Medicare

The idea for a national health insurance plan such as Medicare first took shape with President Harry S. Truman in the 1940s. Two decades later, official legislation creating Medicare, health insurance for seniors, was signed into law by Lyndon Johnson with Truman as the first member. Since then, the program has grown and expanded to include prescription drugs and certain health treatments, regardless of age. The expansion of the program has lead to an increase in monthly premiums, service co-pays, and deductibles, but for many Americans it is their only guarantee of quality health care.

Eligibility

Medicare is generally available for United States citizens over the age of 65. In some cases, individuals with certain disabilities or conditions, such as Lou Gehrig’s disease or renal failure also qualify. Although you do not have to receive Social Security to qualify, anyone who is eligible for Social Security is automatically entitled to plan benefits.

To make sure you get coverage right away, you can sign up for the program as early as three months before you turn 65 and until three months after your birthday.

Medicare Coverage

There are several different plans that you can choose to take part in based on your health care needs and finances. If you have health insurance through employment, get your prescriptions covered as part of your retirement package, or belong to a health maintenance organization, you may decide to sign up for only part of the system. But, if you have no health care insurance coverage at all, you may opt to get the full Medicare plan. The two main segments to the program are Part A and B.

Part A

This plan covers inpatient hospital stays, hospice care, and nursing facilities. In some cases, it may cover home health care, but this is determined on a case-by-case basis.

There is no premium or co-payment for Medicare Part A after you turn 65 as long as you or your spouse paid into the program through your employment for at least 10 years. The premium and co-payment is also waived if you get benefits from Social Security or the Railroad Retirement Board. Citizens who do not meet these criteria can still get Part A, but will have to pay a monthly premium.

Part B

Offering general medical insurance, Part B provides coverage for physician’s visits, therapists, and some outpatient hospital procedures. This plan, however, carries a monthly co-payment, currently at $88.50 for 2006, which is automatically deducted from federal retirement payments like Social Security or the Civil Service Retirement plan. You can also pay by check if you don’t get the automatic deduction.

Other Plans

Medicare Advantage, or Part C, is an optional plan that provides managed care options and specialty plans, much like a private insurance company. It also expands some of the coverage in Part A. You will probably have an additional premium to take part in Advantage, but anyone already a recipient of Part A or B can opt for the coverage.

Prescription drugs are a new addition to the benefits package. Also known as Part D, this voluntary benefit was made available in 2006 to all recipients of other plan benefits. Although it carries an additional monthly payment, the plan will provide prescription medicine to many people who would otherwise pay out-of-pocket for drugs or go without. The enrollment period for Part D ended on May 15, but will reopen in November.
To learn the specifics about coverage and what co-payments are required for service, visit the Medicare Coverage Database.

Contacting Medicare

Using this government back program can be confusing, but there are several ways you can get answers to your questions. A toll-free hotline at 1-800-MEDICARE (1-800-633-4227) is available 24 hours a day in both English and Spanish. You can use this number to request literature, listen to frequently answered questions, or speak with a representative.

Benefits can also be managed online at the My Medicare website. After registering at the site, you can order cards, fill out claim forms, and view your plan information.

[tag]insurance,med[/tag]