MEDICARE: Explained

MEDICARE

Q. WHAT IS MEDICARE?

Medicare is a government health insurance program for persons over 65. A worker begins making contributions to Medicare in his first paychecks through the Federal Insurance Contributions Act or FICA although these are not premiums.

There are many varieties of the program.

You can have original Medicare coverage that provides payment for in patient and outpatient services or a Medicare Advantage plan.

THE FOUR PARTS OF MEDICARE

PART A

This is hospital insurance that will pay for inpatient care or extended stays in a skilled nursing facility for up to 100 days if discharge into outpatient care is likely. There are also some home health care and hospice care services Part A will pay for. This is part of what is referred to as original Medicare because it is provided directly by the government. Medicare does not pay for long term nursing home care that exceeds 100 days or if it is apparent at the beginning of admission that it is unlikely the patient will be discharged from long term care.

PART B

This is insurance that pays for outpatient care including doctor visits, visits to other health care providers, therapists, medical equipment and some preventive services. When the government pays for these services directly, it is part of original Medicare. When you receive these services from an organization or private company other than the government, it is called a Medicare Advantage plan. If there are services or products that you need that are not provided by original Medicare, you can buy a ‘Medigap’ policy that does.

PART C

‘Medicare Advantage’ plans combine both Plans A and B as well as prescription drugs and extra benefits and services. Medicare Advantage plans can provide extra coverage and lower expenses especially when there is an incentive for an insurance company to earn your patronage. With Medicare Advantage plans, Medigap policies are unnecessary because they are duplicative.

PART D

Exclusively governs prescription drug coverage. If you have Part A or Part B you are eligible for Part D. Medicare Advantage includes a variety of prescription plans. Supplemental prescription plans are also available in the form of Medigap plans.

Q. IS MEDICARE THE SAME AS MEDICAID?

Medicaid is a program run by the individual states to assist low income families and individuals pay for health services. For more information on Michigan’s Medicaid program go to https://www.michigan.gov/mdhhs.

Q. CAN I QUALIFY FOR MEDICARE PART A BENEFITS WITHOUT PAYING PREMIUMS?

You must be over 65 years old.

You must be a citizen or a permanent resident.

You must be receiving or eligible to receive Social Security benefits;

You can qualify if you have a spouse who is receiving or eligible to receive Social Security benefits. It may be a current spouse or an ex-spouse.

You can qualify if you or your spouse was a government employee who paid Medicare taxes for a specific period.

You can also qualify for Medicare Part A benefits if you are a parent who was dependent on a fully insured child who has since passed.

Even if you do not qualify for free Medicare Part A services, you can still receive these benefits by paying premiums.

Q. WILL BENEFITS UNDER PART B ALSO BE FREE?

If a person qualifies for Medicare Part A at no cost, they can enroll in Part B by paying a monthly premium. The premiums will usually be higher for persons with higher incomes.

If you are not eligible for Part A at no cost, you are allowed to purchase Part B without having to purchase Part A providing you are a US citizen or

A lawfully admitted noncitizen who has lived in the United States for 5 years.

Q. CAN I ENROLL IN PART B ANYTIME I WANT?

The annual enrollment Medicare open enrollment period is from October 15 through December 7 each year.

If you miss the designated enrollment period when you are first eligible, you may have to pay a late fee as long as you have Part B coverage.