| > | | | | birthday month or during the 3 months following, |
| Medicare is the Federal health insurance program | | | | coverage will be delayed for up to 3 more |
| that is available to older people and to many of | | | | months. Enrollment may also be done between |
| those with disabilities. Generally, a person is eligible | | | | January 1 and March 31 of any year once |
| for Medicare when turning age 65. In other | | | | becoming eligible, but there may be a penalty for |
| instances, a person with a disability may be eligible, | | | | late enrollment and an effective date of July 1. |
| regardless of age. | | | | If one has coverage with a group or business |
| There are two parts to Medicare: Part A and Part | | | | health plan, he/she may enroll any time while still |
| B. Inpatient hospital services, skilled nursing facility, | | | | working and if the employer has more than 20 |
| home health care and hospice services are | | | | employees. If one cancels group coverage while |
| covered by Medicare Part A. Physician services, | | | | still working or retires, he/she is given a special 8 |
| durable medical equipment, clinical diagnostic | | | | month enrollment period beginning when the group |
| laboratory services, laboratory tests, X-rays, | | | | coverage ends. Be aware that when applying for |
| diabetes self-management, outpatient hospital | | | | a Medicare Supplement policy 6 months after |
| services, ambulance services, outpatient mental | | | | Medicare Part B coverage is effective or after |
| health services, mammograms, pap smears, colon | | | | open enrollment ends, health questions would have |
| or prostate cancer screenings, flu and pneumonia | | | | to be answered on the application. Also, when one |
| shots, bone density measurement, and physical | | | | is covered with a group health plan and Medicare, |
| therapy are covered by Medicare Part B. Medicare | | | | as long as the employer has 20 or more |
| generally does not cover preventive care | | | | employees one has the option of making the |
| services, private duty nursing, hospital room | | | | group health coverage primary and Medicare |
| telephone or television, private hospital rooms, | | | | secondary. |
| dental services, eyeglasses, chiropractic services, | | | | If one is automatically eligible for Medicare Part A |
| care outside of the U.S., acupuncture, hearing aids, | | | | then there is no premium to pay. A premium is |
| long term or custodial care in nursing homes or | | | | required for Medicare Part B. If one does not |
| most prescription drugs. | | | | enroll in Medicare Part B when initially eligible, then |
| To qualify for Medicare, a person must meet at | | | | there is a 10% premium penalty for each year of |
| least one of the following: | | | | delayed enrollment. |
| (1)Be age 65 and eligible for Social Security or | | | | Medicare options include original Medicare which |
| railroad retirement benefits, | | | | comes direct from the Federal government, and |
| (2)Have been receiving Social Security disability | | | | Medicare PPO (preferred provider organization), |
| income for at least 24 months, or | | | | Medicare PFFS (private fee-for-service plan), |
| (3)Have end stage renal (kidney) disease. | | | | Medicare MSA (medical savings account plan), and |
| If one continues to work after age 65 or decides | | | | Medicare HMO (health maintenance organization) |
| not to enroll for Social Security benefits at age | | | | or Medicare PSO (provider-sponsored organization) |
| 65, he/she may still receive Medicare benefits. | | | | which are offered by private health plans. There |
| Permanent legal aliens also qualify for Medicare | | | | are also special Medicare programs for people |
| when they have lived in the U.S. for at least five | | | | with low incomes of $4000 per individual or $6000 |
| years or more continuously prior to eligibility date. | | | | per couple not including a house or car. These |
| They may also qualify when they are not eligible | | | | programs are: QMB, SLMB, Q1-1, Q1-2, or |
| for Social Security benefits or railroad retirement | | | | Medicaid. |
| benefits, but they usually will have to pay the | | | | Over 80% of those eligible for Medicare select |
| premiums for Medicare Part A. | | | | original Medicare. It is available everywhere in the |
| If one qualifies for Social Security or railroad | | | | U.S. and one is enrolled in it automatically when |
| retirement benefits, his or her Medicare enrollment | | | | becoming eligible for Medicare. Just about any |
| is automatic. If one is not age 65, he/she may | | | | doctor or hospital may be used with original |
| apply with the local Social Security office during | | | | Medicare, and it pays providers and doctors |
| the 7 month period that starts 3 months before | | | | directly for the services one receives. To fill in |
| their 65th birthday. When applying 3 months | | | | any gaps in the original Medicare coverage, a |
| before turning 65, the Medicare coverage begins | | | | Medicare Supplement insurance plan may be |
| in the birthday month. When applying in the | | | | purchased. |