Health Care Article


Medicare

Medicare is a federal health insurance program that primarily covers Social Security recipients who are at least 65 years old. It also covers those who are younger but have certain disabilities, need kidney dialysis or a kidney transplant. Note that Income level and assets have no bearing on an individual’s eligibility for coverage.

 

Generally, Medicare participants may choose between the Original Medicare Plan, a Medicare Advantage Plan (HMO, PPO, special needs and private fee-for-service plans) and, in some instances, other Medicare health plans that are only available in certain parts of the country. The participant pays the deductibles, co-payments and, in some cases, a monthly premium. Medicare then pays the rest of the tab for covered services.

 

The program has three parts:

  • Part A, referred to as hospital insurance, covers inpatient hospital care, some skilled nursing and home health care and hospice care.
  • Part B, which has an $115.40 monthly premium (in 2011), helps pay for additional medical services. (It may cover physical and occupational therapy, for example, and some medically necessary home health care). This premium can change depending on your income.
  • Part D was launched in 2006 to provide prescription drug coverage. If you have very little income or currently receive certain other government benefits, you may qualify for greater help with your prescription drug bills.

More about Part D

All Medicare beneficiaries now qualify for prescription drug coverage. As a beneficiary, you can choose from a variety of Medicare-approved prescription drug plans. Keep in mind that these private insurance plans may have different premiums, deductibles, co-payments and lists of covered prescription drugs. There is also the Medicare Advantage Plan that covers physician and hospital care as well as prescription drugs. Before enrolling in any plan, make sure it meets your particular needs.

In addition, you may not need to enroll at all. You may already have a Medicare-approved prescription drug plan through Veteran Affairs, for example, or your employer, former employer, union or existing Medicare Advantage Plan. (If you are uncertain, contact your benefits advisor for guidance.)

Personalized Assistance

You have choices once enrolled in Medicare. For help in understanding Medicare and other health care options, eligibility, benefits, cost sharing programs, long term care insurance and claim filing, contact the State Health Insurance Assistance Program (SHIP) toll free at (800)432-4040.

SHIP is a free health benefits counseling service for Medicare beneficiaries and their families or caregivers. SHIP counselors are specialists trained in health insurance counseling, Medicare laws and regulations. Ship counselors are not connected with any insurance company.

You might also want to check out Medicare’s Official Web site for more indepth information about Medicare programs.


Comments:

QUESTIONS

  • My parents are on social security income only and we are evaluating whether to put my Dad in a nursing home. He would most likely be eligible for ALTCS. My parents own their home and it is the only asset left to support my mother. I heard that a nursing home can take half the house value if the house is sold within 3 years of my father entering a facility. Can the home be put into a trust for my mother or sold to a family member before my father enters a nursing home to avoid this?
  • My mother is 85 and being treated by a naturopathic doctor. My sister and I are concerned that the care she is getting is harming her overall health. We have contacted the Naturopathic Physician Medical Board to file a complaint. They are willing to move forward and subpoena her medical records for review. The problem is that they say there is no way to keep this physician from mentioning it to our mother. We feel that our mother puts an abnormal amount of "faith" in this physician and that she has been, for lack of a better word, "brainwashed" into believing that he can do no harm. We want to proceed without fear that he will convince my mother that we are "the bad guys." What do we need to do to proceed without fear that he will discuss this with our mother? Any suggestions or guidance would be greatly appreciated.
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  • My mother's second husband (married 3 years) agrees with my brothers and I that my mother has progressing memory degeneration. We have asked her to get a check up for her own good. Her husband will not help us get her to go for a check up. Is there anything we can do?
  • I have a question dealing with statute of limitations. I had cosmetic surgery in July 2017. Afterwards I had Ramsey Hunt Syndrome in my left ear. I have lost balance and dizziness problems due to the damage. I had tests performed by a doctor in fall of 2019 which diagnosed the extent of damage from this. Would the statute of limitations be from date of Ramsey Hunt diagnosis or could it be from the date the damage was measured and diagnosed by a doctor?
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  • if i lost my gun rights (due to going to prison) but waited 12 years after getting out and started buying guns , and then got charged with misconduct with weapons. Because i did not know i had to file something, but after my arrest i have filed and got my civil and gun rights back, but am facing a class 4 felony and 4.5 years in prison. Is this beatable in trial due to to the fact i have my rights back now, after my new arrest though. Please help ASAP
  • What are rules for Medicaid recipients with regard to the other spouses rights? I'm planning for if I would have to go to a Nursing Home.

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