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Medicare is a health
insurance program for:
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people age 65 or older,
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people under age 65 with certain disabilities, and
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people of all ages with End-Stage Renal Disease (permanent
kidney failure requiring dialysis or a kidney transplant).
Medicare has:
Part A Hospital Insurance - Most people don't pay a
premium for Part A because they or a spouse already paid for it through
their payroll taxes while working. Medicare Part A (Hospital Insurance)
helps cover inpatient care in hospitals, including critical access
hospitals, and skilled nursing facilities (not custodial or long-term
care). It also helps cover hospice care and some home health care.
Beneficiaries must meet certain conditions to get these benefits.
Medicare Part A (Hospital Insurance) helps cover inpatient care in
hospitals, including critical access hospitals, and skilled nursing
facilities (not custodial or long-term care). It also helps cover
hospice care and some home health care. Certain conditions must be met
to get these benefits.
Cost: Most people don’t have to pay a monthly payment, called a
premium, for Part A. This is because they or a spouse paid Medicare
taxes while working. If a beneficiary doesn't get premium-free Part A,
they may be able to buy it if they (or their spouse) aren’t entitled to
Social Security, because they didn’t work or didn’t pay enough Medicare
taxes while working, are age 65 or older, or are disabled but no longer
get free Part A because they returned to work.
If they have limited income and resources, their state may help them
pay for Part A (see page 60). For more information, they can visit
www.socialsecurity.gov on the web or call the Social Security
Administration at 1-800-772-1213. TTY users should call 1-800-325-0778
Part B Medical Insurance - Most people pay a monthly
premium for Part B. Medicare Part B (Medical Insurance) helps cover
doctors' services and outpatient care. It also covers some other medical
services that Part A doesn't cover, such as some of the services of
physical and occupational therapists, and some home health care. Part B
helps pay for these covered services and supplies when they are
medically necessary.
Medicare Part B (Medical Insurance) helps cover doctors’ services and
outpatient care. It also covers some other medical services that Part A
doesn’t cover, such as some of the services of physical and occupational
therapists, and some home health care. Part B helps pay for these
covered services and supplies when they are medically necessary.
Cost: The Medicare Part B premium each month ($78.20 per month in
2005). In some cases, this amount may be higher if the beneficiary
didn’t sign up for Part B when they first became eligible.
Caution: If the beneficiary didn’t take Part B when they were first
eligible, the cost of Part B will go up 10% for each full 12-month
period that they could have had Part B but didn’t sign up for it, except
in special cases. They will have to pay this penalty as long as they
have Part B.
They also pay a Part B deductible each year before Medicare starts to
pay its share. The Part B deductible for 2005 is $110.00. The
beneficiary may be able to get help from their state to pay this premium
and deductible.
Medicare deductible and premium rates may change every year in
January.
Prescription Drug Coverage - Most people will pay a
monthly premium for this coverage. Starting January 1, 2006, new
Medicare prescription drug coverage will be available to everyone with
Medicare. Everyone with Medicare can get this coverage that may help
lower prescription drug costs and help protect against higher costs in
the future. Medicare Prescription Drug Coverage is insurance. Private
companies provide the coverage. Beneficiaries choose the drug plan and
pay a monthly premium. Like other insurance, if a beneficiary decides
not to enroll in a drug plan when they are first eligible, they may pay
a penalty if they choose to join later.
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