Medicare 101  

Medicare is a federal government program that provides health insurance to people over age 65 (and to some people under age 65 with disabilities).

If you are eligible for Medicare, your coverage includes:

Medicare Part A, (Hospital Insurance) – includes inpatient hospital care, skilled nursing facilities and some home health care.  Part A has an annual deductible and co-payments.  There is no monthly premium for most people.

Medicare Part B, (Medical Insurance) – includes doctor visits but not routine exams, medically necessary medical supplies and equipment, physical and occupational therapy, outpatient mental health services and other outpatient hospital services.  Part B has a premium that is deducted from Social Security, Civil Service or Railroad Retirement pension benefits. In 2004, the monthly premium for Part B is $66.60.  There is an annual deductible of $100 and a co-payment of 20% of approved charges. 

What is not covered under Medicare? 

Medicare does not cover most long-term care and covers only limited home health care and nursing home costs – usually following a hospital stay. 
 
Medicare also does not currently cover out patient prescription drugs although legislation enacted in 2003 will create an optional prescription drug plan for Medicare, effective in 2006.  Medicare will also provide discount cards for prescription drugs in Spring 2004 as an interim measure until the new Medicare drug plans take effect. 

Who is eligible for Medicare? 

Generally, individuals are entitled to Medicare if they are 65 years old and have 40 quarters of work credit in covered employment or if their spouse is eligible for Medicare.  You do not have to be retired to enroll in Medicare and the eligibility age will remain 65 even after Social Security eligibility age rises to 67.  Younger individuals may qualify for coverage if they have a disability or end stage renal disease. 

New Medicare Part D (Prescription Drug Benefit) will begin paying benefits January 1, 2006.

 

In addition to enrolling in Medicare, many seniors purchase Medicare Supplement plans to cover the gaps in coverage (such as deductibles etc. ).

The top Health Insurance carriers that offer Medicare supplements include Blue Cross Blue Shield, and AARP