Health Care

questions & answers

Question: What is Medicare?

Answer:

Medicare is a federal health insurance program that primarily covers Social Security recipients who are at least 65 years old or who are younger but have certain disabilities or who need kidney dialysis or a kidney transplant. 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 components:

Part A, often referred to as hospital insurance, covers inpatient hospital care, some skilled nursing, home health care and hospice care.

Part B, which has an $96.40 monthly premium (in 2009), helps pay for additional medical services. (It may cover physical and occupational therapy, for example, and some medically necessary home health care). This premium may change depending on the total income of the applicant.

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.) Under 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.
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.) Before enrolling in any plan, make sure it meets your particular needs.

For more personalized assistance, visit Medicare on-line, contact a Medicare representative or seek assistance from a State Health Insurance Assistance Program (SHIP) counselor by calling (800)432-4040.