Understanding Medicare

|   Basic facts in everyday language

WHAT IS MEDICARE?
Medicare is our federal government's health insurance program for people 65 and better (and for some people with disabilities). Original Medicare has two parts:

1. Part A — Hospital Insurance
   This part is paid for from the Social Security (FICA) taxes deducted from your paycheck, and from contributions by your employer.
2. Part B — Medical Insurance
   You pay a monthly premium when you enroll in this part of Medicare.

IS EVERYONE ELIGIBLE FOR ORIGINAL MEDICARE?
Eligibility varies. People age 65 and better are eligible for Part A if (1) they are getting (or are entitled to) Social Security or Railroad Retirement benefits, or (2) they have been a government employee for the required number of years. If you don't qualify for Part A, you might still be able to enroll if you pay a monthly premium. Nearly everyone 65 or better is eligible for Part B.

WHAT DOES PART A (HOSPITAL INSURENCE) COVER?
Medicare Part A helps pay for:

1. Hospital Care
   Up to 90 days per benefit period are covered. (A benefit period starts when you are admitted to the hospital and ends when you have not received hospital care or skilled care for 60 days in a row.) Your Part A Hospital Insurance will cover the first 60 days after the first $1,068. For the next 30 days, Medicare will cover all covered costs beyond $267 per day.
2. Skilled Nursing or Rehabilitative Care
   After a hospital stay of at least three days, your stay in a Medicare-certified Skilled Nursing Center can be covered at 100% for the first 20 days. For the next 80 days, Medicare Part A covers everything except the daily co-insurance.
3. Home Health Care
   If you need follow-up healthcare in your own home, Part A pays the approved cost of covered services, including part-time skilled nursing or home care aide; physical, speech, and occupational therapy; medical social services; and medical supplies.
4. Hospice Care
   If you are certified as terminally ill, Medicare Part A pays covered costs associate with Hospice. Outpatient drugs and Respite Care are partially covered.

WHAT ELSE DO I NEED TO KNOW ABOUT MEDICARE PART A?

1. Be sure that the care you receive is from a hospital, facility, or in-home care provider that is Medicare-certified. (The Skilled Nursing, Rehabilitation, and Home Health care offered by Providence Life Services is all Medicare-certified.)
2. Make sure your care has been approved by a Quality Improvement Organization (QIO). Medicare covers only care that is "reasonable and necessary." QIOs determine whether your claims will be covered.

HOW DO I SIGN UP FOR MEDICARE PART A?
If you already get Social Security or Railroad Retirement benefits, you will be enrolled automatically in Medicare Part A. Your coverage will begin the first day of the month you turn 65. If you’re not sure, contact Social Security three months before you turn 65.

WHAT DOES MEDICARE PART B (MEDICAL INSURANCE) COVER?
Medicare Part B helps pay for:

1. Physician's Services — such as medical care, surgery, x-rays, medical supplies, and a one-time check-up within the first six months of coverage.
2. Services from Other Practitioners — including clinical psychologists, social workers, registered nurse anesthetists, physician assistants, nurse practitioners, and clinical nurse specialists.
3. Some Home Health Services (these are also covered under Medicare Part A)
4. Some Ambulance Services — such as transport to a hospital or transfer to a skilled nursing facility if the services are deemed medically necessary.
5. Various Other Services — including rural health clinic services, outpatient physical and occupational therapy, speech pathology services, screening for some cancers, kidney dialysis and transplants, diabetes screening, durable medical equipment, and more.

There are certain restrictions on Part B coverage, so contact your local Social Security office or Medicare carrier for more detailed information.

HOW DO I SIGN UP FOR MEDICARE PART B?
If you already get Social Security or Railroad Retirement benefits, you will be enrolled automatically in Medicare Part B — unless you specifically say you don't want Medical Insurance. You'll receive a Medicare information packet about three months before your 65th birthday. If you are not enrolled automatically, or if you have questions about your eligibility, contact Social Security.

When you enroll in Medicare Part B, the monthly premium will be automatically deducted from your Social Security, Railroad Retirement, or civil service check.

WHAT KINDS OF EXPENSES ARE NOT COVERED BY MEDICARE PART A OR PART B?

• Any care that is not considered "reasonable and necessary"
• "Custodial care," such as help with bathing or walking
  
• Personal comfort items, such as TV or phone in a hospital room
• Routine dental care
• Check-ups
• Immunizations
• Prescription drugs (unless you are an inpatient in a hospital or skilled nursing center)
  You might want to supplement your Medicare coverage by enrolling in some other form of healthcare insurance — Medigap insurance, Medicaid, or group health insurance may be options you want to look at.

I THOUGH PRESCRIPTION DRUGS WERE COVERED BY MEDICARE — AREN'T THEY?
There is a Medicare Part D that offers a variety of plans to cover prescription drugs. Enrollment in Part D is not automatic, and the options vary depending on what area you live in.

For more information about Medicare, visit the official Medicare website: http://www.medicare.gov/
Or order a simple booklet, Medicare and You.