Medicare
Medicare in Chinese graphic

dot-red.gif (973 bytes)Who's Eligible for Medicare?

Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States.  You might also qualify for coverage if you are a younger person with a disability or with chronic kidney disease.

Here are some simple guidelines.  You can get Part A at age 65 without having to pay premiums if:

  • You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.
  • You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A without having to pay premiums if:

  • You have received Social Security or Railroad Retirement Board disability benefits for 24 months.
  • You are a kidney dialysis or kidney transplant patient.

While you do not have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it.  The Part B monthly premium in 1999 is $45.50.  It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check.

If you have questions about your eligibility for Medicare Part A or Part B, or if you want to apply for Medicare, call the Social Security Administration.   The toll-free telephone number is: 1-800-772-1213.   The TTY-TDD number for the hearing and speech impaired is 1-800-325-0778.  You can also get information about buying Part A as well as part B if you do not qualify for premium-free part A.


dot-red.gif (973 bytes)Enrollment

Enrollment in Medicare is handled in two ways: either you are enrolled automatically or you have to apply. Here's how it works.

upyellow.gif (856 bytes)Automatic Enrollment

If you are not yet 65 and already getting Social Security or Railroad Retirement benefits, you do not have to apply for Medicare. You are enrolled automatically in both Part A and Part B and your Medicare card is mailed to you about 3 months before your 65th birthday. If you do not want Part B, follow the instructions that come with the card.

If you are disabled, you will be automatically enrolled in both Part A and Part B of Medicare beginning in your 25th month of disability. Your card will be mailed to you about 3 months before you are entitled to Medicare.

upyellow.gif (856 bytes)Applying for Medicare

You need to apply for Medicare if you are not receiving Social Security or Railroad Retirement Benefits three months before you turn 65, or if you require regular dialysis or kidney transplant. That's the beginning of your 7-month initial enrollment period. By applying early, you'll avoid a possible delay in the start of your Part B coverage. You apply by contacting any Social Security Administration office or, if you or your spouse worked for the railroad, the Railroad Retirement Board.

If you do not enroll during this 7-month period, you'll have to wait to enroll until the next general enrollment period. General enrollment periods are held January 1 to March 31 of each year, and Part B coverage starts the following July.

Don't put off enrolling. If you wait 12 or more months to sign up, your premiums generally will be higher. Part B premiums go up 10 percent for each 12 months that you could have enrolled but did not. The increase in the Part A premium (if you have to pay a premium) is 10 percent no matter how late you enroll for coverage.

Under certain circumstances, however, you can delay your Part B enrollment without having to pay higher premiums. If you are age 65 or over and have group health insurance based on your own or your spouse's current employment, or if you are disabled and have group health insurance based on your current employment or the current employment of any family member, you have a choice:

You may enroll in Part B at any time while you are covered by the group health plan; or,

You can enroll in Part B during the 8-month enrollment period that begins the month employment ends or the month you are no longer covered under the employer plan, whichever comes first.

If you enroll in Part B while covered by an employer plan or during the first full month when not covered by that plan, your coverage begins the first day of the month you enroll. You also have the option of delaying coverage until the first day of the following 3 months. If you enroll during any of the 7 remaining months of the special enrollment period, your coverage begins the month after you enroll.

If you do not enroll by the end of the 8-month period, you'll have to wait until the next general enrollment period, which begins January 1 of the next year.

Even if you continue to work after you turn 65, you should sign up for Part A of Medicare. Part A may help pay some of the costs not covered by the employer plan. It may not, however, be advisable to sign up for Part B if you have health insurance through your employer. You would have to pay the monthly Part B premium, and the Part B benefits may be of limited value to you as long as the employer plan was the primary payer of your medical bills. Moreover, you would trigger your 6-month Medigap open enrollment period (see Medigap Insurance).

dot-red.gif (973 bytes)Assistance for Low-Income Beneficiaries

If you have a low income and limited resources, your State may pay your Medicare costs, including premiums, deductibles, and coinsurance. To qualify:

  • You must be entitled to Medicare hospital insurance (Part A).
  • Your annual income level must be at or below the national poverty guidelines.
  • and You cannot have resources such as bank accounts or stocks and bonds worth more than $4,000 for one person or $6,000 for a couple (your home and first car don't count).

