Health Resources 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.