Medicare and You

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What is Medicare? Medicare is a federally administered health insurance program for which most people age 65 years and over are eligible. It also helps those who have permanent kidney failure, and certain people with disabilities. Medicare has two parts: hospital insurance (Part A) and medical insurance (Part B). Typically, a Medicare recipient assumes some of the costs associated with medical care covered under the program. The Health Care Financing Administration (HCFA) oversees this federal program.

What are Medicare Health Plans? The different options you have for getting your Medicare benefits are called Medicare health plans. One option is the Original Medicare Plan. Another option is a Medicare Advantage Plan.  Private companies contract with the Medicare program to offer Medicare Advantage Plans. How you get your health care in the Medicare program depends on which health plan you choose. Depending on where you live, you may have more than one plan to choose from.

In 2008, Medicare offers the following types of Medicare Health Plans:

           The Original Medicare Plan - a fee-for service plan

           Medicare Advantage Plans, including:

           Medicare Health Maintenance Organization Plans (HMO)

           Medicare Preferred Provider Organization Plans (PPO)

           Medicare Special Needs Plans

           Medicare Private Fee-for-Service Plans

           Medicare Part D - Prescription plan

           Other Medicare Health Plans (that aren't Medicare Advantage Plans)

               Medicare Cost Plans

               Demostrations

               PACE

What is Medicare Part A? Medicare Part A (Hospital Insurance) helps cover you inpatient care in hospitals, critical access hospitals and skilled nursing facilities. It covers hospice care and some home health care under certain circumstances...learn more

What is the cost of Part A? For most people nothing. However, if you or your spouse did not pay Medicare taxes while you worked and you are 65 or older, you may be able to buy Part A. Look for the cost of Part A in Medicare Premiums for 2008.

What is Medicare Part B? Medicare Part B (Medical Insurance) helps cover your doctors' services, and outpatient hospital care.  It also covers some medical services that Part A does not cover, such as occupational and physical therapy, and some home health care. Part B pays for these supplies and services when they are medically necessary...learn more

What is the cost of Part B? You pay a premium of $58.70 per month in 2003. You will automatically be enrolled the first day of month that you turn age 65.  The cost of Part B may go up 10% for each 12 month period that you could have had Part B but did not sign up for it. Look for the cost of Part B in Medicare Premiums for 2007

When do I enroll for Medicare Part B? Enrolling in Part B is your choice. You can sign up for Part B during your initial enrollment period. It begins three months before you turn age 65. It ends three months after you turn age 65. If you are receiving Social Security or Railroad Retirement benefits, you are automatically enrolled in Part B starting the first day of the month that you turn age 65.  If you are under age 65 and disabled, you are automatically enrolled in Part B after you get Social Security or Railroad retirement for 24 months. 

When will Medicare cover prescriptions? Starting January 1, 2006, Medicare will offer insurance coverage for prescription drugs through Medicare prescriptions drug plans and other health plan options. Medicare's new prescription drug coverage will typically pay over half of your drug costs next year, for a monthly premium. It will also provide peace of mind because it protects you once your out-of-pocket drug spending is more than $3600 in a year. Even if you don't use a lot of prescription drugs now, you should consider joining. Learn more about the Medicare Prescription Drug Program

What preventative services are provided by Medicare? Under the Balanced Budget Act of 1997, the U.S. Congress provided a $115 Billion dollar savings plan for Medicare over the next five years. The budget agreement made critical provisions to control Medicare spending, reduce the amount of fraud in the current Medicare program, add preventive medical services, and increase the amount of choice for Medicare beneficiaries through the new "Medicare + Choice" program.

Preventive Services

• yearly mammograms and pap smear (for women)

• prostrate screening (for men)

• glaucoma screening

• diabetes glucose monitoring and diabetes education (for people with diabetes)

• colorectal cancer screening (for everyone)

• bone mass measurement

• Flu and pnemococcal shots also remain a benefit for all

Why would I need a Medigap policy? A Medigap or Medicare Supplement policy helps pay for your deductible and co-pay if you choose "The Original Medicare Plan". Learn more about the 10 Medicare Supplement Plans.

How can I get more information on Medicare? This information is included in the 2003 Guide to Health Insurance for People with Medicare. You can also call 1-800-MEDICARE for answers to your Medicare questions. You can go directly to the helpful page on Medicare's website by clicking on any of the links below:

Is there a guide on Medicare? Yes. Click on this link to download the 2007 Medicare and You Guide.

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Senior Care Concepts, 2008