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Medicare Overview
Medicare is run by the Health Care Finance Administration of the Department of Health and Humans Services. Medicare is a health plan offered by the United States government to eligible US Citizens for a free charge or at an affordable rate, depending on the plans you choose. Depending on the plan/coverage you choose, you will either work directly with the Health Care Finance Administration or with a private insurer who will handle the paperwork and the claims.
Medicare is a 4 part health coverage, where each part covers a different aspect of health care: Medicare A, Medicare B, Medicare C, Medicare D. The combination of Medicare Part A and Medicare Part B is called Original Medicare or Traditional Medicare. Traditional Medicare covers most of the medical expenses but not all, where Medicare Part C comes in to supplement. Part C, also known as Medicare Advantage, can be purchased with a private insurance company which has a contract with Medicare. Part C is the combination of Part A and Part B plus more benefits. Part D is coverage specifically for prescription drugs and can be added to your Traditional Medicare plan or to your Medicare Advantage plan if it doesn't cover prescription drugs.
Who is Eligible for Medicare?
Medicare is a health care plan for you if you meet the requirements below:
- If you're 65 years of age or older
Or, if you're under age 65 years with certain
disabilities
Or, if you're at any age with End-Stage Renal Disease (permanent kidney failure
requiring dialysis or a kidney transplant).
- If you receive or are eligible to receive Social Security or Railroad Retirement Board benefits based on your own work record (40 or more quarters of US based employment) or on someone else's work record (such as a spouse, divorced spouse, widow, widower, divorced widow, divorced widower, or parent), or
- You or your spouse worked long enough in a government job where Medicare taxes were paid.
- Or, if you are under age 65, you can get Part A without paying a monthly premium if you have received Social Security or Railroad Retirement Board disability benefits for 24 months, or if you are on kidney dialysis or are a kidney transplant patient.
Note: Even if you're not eligible for free Part A coverage, you may still be able to purchase it by paying a premium. For example, if you've worked 39 quarters or less in the US, then you are not eligible for free Medicare Part A, but you can purchase Medicare Part A at a discounted rate. Call the Social Security Administration (SSA) at (800) 772-1213 for more information. Click here if you're a new immigrant who would like medicare coverage.
Medicare Enrollment
There are 2 enrollment periods where you can enroll in Medicare:
- The Initial Enrollment Period is a duration of 7 months. These 7 months include the month you become eligible for medicare (your 65th birthday), 3 months before and 3 months after. You are automatically enrolled in Medicare Part A and Part B and will receive a medicare handbook and a medicare card during the initial period. You have the option of changing your medicare options at this point; the details are explained in the medicare packet.
- The General Enrollment Period starts from January 1st to March 31st each year. If you decline your enrollment or were not enrolled for other reasons during your Initial Enrollment Period, than the General Enrollment Period is when you can re-enroll when you are ready to be covered by Medicare. If you enroll during the General Enrollment Period, your coverage will begin on July 1st of that year.
How do you sign up for Medicare?
Any individual who is receiving Social Security benefits will automatically be enrolled in Medicare Parts A and B at age 65 when he or she becomes eligible. If you are not receiving Social Security benefits before age 65, you will be automatically enrolled when you apply for benefits at age 65 at retirement. But
if you decide to delay retirement until after age 65, remember to enroll in Medicare Parts A and B at age 65 anyway, because your enrollment won't be automatic. Call 1800.MEDICARE for more information and enrollment.
If you're going to be automatically enrolled in Medicare, you'll receive an initial enrollment package by mail from the SSA, usually three months before your 65th birthday. Of course, even if you sign up for Part A, you don't have to enroll in Part B, or you can decide to
delay enrolling. But first, carefully read the information contained in your initial enrollment package. It explains the consequences of not enrolling at age 65 (e.g., you may have to pay a higher premium later) and will help you learn more about the Medicare program.
For more information about Medicare Enrollment, call the SSA at (800) 772-1213.
Understanding your Medicare Options
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Part A+B: Original Medicare |
Alternative to Original Medicare (Parts A+B) |
An Addition to Original Medicare or Part C |
| Medicare |
Part A |
Part B |
Part C |
Part D |
| |
Hospital Care |
Medical insurance |
Medicare Advantage |
Prescription Drug |
| Services: |
Services associated with hospital, hospice, skilled nursing care, and home health care. |
Physician services, outpatient hospital care, and many other services typically covered under medical plans. |
Original Medicare covered services with extra benefits not covered by Original Medicare. |
Provides insurance for prescription drugs. |
| Premium: |
$0 Premium for eligible US citizens |
Premiums paid by you and by contributions from the federal government. |
Varied premiums paid by you and by contributions from the federal government. |
Varied premiums paid by you and by contributions from the federal government. |
| Out-of-Pocket Expense: |
You pay for co-payments and deductibles. |
You pay for co-payments and deductibles. |
You pay for co-payments and deductibles. |
You pay for co-payments and deductibles. |
| Enrollment: |
Automatic as of age 65 for eligible participants. You'll be sent a booklet with details on date of eligibility. |
Automatic with Part A during the Initial Enrollment Period. |
Must be enrolled in both Plan A+B first; then Part C replaces Part A+B.
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You can either enroll as a stand alone prescription drug plan (PDP) or as an addition to Part C. |
| Purchasing: |
Free |
Premium/month: 2007 - is based on your income
2006 - $88.50 |
Available from insurance companies that have a contract with Medicare. |
Available from insurance companies that have a contract with Medicare. |
You can have the following combinations with Medicare?
The medicare combination you choose will depend on your own personal health care requirements.
Medicare for Immigrants
If you're a recent immigrant to the United States and are 65 years or older, it will be tough for you to get reasonably priced health care coverage with decent coverage. For US citizens who have worked in the US for 40 quarters or more have the option of free Medical insurance, in the form of Medicare. If you don't qualify for free medicare, you can still purchase Parts A and B if the following is true:
- You're 65 years or older.
- You’re a recent United States citizen by naturalization and haven't worked enough quarters to have social security coverage.
- Or, you're a lawful admitted alien (greencard holder) and have lived in the United States 5 years or longer continuously and don't qualify for social security benefits.
The first step to purchasing medicare is to enroll in Medicare Part B by calling 1800.MEDICARE (1800.633.4227). After your purchase of Medicare Part B, you can then enroll in Medicare Part A. The premium for Part A is $393/month for 2006 and $410/month for 2007.
For more information call: 1800.MEDICARE (1800.633.4227) or visit www.medicare.gov
>> Understanding Medicare Part A, B, C & D |
