Medicare is a federal program that
provides health insurance to retired individuals, regardless
of their medical condition. Below are some basic facts about
Medicare you should know.
What does Medicare cover?
Medicare coverage consists of two parts--Medicare Part A
(hospital insurance) and Medicare Part B (medical
insurance). A third part, Medicare Part C (Medicare+Choice)
is a program that allows you to choose from several types of
Medicare Part A (hospital insurance)
Generally known as hospital insurance, Part A covers
services associated with inpatient hospital care (i.e., the
costs associated with an overnight stay in a hospital,
skilled nursing facility, or psychiatric hospital, such as
charges for the hospital room, meals, and nursing services).
Part A also covers hospice care and home health care.
Medicare Part B (medical insurance)
Generally known as medical insurance, Part B covers other
medical care. Physician care--whether it was received while
you were an inpatient at a hospital, at a doctor's office,
or as an outpatient at a hospital or other health-care
facility--is covered under Part B. Also covered are
laboratory tests, physical therapy or rehabilitation
services, and ambulance service.
Medicare Part C (Medicare+Choice)
The 1997 Balanced Budget Act expanded the kinds of private
health-care plans that may offer Medicare benefits to
include managed care plans, medical savings accounts, and
private fee-for-service plans. The new Medicare Part C
programs are in addition to the fee-for-service options
available under Medicare Parts A and B.
Are you eligible for Medicare?
Most people become eligible for Medicare upon reaching age
65 and becoming eligible for Social Security retirement
benefits. In addition, you may be eligible if you are
disabled or have end-stage renal disease.
Who administers the Medicare program?
The Health Care Financing Administration (HCFA), a division
of the U.S. Department of Health and Human Services, has
overall responsibility for administering the Medicare
program. Although the Social Security Administration
processes Medicare applications and claims, the HCFA sets
standards and policies.
However, as a beneficiary, you deal mostly
with the private insurance companies that actually handle
the claims on the local level for individuals receiving
Medicare coverage. Insurance companies handling Medicare
Part A claims are called Medicare intermediaries, and
insurance companies handling Part B claims are called
Medicare carriers. Managed care plans handle Part C claims.
Although the same private insurance company may handle both
Part A and Part B claims, Part A and Part B are very
different in regard to administration (e.g., different
deductibles and co-payment requirements). There is virtually
no overlap; it is as if you have two separate health
How do you sign up for Medicare?
Any individual who is receiving Social Security benefits
will automatically be enrolled in Medicare at age 65 when he
or she becomes eligible. If you are not receiving Social
Security benefits prior to age 65, you will be automatically
enrolled when you apply for benefits at age 65. However, if
you decide to delay retirement until after age 65, remember
to enroll in Medicare at age 65 anyway, because your
enrollment won't be automatic. Individuals who will be
automatically enrolled in Medicare will receive notification
by mail from the Social Security Administration, usually
three months before their 65th birthday.
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Please Note: The
information contained in this Web site is provided solely as a source of
general information and resource. It is a not a statement of
contract and coverage may not apply in all areas or circumstances. For a complete
description of coverages, always read the insurance policy, including