About Medicare

Old Woman in a WheelchairWhat is the difference between Medicare and Medicaid?

Medicaid is a need-based health care program for people with low income and limited assets. Medicare is the country’s basic health insurance program for people 65 and older and many people with disabilities. Medicare Part A provides hospital insurance that helps pay for inpatient hospital care and certain follow-up services. Medicare Part B helps pay for doctors’ services, outpatient hospital care and other medical services. Part B is optional.

How do I apply for Medicare?

One is eligible for Medicare Part A upon turning 65 years old. You are automatically qualified if you receive social security or railroad benefits upon turning 65. You also qualify if you have been receiving social security disability benefits for 24 months. You may also qualify on a spouse’s record, even if you are divorced. Government employees not covered by social security who paid the Medicare part of social security tax also qualify, as do people who have permanent kidney failure that requires maintenance dialysis or a kidney replacement if they are insured or if they are the spouse or child of an insured worker. Anyone who is eligible for free Medicare hospital insurance (Part A) can enroll in Part B by paying the monthly premium. Part B is optional and costs $96.40 per month (in 2008) if you choose to enroll.

If you are receiving social security benefits upon turning 65, enrollment in Medicare Part A is automatic. If you turn 65 and plan to keep working, but do not plan to sign up for social security benefits, you should call 1-800-722-1213 or visit a local social security office to discuss whether you should sign up for Medicare only. Please be advised that there are many other rules associated with Medicare enrollment including penalties for not enrolling in Part B when you are first eligible. You may call the toll free number or discuss this with a local social security office.

I am disabled and unable to work. Does my disability entitle me to Medicare benefits?

Yes, you qualify for Medicare Part A if you have been receiving social security benefits for 24 months. You also qualify if you have permanent kidney failure that requires maintenance dialysis or a kidney replacement, if you are insured or if you are the spouse or child of an insured worker. In order to have Part B coverage, you must enroll and pay the monthly premium.

Are my spouse and minor children also eligible to receive Medicare benefits?

Generally, only U.S. citizens or permanent U.S. residents 65 years of age and older are eligible for Medicare. They or their spouse must have worked for at least ten years in Medicare-covered employment. Disabled people under 65 years of age, receiving social security disability for two years and people with end-stage renal disease (permanent kidney failure treated with dialysis or a transplant) are also eligible.

Do I have to pay a premium to receive Medicaid benefits?

Medicare Part A is free if you are eligible because it has been paid for through your taxes while you worked. However, Part B, which is optional, has an additional cost of $96.40 per month (in 2008) should you choose to enroll.

If I am disabled and require home health care, will I be entitled to receive Medicare coverage to pay for my home care?

Medicare provides basic health care coverage only. Medicare does not pay for custodial care, which is care that can be given safely and reasonably by a person who is not medically skilled and is given mainly to help the patient with daily living. This includes help with walking, bathing and dressing. However, if you receive a skilled service such as occupational therapy, physical therapy or speech therapy or need a registered nurse to monitor your care, you may be eligible for up to 20 hours of home health aide coverage if you are housebound. Housebound means that you are unable to leave your home without assistance.

If I need nursing home care, will Medicare cover my stay?

Medicare covers up to 100 days of skilled care. The first 20 days are covered in full and the remaining days are covered with a co-insurance of $128.00/day in 2008.

What routine services does Medicare cover?

Medicare Part A covers in-patient hospital care, home health services and hospice care. The in-patient hospital services covered include semi-private rooms, meals, regular nursing services, special care such as coronary or intensive care, drugs furnished by the hospital, laboratory tests billed by the hospital, x-rays and radiology services, therapy billed by the hospital, medical supplies including casts and splints, operating and recovery room costs and use of appliances such as wheelchairs. Medicare Part B mostly covers physician services, such as physician services rendered while one is in the hospital. However, there may be limitations to the coverage.

Medicare does not cover most nursing home care; dental care and dentures; routine checkups and the tests directly related to these checkups (some screening, Pap smears and mammograms are covered); most immunization shots (some flu and pneumonia shots are covered); most prescription drugs; routine foot care; tests for, and the cost of, eyeglasses or hearing aids; personal comfort items, such as a phone or TV in your hospital room; and services outside the U.S.

My spouse died and he or she was receiving Medicare. What benefits will continue for me as a surviving spouse?

You are eligible if you are a U.S. citizen or permanent U.S. resident 65 years of age or older and if your spouse has worked for at least ten years in Medicare-covered employment.