligible for Medicare.

To obtain or replace a Medicare card, you should have your loved one’s Medicare number ready and contact the Social Security Administration in one of these three ways:

  • Look up your local office in the Yellow Pages under “US Government” or “Social Security Administration”
  • Call the toll-free number 1-800-772-1213 and request the local phone number
  • Apply online on the Social Security Internet site http://www.ssa.gov/medicareonly/

Medicare Coverage

Medicare consists of two types of insurance, including hospital insurance (Part A) and medical insurance (Part B). Part A covers certain types of follow-up care and inpatient hospital care. Individuals who have worked for at least 10 years for an employer participating in the Medicare program can qualify for Medicare. The Social Security taxes paid while individuals are still working fund Part A fees.

Part B pays for doctor’s services and some services not covered by hospital insurance. These can include:

  • Arm, leg, back, and neck braces
  • Breast prostheses following a mastectomy
  • Diabetic supplies, including blood glucose test strips, glucose control solutions, glucose testing monitors, lancets, and spring powered devices for lancets
  • Immunosuppressive drugs for transplant patients
  • Medical equipment, including oxygen and wheelchairs
  • One pair of eyeglasses with an intra-ocular lens after cataract surgery
  • Oral anti-cancer drugs
  • Medical supplies, including ostomy bags, surgical dressings, splints, and casts

Medicare Plan B does not cover:

  • Cosmetic surgery
  • Custodial care
  • Dental care
  • Eye glasses
  • Hearing aids
  • Orthopedic shoes
  • Prescription drugs or health care obtained outside the U.S.
  • Routine foot care
  • Routine physical exams

Part B also covers some nursing facility services, and home health services.

Premiums And Coinsurance

If your loved one is eligible for Medicare coverage, he or she may have to pay certain premiums and coinsurance rates according to Medicare regulations. Once your loved one has a Medicare card, his or her doctor will normally file any claims with Medicare. When the doctor has done so, your loved one will receive a statement showing the amount that he or she needs to pay. If he or she has supplemental insurance or Medigap coverage, these will help to pay for part of the health care costs.

Additionally, some low-income individuals qualify for state aid, which is used to pay Medicare premiums, deductibles, and coinsurance. If your loved one has an income limited to $4,000 (or $6,000 per couple, if your loved one is married), he or she may qualify for Qualified Medicare Beneficiary (QMB) or Specified Low Income Medicare Beneficiary (SLMB) assistance programs. QMB pays for Part B premiums, deductibles, and coinsurance. SLMB helps pay the Part B premium. To find out if your loved one qualifies for aid, contact his or her state Medicare office.

Choosing A Plan

Your loved one also has several different options when choosing a Medicare plan. For instance, if your loved one already has adequate health insurance, he or she may decide not to participate in Medicare Part B. To opt out of Part B, your loved one needs to place an “X” in the refusal box on the enrollment form, sign the form, and mail it back to the Social Security Administration when the Initial Enrollment Package is received.

If your loved one does not initially choose to opt out of Part B he or she can always do so in the future. Additionally, if your loved one initially opts out of Part B he or she can choose to enroll in January, February, or March of any year, and coverage will begin July 1st.

Your loved one can switch Medicare plans or disenroll from a plan if he or she wishes to. If he or she would like to switch plans or quit a Medicare program your loved one can do so in one of three ways:

  • Call the plan and request a disenrollment form
  • Call 1-800-MEDICARE (1-800-633-4227) and request that his or her disenrollment be processed over the phone
  • Call or visit the Social Security Administration and file a disenrollment request

If your loved one switches plans he or she will be automatically disenrolled from the old plan when the new plan is activated. Normally, this disenrollment will be completed the following month if he or she files it before the 10th day of the month.

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