If your income is just above the poverty guidelines, you may qualify for help with paying your Part B premiums. If you think you qualify, contact your state or local welfare, social service, or Medicaid agency. The contact number is available on the Internet at www.medicare.gov. Ask about the Qualified Medicare Beneficiary (QMB) program, the Medicare Buy-In program, the Specified Low-Income Medicare Beneficiary (SLMB) program, or the Qualifying Individual (QI) program.

If you have young children in your care, you also should ask about your State's Child Health Program to help pay their health care costs.

dot-red.gif (973 bytes)Medicare Covered Services

upyellow.gif (856 bytes)Hospital Insurance (Part A)

Medicare hospital insurance helps pay for necessary medical care and services furnished by Medicare-certified hospitals, skilled nursing facilities, home health agencies, and hospices.

The number of days that Medicare covers care in hospitals and skilled nursing facilities is measured in benefit periods. A benefit period begins on the first day you receive services as a patient in a hospital or skilled nursing facility and ends after you have been out of the hospital or skilled nursing facility and have not received skilled care in any other facility for 60 days in a row. There is no limit to the number of benefit periods you can have.

upyellow.gif (856 bytes)Inpatient Hospital Care

Medicare Part A helps pay for up to 90 days of inpatient hospital care in each benefit period. Covered services include your semi-private room and meals, general nursing services, operating and recovery room costs, intensive care, drugs, laboratory tests, X-rays, and all other necessary medical services and supplies.

upyellow.gif (856 bytes)Skilled Nursing Facility Care

You may need inpatient skilled nursing or rehabilitation services after a hospital stay. If you meet certain conditions, Part A helps pay for up to 100 days in a participating skilled nursing facility in each benefit period. Medicare pays all approved charges for the first 20 days; you pay a coinsurance amount for days 21 through 100. Covered services include your semi-private room and meals, skilled nursing services, rehabilitation services, drugs, and medical supplies.

upyellow.gif (856 bytes)Home Health Care

If you meet certain conditions, Medicare pays the full approved cost of covered home health care services. This includes part-time or intermittent skilled nursing services prescribed by a physician for treatment or rehabilitation of homebound patients. The only amount you pay for home health care is a 20 percent coinsurance charge for medical equipment such as a wheelchair or walker.

upyellow.gif (856 bytes)Hospice Care

Medicare helps pay for hospice care for terminally ill beneficiaries who select the hospice care benefit. There are no deductibles, but you pay limited costs for drugs and inpatient respite care.

upyellow.gif (856 bytes)Medical Insurance (Part B)

Medicare Part B helps pay for doctor's services, outpatient hospital services (including emergency room visits), ambulance transportation, diagnostic tests, laboratory services, some preventive care like mammography and Pap smear screening, outpatient therapy services, durable medical equipment and supplies, and a variety of other health services. Part B also pays for home health care services for which Part A does not pay.

Medicare Part B pays 80 percent of approved charges for most covered services. You are responsible for paying a $100 deductible per calendar year and the remaining 20 percent of the Medicare approved charge. You will have to pay limited additional charges if the doctor who cares for you does not accept assignment. This means the doctor does not agree to accept the Medicare approved charge for services.

upyellow.gif (856 bytes)Services Medicare Does Not Cover

Medicare Part A does not pay for convenience items such as telephones and televisions provided by hospitals or skilled nursing facilities, private rooms (unless medically necessary), or private duty nurses.

The only type of nursing home care Medicare pays for is skilled nursing facility care for rehabilitation, such as recovery time after a hospital discharge. Medicare does not pay if you need only custodial services (help with daily living activities like bathing, eating or getting dressed).

Medicare Part B usually does not pay for most prescription drugs, routine physical examinations, or services not related to treatment of illness or injury. Part B does not pay for dental care or dentures, cosmetic surgery, routine foot care, hearing aids, eye examinations, or eyeglasses.

Except for certain limited cases in Canada and Mexico, Medicare does not pay for treatment outside the United States.

dotgrencube.gif (241 bytes) More Information in Chinese dotgrencube.gif (241 bytes) More Information in English dotgrencube.gif (241 bytes) FAQ
dotgrencube.gif (241 bytes) Contact Medicare dotgrencube.gif (241 bytes) Glossary of Terms

(Source: medicare.gov)


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