5 Facts About Medicare
Medicare is a federally funded insurance program that was established in 1964. The following groups of people may be eligible for benefits:
• People who are at least 65 years old.
• People under 65 who have specific disabilities.
• People of all ages who have permanent renal failure that require dialysis.
People who still work at age 65 must enroll in Medicare Part A to receive benefits for expenses not covered by private insurance. A variety of private plans, called Medigap, that were designed to cover temporary gaps in benefits or supplement uncovered benefits are available to meet specific needs.
Medicare is divided into four categories and pays some of the costs for each of the following needs:
• Part A: hospital care for hospitalized patients, hospice, skilled nursing facilities, home health care.
• Part B: outpatient hospital care, doctor’s office visits, home health care; some expenses not covered by Part A
• Part C: certain types of preventive care; also called Medicare Advantage plans
• Part D: prescription drugs from companies approved by Medicare; help with recipes; possibly lower the prices of prescription drugs; also called Medicare prescription drug coverage.
1. Medicare and Medicaid are two completely different programs. Unlike Medicare, Medicaid is managed by the state and helps pay for the specific needs of people with low incomes. However, some people meet the requirements for both programs.
2. Medicare preventive services are designed to prevent illness or worsening. These services may include information, assessments, vaccinations and tests that help maintain healthy lifestyles. Patients who have had Part B for 12 months qualify for an annual “wellness” visit.
3. Medicare-approved private insurance companies provide coverage for Medicare C and D. These plans may involve additional costs.
4. Physicians must submit claims for patients covered by Original Medicare. Doctors are not required to file claims for patients who have Medicare Advantage because medical providers receive small monthly payments from these insurance companies.
5. Medicare generally does not pay for custodial care provided by nursing homes. However, patients who qualify for Medicaid may be eligible for these services. Negotiating benefits and annual health insurance changes can take a long time and be confusing. For detailed information and answers to specific questions, visit medicare.gov or call 1-800-Medicare.