Medicare is the health insurance program administered by the federal Centers for Medicare & Medicaid Services (CMS) for people 65 years of age or older, people of any age with permanent kidney failure, and some disabled individuals under age 65. Although Medicare may pay a large part of your health care expenses, it does not pay for them all. Some services and medical supplies are not fully covered. A handbook titled Medicare and You 2007 is available free from any Social Security office. The handbook provides a detailed explanation of Medicare.

Individuals are generally eligible for Medicare if:

• They or a spouse worked for at least ten years in Medicare-covered employment.

• They are 65 years old.

• They are a citizen or permanent resident of the United States.

• Younger individuals with a disability or with permanent kidney failure (requiring dialysis or transplant) may also qualify for coverage.

Types:

Medicare is divided into two types of coverage, Part A and Part B.

• Medicare Part A (Hospital Insurance) helps cover your medically necessary inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. You must meet certain conditions to get these benefits.

• Medicare Part B (Medical Insurance) helps cover your doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Specific Limitations:

Medicare was not designed to pay all your health care expenses. It does not cover long-term care expenses. Medicare provides limited coverage for skilled nursing care and for home health care.

Medicare Plans:

•  The Original Medicare Plan – This is a fee-for-service plan that covers many health care services and certain drugs. You can go to any doctor or hospital that accepts Medicare. When you get your health care, you use your red, white, and blue Medicare card.

The Original Medicare Plan pays for many health care services and supplies, but it doesn’t pay all of your health care costs. There are costs that you must pay, like coinsurance, copayments, and deductibles. These costs are called “gaps” in Medicare coverage. You might want to consider buying a Medigap policy to cover these gaps in Medicare coverage. You can also add prescription drug coverage by joining a Medicare Prescription Drug Plan.

• Medicare Advantage Plans – Available in many areas. If you have one of these plans, you don’t need a Medigap policy. These plans include:

1.       Health Maintenance Organizations (HMO),

2.       Preferred Provider Organizations (PPO)

3.       Private Fee-for-Service Plans

4.       Medicare Special Needs Plans

5.       Medicare Medical Savings Account Plans (MSA)

These plans may cover more services and have lower out-of-pocket costs than the Original Medicare Plan. Some plans cover prescription drugs. In some plans, like HMOs, you may only be able to see certain doctors or go to certain hospitals to get covered services.

•  Medicare Prescription Drug Plans – These stand-alone plans add prescription drug coverage to the Original Medicare Plan, some Medicare Cost Plans, some Medicare Private Fee-for-Service Plans and Medicare Medical Savings Account

Last Updated on 9/24/2007