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Medicare. By: Taylor Davis Sociology 431. Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

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Medicare

Medicare

By: Taylor Davis

Sociology 431


What is medicare

What is Medicare?


Different parts of medicare

  • Medicare Part A (Hospital Insurance) who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

    • Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

  • Medicare Part B (Medical Insurance)

    • Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.

Different Parts Of Medicare


Continued

  • Medicare Part C (Medicare Advantage Plans) who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

    • A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren't paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.

Continued…


Continued1

  • Medicare Part D (prescription drug coverage) who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

    • Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

Continued…


How do i decide

  • Step 1: Decide if you want Original Medicare or a Medicare Advantage Plan

  • Step 2: Decide if you want prescription drug coverage (Part D)

  • Step 3: Decide if you want supplemental coverage (Original Medicare only)

    • You may want to get coverage that fills gaps in Original Medicare coverage. You can choose to buy a Medicare Supplement Insurance (Medigap) policy from a private company.

      • Costs vary by policy and company.

      • Employers/unions may offer similar coverage.

How do I decide?


Who can enroll

Anyone Advantage Planwho meets the Medicare eligibility requirements can enroll in a Medicare plan. Medicare eligibility is determined primarily by age, but can be determined by disability or diagnosis under certain circumstances. In general, you are eligible for Medicare enrollment if you are a U.S. citizen or permanent resident of the United States and have worked (or have a spouse who has worked) for at least 10 years in Medicare-covered employment. In addition, you must either:

  • Be over the age of 65,

  • Be under the age of 65 with a particular disability, or

  • Have been diagnosed with End-Stage Renal Disease (i.e. kidney failure).

Who Can enroll?


How do you apply

  • You can apply quick and easy online Advantage Plan

  • You can go to your local security office

  • For more information about applying for Medicare only and delaying retirement benefits, visit Applying for Medicare Only – Before You Decide.

How do You Apply?


Medicare health plan

A plan offered by a private company that contracts with Medicare to provide Part A and Part B benefits to people with Medicare who enroll in the plan. Medicare health plans include all Medicare Advantage Plans, Medicare Cost Plans, Demonstration/Pilot Programs, and Programs of All-inclusive Care for the Elderly (PACE).

  • Medicare Advantage Plans

  • Medicare Savings Account (MSA) Plans

  • Other Medicare health plans

  • Medicare Cost Plans

  • Demonstrations/Pilot Programs

  • Programs of All-inclusive Care for the Elderly (PACE)

  • Medication Therapy Management (MTM) programs for complex health needs

Medicare Health Plan


Factors that affect original medicare out of pocket costs

  • Whether you have Part A and/or Part B. Most people have both.

  • Whether your doctor, other health care provider, or supplier accepts assignment.

  • The type of health care you need and how often you need it.

  • Whether you choose to get services or supplies Medicare doesn't cover. If you do, you pay all the costs unless you have other insurance that covers it.

  • Whether you have other health insurance that works with Medicare.

  • Whether you have Medicaid or get state help paying your Medicare costs.

  • Whether you have a Medicare Supplement Insurance (Medigap) policy.

  • Whether you and your doctor or other health care provider sign a private contract.

Factors that affect Original Medicare out-of-pocket costs


What does it cover

Part A both.

  • Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, as well as skilled nursing facility, hospice, and home health care.

    Part B

    • Medicare Part B (Medical Insurance) helps cover doctor and other health care providers' services, outpatient care, durable medical equipment, home health care, and some preventive services.

What does it cover?


For more information

Phone both.

  • 1-800-MEDICARE (1-800-633-4227)

    • For specific billing questions and questions about your claims, medical records, or expenses, visit MyMedicare.gov, or call 1-800-MEDICARE.

    • If you want someone to be able to call 1-800-MEDICARE on your behalf or you want Medicare to give your personal information to someone other than you, you need to fill out a "Medicare Authorization to Disclose Personal Health Information."

For More Information


References

  • http://www.cms.gov both./

  • http://www.medicare.com/

  • http://www.socialsecurity.gov/medicareonly/

  • http://www.socialsecurity.gov/pubs/media/pdf/EN-05-10043.pdf

References


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