Most senior citizens rely on Medicare for their health insurance. Here's what you need to know:
Who gets Medicare?
- Anyone who is age 65 and is eligible for Social Security (or Railroad Retirement or Civil Service Retirement) benefits
- The 65 year old spouse of someone eligible for Medicare and Social Security
- Anyone at any age who has end-stage renal disease or a qualifying disability
How do you get Medicare?
- To find out if your elder is eligible, contact a local Social Security office.
- A senior can apply for Medicare 3-4 months before her 65th birthday
(contact a local Social Security office or call 1-800-772-1213).
- A senior can apply for Medicare at the same time that she applies for Social Security benefits.
- If your elder doesn't apply for it by 3 months after her 65th birthday, she will have to wait for the next open enrollment period (January 1- March 31) and the Medicare will not be effective until the following July 1.
What does Medicare pay for?
Medicare is broken down into two programs: Part A and Part B.
Part A pays for:
- Hospitalizations (part of hospital costs for up to 90 days)
- Skilled nursing facility care (part of skilled nursing facility costs for up to 100 days if certain criteria is met)
- Home health care
- Hospice care
Part B pays for:
- Medical expenses (80% of costs)
- Laboratory services
- Outpatient hospital treatment
- Physical & Occupational Therapy
- Durable Medical Equipment
- Diabetic Supplies
- Preventive Health Services & Screenings
As you can see, each of these benefits has it's own length of coverage. There are also specific qualifying criteria in order for Medicare to pay for these health care costs. Consult the "Medicare and You" pamphlet provided by the Health Care Financing Administration (obtained at any Social Security office) for detailed information about Medicare benefits.
What doesn't Medicare pay for?
- Most Prescription medications
- Long term nursing care or custodial care (at home or in a nursing facility)
- Services that are not medically necessary
- Routine physical exams not related to a specific diagnosis
- Eye exams and glasses
- Hearing aids
- Most dental services and dentures
- Routine foot care (except for diabetics)
- Private hospital room (unless medically necessary)
- Personal comfort items while in a hospital or nursing home (telephone, television, private-duty nursing)
- Cosmetic surgery
- Acupuncture
- Most treatment provided outside of the United States
How much do Seniors pay for Medicare?
- Medicare Part A is free of charge.
- Medicare Part B has a monthly premium ($66.60 in 2004) that is automatically deducted from the elder's Social Security checks.
- There are various deductibles that a patient must pay for certain services before Medicare benefits begin.
What about seniors who can't afford it?
Many seniors cannot afford Medicare deductibles and monthly premiums. Here are some alternatives:
- HICAP - Health Insurance Counseling and Advocacy Program
- If the elder qualifies for Medi-Cal these costs will be met by Med-Cal.
Medicare offers three programs for low-income seniors that assume some of these costs.
They are:
- Qualified Medicare Beneficiary (QMB)
- Specified Low-Income Medicare Beneficiary (SLMB)
- Qualifying Individual (QI)
Contact the Medicare hotline (1-800-633-4227 or TTY/TDD 1-877-486-2048), your elder's local Social Security office, or the
Social Security hotline (1-800-772-1213).
Who can answer my Medicare questions?
- Billing department staff at a hospital or doctor's office Medicare Hotline (1-800-633-4227 or TTY/TDD 1-877-486-2048)
- Discharge planners or social workers at a hospital
- Social Security Administration (1-800-772-1213)
- "Fiscal intermediaries"- the private insurance companies that Medicare contract with to process Medicare bills (such as Blue Cross). Your elder's Medicare statements will indicate the name and contact information of the fiscal intermediary.
- HICAP
