Medicare

Those who have worked for a time in the United States, and their spouse, are generally eligible for Medicare. The age of eligibility is 65, unless there is a disability involved, in which case one may be younger to qualify.

A person who is 65, a legal resident of the United States and has been so continuously for 5 years, may be eligible to buy into Medicare by buying into Part A and also Part B coverage of Medicare. The buy-in amount varies and can be determined for you by workers in your local Social Security office.

Even if you are not going to file for Social Security at 65, FILE FOR MEDICARE at 65. If you delay filing, it may cost you more money to file later!

Medicare is divided into Part A and Part B coverage.

Part A, provided free of patient premiums to those who have worked the necessary number of quarters, includes:

  • In-patient hospital care for up to 90 days in a benefit period.
  • A Benefit Period ends when you’ve been out of the hospital 60 consecutive days.
  • There is no limit to how many benefit periods you can have.
  • There are 60 reserve hospital days that can be used in any benefit period.
  • There is a deductible of $840 per hospital stay per benefit period.
  • The deductible is paid by the patient (or a medigap insurance provider).
  • From 61-90 days there is a per day co-pay.
  • Inpatient care in a participating skilled nursing facility
  • Home health care (distinguished from non-medical home help)
  • Hospice care

Part B is provided at a premium “which most people pay through an automatic deduction from their social security check” and helps pay for:

  • Doctor services.
  • Outpatient hospital care.
  • Diagnostic tests.
  • Durable medical equipment.
  • Ambulance services.
  • Many other health services/supplies, not covered by Part A.
  • Part B deduction is $78.20 per month starting in 2005 with a $110 deductible.

If you live in a rural area Medicare regulations enable some reimbursement of home care visits. Your closest Social Security Office can provide details regarding availability in your state. This is another segment of trying to provide better services overall for seniors in rural regions of the country. Earlier efforts to provide for rural patients was approval of limited telehealth services for “teleradiology” and “telepathology”.

Some seniors qualify for Supplemental Security Income Program (SSI) because of a “disability” or other exceptional circumstance and “low income”. Eligibility for maximum payments under SSI are reduced by “countable” income and assets beyond home ownership. Some states supplement the SSI payment from Medicare when a qualified recipient lives in a care home. SSI recipients may also qualify for additional help I.e. food stamps or Medicaid.

Medicare and SSI information provided here is meant to be a primer, and a place to start. It is not meant to replace information available from Medicare. The Medicare Hotline is 1.800.633.4227.

 

Medicare Insurance Providers:

 

 

           

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