Medicare Benefits

Medicare Overview

The Medicare System was established in 1965 by Lyndon B. Johnson to provide health care services to retired U.S. citizens over the age of 65. Medicare has been changed and modified over the decades to include more benefits and to reduce the costs.

Participants in Medicare usually have deductibles or co-payments that they need to make. They may also need to transfer their care to physicians and medical centers that are approved by Medicare.

There are several different plans within the Medicare System, allowing participants to choose the options they need the most.

Medicare Eligibility

Before you worry about which Medicare benefits are right for you, you need to make sure you are eligible to receive them. In most cases, you can begin receiving Medicare when you reach age 65 and have worked for at least 10 years. You must also be a United States citizen.

Exceptions to this rule are younger disabled people or patients with kidney failure. You are also eligible for Medicare if you receive or qualify for railroad or social security benefits.

To find out if you qualify for Medicare or to apply for Medicare benefits, contact your local Social Security office or call 1-800-772-1213.

Medicare Plan A Benefits

This plan covers hospital visits and related expenses. There is generally no cost for Plan A, making it the standard that most people carry. Plan A covers:

• Inpatient hospital stays, including your room, supplies, nursing care, and meals
• A nursing facility if necessary after a hospital visit
• In-home nursing care ordered by your doctor
• Hospice care if dealing with a terminal illness

Medicare Plan B Benefits

Participants in Medicare Plan B pay a monthly premium of about $88 for this service (in 2006). It is an optional plan that many people take advantage of rather than relying on medical coverage related to their retirement benefits or paying for private coverage. This is similar to typical health insurance that covers doctor visits and routine care. Plan B also covers:

• Outpatient surgery and testing
• Mental health treatment
• Therapy services like rehabilitation and speech-language pathology
• At-home medical equipment and supplies

Medicare Plan B also provides for certain preventative testing like diabetes and cardiovascular screenings, mammograms, bone density scans, and flu shots.

Medicare Prescription Benefits

Prescription drug coverage, also known as Part D, is a relatively new Medicare benefit, having just been introduced in early 2006. This coverage is available for all Medicare beneficiaries to help cover the costs of prescription medicine, both generic and name-brand. The drug program comes with a monthly premium around $32, but the premium may be waived based on low-income or lack of resources. Most participants also have a $250 deductible each year. After meeting the deductible, participants will be responsible for paying 25 percent of their annual prescription costs up to $2,250.

Medicare Advantage

Since 1987, Medicare beneficiaries can choose to have their plan administered by a private health insurance company. These companies are approved by Medicare and vary by coverage area. These Medicare Advantage plans provide additional coverage through HMOs, PPOs, and fee-for-services. You will need to visit doctors and hospitals that are approved through the plan, but you will usually enjoy more benefits and less out-of-pocket expenses than with the traditional Medicare plans. Some of these plans also offer prescription drug benefits.

Contacting Medicare

If you have more questions about your Medicare benefits, you can visit the Medicare website or call them at 1-800-MEDICARE (1-800-633-4227) or 1-877-486-2048 for TTY.