Medicare was one of two bills passed as part of the Social Security Act of 1965. It is a medical insurance program that is designed for individuals who are over the age of 65, individuals who are under the age of 65 but who may have certain disabilities, and individuals of any age who may have been diagnosed with End-Stage Renal Disease (ESRD). ESRD is the term used for permanent kidney failure that may require dialysis treatment or a kidney transplant. Medicare provides coverage for over 40 million beneficiaries.
Types
The Medicare plan has four parts. There is Medicare Part A which provides hospital-only coverage. Most individuals, if eligible, do not have to pay for this coverage. Medicare Part B provides medical insurance coverage. Part B is optional and most individuals are required to pay a monthly premium for this coverage. Medicare Part C is also known as the Medicare Advantage Plan. As of 2003, Medicare also offers Part D, which helps to cover prescription expenses.
Coverage
Medicare Part A includes coverage for inpatient care in hospitals, nursing homes and skilled nursing facilities. It also covers home health services and hospice care. Medicare Part B helps to cover services and supplies, including ambulance services, diabetic screening and supplies, lab tests, preventive treatments and many other medically necessary services. Medicare Part C is a combination of both Part A and Part B and it covers all medically needed services. With Part C, individuals are required to use doctors and/or hospitals within their network. Only private insurance companies that are approved by Medicare provide Part C coverage. Medicare Part D is the prescription drug coverage that is also provided through private insurance companies approved by Medicare.
Eligibility
If you're over the age of 65 you can automatically receive Part A benefits without having to pay any premiums. You are eligible if you are already receiving Social Security retirement benefits and/or Railroad Retirement benefits. You would also be entitled to Part A benefits if you are eligible to receive the previously mentioned retirement benefits but have not filed for them yet. Another qualifying factor would be if you or your spouse worked for a Medicare-covered government employer. If an individual is under the age of 65, he can also receive Part A benefits without having to pay any premiums. To qualify, the individual must be receiving Social Security disability benefits or Railroad Retirement Board (RRB) disability benefits for at least 24 months.
ESRD Eligibility
Individuals who have been diagnosed with ESRD can receive Part A benefits at any age. There are certain conditions that determine eligibility. If you meet even one of these conditions, then you may be eligible. One condition is that you must have worked long enough under Social Security, the RRB, or as a government employee. Another condition is that you are already receiving or are eligible for Social Security and/or Railroad Retirement benefits. Lastly, you're eligible if you are the dependent child or the spouse of a person who has worked the essential amount of time under Social Security, the RRB, or as a government employee---or if they too are receiving Social Security, Federal retirement, or Railroad Retirement benefits.
Enrollment
For some, enrolling in Medicare is automatic. If you are almost 65 and already receiving Social Security Benefits, then you will be enrolled automatically in Part A and Part B within a month of your 65th birthday. Three months before your 65th birthday, you will receive your Medicare card in the mail. If you wish to opt out of the Part B coverage, you will just need to follow the instructions that came along with your Medicare card.
If you're almost 65 but you don't receive Social Security Benefits, then you would have the option of applying for both services at the same time. You will not be automatically enrolled. You must apply three months prior to your 65th birthday to ensure that Medicare coverage starts on time.
Individuals under the age of 65 or who are diagnosed with ESRD must make an appointment with their local Social Security office to speak with someone about enrollment.
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