Medicare Overview

The Centers for Medicare & Medicaid Services (CMS) administers the Medicare program. CMS is mandated by the United States Department of Health and Human Services. The Medicare program provides medical care for elderly and disabled citizens or permanent residents of the United States.

You are eligible for Medicare if meet the following requirements.

• You or your spouse were employed for at least 10 years
• You are 65 years or older
• You are a citizen or permanent resident of the United States.

You may also be eligible if you are disabled and eligible for Social Security Benefits or if you have End-Stage Renal Disease.

If you receive Social Security Benefits, you may automatically be enrolled in Medicare. If you are eligible for Medicare but do not receive Social Security Benefits, follow the link below and complete the online form. If you are a widow or widower, please contact Social Security at 1-800-772-1213 for further assistance.

Medicare Eligibility Form: :raw-html:`<a href="http://www.medicare.gov/MedicareEligibility/" target="_blank">http://www.medicare.gov/MedicareEligibility/</a>`

Once you are eligible, there are 4 parts of Medicare to learn; Part A, Part B, Part C, and Part D. If you are eligible for Medicare, you will be automatically enrolled in Medicare Part A and Medicare Part B. Once enrolled, you can check coverage for costs and services here: :raw-html:`<a href="http://www.medicare.gov/Coverage/Home.asp" target="_blank">http://www.medicare.gov/Coverage/Home.asp</a>` Medicare Part C and Medicare Part D are optional plans that provide additional coverages through private insurance companies contracted with the CMS.

Medicare Part A - Hospital Insurance is free and provides limited coverage for approved inpatient care in hospitals, skilled nursing facilities, hospices, and home health care.

Medicare Part B - Medical Insurance costs a minimum of $110.50 (in 2010) per month and provides coverage for doctors' services, outpatient care, home health care, preventative services, and maintenance services. You may pay more monthly depending on how much "adjusted gross income" you reported on your Income Tax Return filed 2 years before you are eligible for the Medicare program. Part B covers similar to a Traditional Insurance Plan, in that, you must pay an annual deductible ($155.00 in 2010) before the plan would pay 80% toward any approved medical expenses. You would be responsible for paying the remaining 20% of the bill.

When you become eligible for Medicare and enroll in Part A, you will also be enrolled in Part B. Any monthly premium would be automatically deducted from your Social Security Benefit check. You can choose to decline to participate in Part B. However, if you change your mind and decide to carry Part B later you may be required to pay a late enrollment penalty and your monthly premiums may increase 10% for each full year you were eligible for Part B. States have programs that help provide financial assistance for the premiums, deductibles, and coinsurance. To qualify for financial assistance, most States require that you are enrolled in Medicare Part A and report low monthly income.

Medicare Part C - Medicare Advantage Plans are offered through private insurance companies contracted with the CMS. These companies may offer types of Health Maintenance Organization (HMO) Plans, Preferred Provider Organizations (PPO) Plans, Private Fee for Service (PFFS) Plans, Medical Savings Account (MSA) Pans, and Special Needs (SNP) Plans. To be eligible for Part C, you would need to have Part A, pay for Part B, and pay an additional premium for Part C. Some of these plans also cover prescription drugs, hearing, dental, and vision services.

• Private Fee-For-Service (PFFS) Plan Members through this plan are not required to use a network of providers. A PFFS plan is required to cover costs and services described under Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) and usually also covers hearing, dental, vision, and some prescription drugs. The member would have to be enrolled in Part A (Hospital Insurance), pay the monthly premium for Part B (Medical Insurance), and pay the monthly premium for the Part C (PFFS Plan). Additional "out of pocket" expenses would include a co-payment for each doctor visit and percentage of major medical services. PFFS plans are managed the State departments.

Medicare Part D - Medicare Prescription Drug Coverage helps cover the cost of prescription drugs. The plan is maintained by a private insurance company contracted with the Medicare Program.