Medicare/Medicaid

Medicare

Medicare

What is Medicare

Medicare is a federally funded health plan for seniors 65 and older and those who are under 65 and considered disabled or have end stage kidney failure.

Medicare is divided into four parts: A, B, C and D

Part A

This part of Medicare covers:

· Inpatient care (hospitals) includes Long Term Acute Care (LTAC) stays

· Blood after first 3 units*

· Hospice Care

· Home Health

· Skilled Nursing facilities (non-custodial)

*the member normally is financially responsible for the first three units of blood if the hospital paid for the blood. If not, the member will not have to pay.

Part B

This Part of Medicare covers:

· Outpatient Care

· Medical Equipment (DME)

* Home Health (if not covered by Part A)

Does not cover:

Vision Care

Dental Care

Hearing Care

Private Duty Nursing

Cosmetic Surgery

Care received outside the US

Part D

This Part of Medicare (Drug coverage)

Part C

· Combines benefits of parts A and B and in some cases part D

· Obtained through private health plans

· Must be paying part B premiums

Eligibility and Enrollment

You can be automatically enrolled in Part A and B if you:

· Already receiving social security benefits

· Under 65 and are disabled

· Have ALS (Lou Gehrig’s disease)

For those who are not automatically enrolled:

· For those approaching 65 years of age and are not receiving social security can enroll for Part A and Part B three months prior or three months after their birthday.

· Enrolling into Part B later will cost you a penalty.

· There is a Premium for Part B

Enrollment Period

You can enroll in Part A and B during a 7-month period that begins 3 months before your birthday and 3 months after. If you do not enroll at that time there is the general enrollment time which begins January 1st until March 31st of each year.

NOTE: If you choose the second option you might pay more for Part A/B premiums.

More Information

Medicare: 800-633-4227

Social Security: 800-772-1213

Department of Defense (Tricare) 866-773-0404

Department of Health and Human Services (Office for Civil Rights) 800-368-1019

Department of Veterans Affairs: 800-827-1000

Railroad Retirement Board: 877-772-5772

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