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More About Medicare

Click on the following for an overview of and its coverage:

The Medicare Program
What is Covered Under Medicare
What is Not Covered Under Medicare
Who is Eligible for Medicare Coverage
When You Should Enroll in Medicare

The Medicare Program Medicare is a federal health insurance program funded by taxable wages and administered by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services. You or your spouse have already paid for part of your coverage through taxes you paid when you were employed. Medicare helps seniors and people with disabilities pay for medical, hospital, skilled nursing care and home health care.

When you enroll in Part B of Medicare, you will pay an additional monthly premium that is usually automatically deducted each month from your Social Security benefits. In calendar year 2018, the monthly Part B premium is $134.00.

Medicare is divided into two parts: Hospital Insurance, under Part A and Medical Insurance, under
Part B.

Your local Social Security Administration office accepts applications for Medicare and can provide general information to you about the program. Ask for a Medicare Handbook.

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What is Covered Under Medicare Medicare Part A (Hospital Insurance) helps pay for your care in hospitals and skilled nursing facilities, and for home health care and hospice care. Medicare Part A has deductibles and copayments you must pay.

For example, in calendar year 2018, for inpatient hospital services you are required to pay:
  • $1340.00 as a deductible for each hospital benefit period (a benefit period begins with the first day of a Medicare covered hospital stay and ends with the close of a period of 60 days straight during which no inpatient care is received);
  • $335.00 each day for days 61-90 in a hospital;
  • $670.00 for days 91-150. These days are referred to as "lifetime reserve days" in a hospital and can be used only once.
  • $167.50 each day for days 21-100 in a skilled nursing facility.
  • $5.00 for outpatient prescription drugs related to hospice care and [5%] of the Medicare approved amount for inpatient respite care.
Medicare Part B (Medical Insurance) helps pay for outpatient hospital care and physician services, subject to deductibles and payments you must pay. For most of the services, you pay:
  • $183.00 as a deductible each calendar year;
  • 20% of Medicare's approved amounts;
  • "Excess charges" up to 15% above Medicare's approved amounts, but only if your doctor does not participate in the Medicare program.
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What is Not Covered Under Medicare Although Medicare helps with your health care costs, it does not pay for everything. You are responsible for deductibles and coinsurance amounts. Generally, Medicare does NOT cover:
  • Routine physical examinations
  • Eye glasses (except after cataract surgery)
  • Custodial nursing care
  • Dental care
  • Routine foot care
  • Hearing aids
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Who is Eligible for Medicare Coverage At age 65 (or younger if you are disabled), you are eligible for Medicare if any of the following apply:
  • You are eligible for Social Security benefits upon completing 10 years of employment, and during which time Social Security taxes were withheld.
  • You are the spouse of a qualified wage earner who completed 10 years of employment, and during which time Social Security taxes were withheld.
  • You are a qualified Railroad Retirement beneficiary.
  • You meet the requirements for a special transitional provision.
  • You are an employee of the federal government eligible for Social Security benefits if your work qualified as "covered work" under the Social Security Act.
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When You Should Enroll in Medicare If you are Medicare eligible, you are automatically enrolled in Medicare Part A when you turn age 65. Or, if you are under 65, you are enrolled if you have received Social Security disability benefits for 24 months, or Railroad Retirement disability benefits for the prescribed time and meet the Social Security Act disability requirements.

For Medicare Part B coverage:
  • You are given a 3 month initial election period for you to enroll that begins three months before the month you first become Medicare eligible.
  • There is an annual open enrollment period from January 1 through March 31 each year for if you do not enroll at age 65. (Note your Medicare Part B monthly premium will increase by 10% for each 12-month period you delay your enrollment in Medicare).
  • You can delay your Medicare Part B enrollment without experiencing a rise in premium if you are age 65 or older and you have group health insurance coverage based upon your own or your spouse's employment; or, if you are disabled and have group insurance based upon your employment or the employment of any family member.
If you are under age 65 and are entitled to Social Security disability benefits for 24 consecutive months, you are eligible for Medicare. If you have End-Stage Renal Disease that requires a kidney transplant or dialysis, you are eligible for Medicare at any age.

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References: Judith A. Stein and Alfred J. Chiplin, Jr., Medicare Handbook, Aspen Publishers (2010).

This is a commercial message from Equitable Life & Casualty Insurance Company, a private insurance company which is not connected with or endorsed by the United States Government or the federal Medicare program.