OVERVIEW OF THE MEDICARE PROGRAM

What is Medicare?

Medicare is a national health insurance program for:

· People 65 years of age and older
· Certain persons with disabilities under the age of 65
· People with end stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant)

Medicare is not a entitlemment   program and should not be confused with Medicaid. The income and assets of a Medicare beneficiary are not a consideration in determining eligibility or benefit payment. 

Medicare has three components of benefits:  Part A, Part B and Part D 

· Part A covers inpatient hospital care, hospice care, inpatient care in a skilled nursing facility, and home health care services. Individuals have either paid into Medicare over the course of their employment and automatically become enrolled at age 65, or, if they have been a legal resident for five years or more, they can buy into Medicare.

· Part B covers medical care and services provided by doctors and other medical practitioners, durable medical equipment, some outpatient care and home health care services. Individuals choose to become enrolled in Part B when they become eligible for Medicare and pay a monthly premium for that enrollment.

 · Part D is a new Medicare benefit that covers some prescription drug expenses.   

• The benefit is available to any Medicare beneficiary who has Medicare Part A or Part B or both

• Part D drug plans are being sold by private companies

• There will be a monthly premium, an annual deductible & co-payments.  The costs depend on which Plan    you choose

• Medicare beneficiaries with limited income & assets may be eligible for a subsidy (Extra Help) to help pay part or all of the costs.   To apply, go to www.ssa.gov/prescriptionhelp

• Enrollment is optional.   But if do not sign up when you are first eligible & change your mind later on, you  may have to pay a penalty of higher premium.  However, there are some exceptions to the penalty

• Annual Enrollment period is from November 15 to December 31.  However, there are exceptions:  If you first become eligible for Medicare, you can enroll into a Medicare Prescription Drug Plan the first day you become eligible for Part A or part B.   You can also enroll in a Medicare Prescription Drug Plan when you first become elibgible for low income subsidy (Extra Help)
   
• For more information on Medicare Prescription Drug coverage, call CHOICES  at 1-800-994-9422 or click on the following link to the Medicare web site:  www.Medicare.gov

Medicare Health Plans include:

· The Original Medicare Plan

· Medicare Advantage Plans (MA) 

The Original Medicare

The Original Medicare Plan is a "fee-for-service" plan.   A beneficiary is usually charged a fee for each health care service or supply that he/she receives. The plan is managed by the Federal Government through the Centers for Medicare and Medicaid Services (CMS), is available nationwide & is available to ALL beneficiaries. If a beneficiary is in the Original Medicare Plan, he/she uses the red, white and blue Medicare card when he receives health care services.  Coverage under Original Medicare pays a portion of the cost of medical care. Often, deductibles and co-insurance (partial payment of initial and subsequent costs) are required of the beneficiary, unless the beneficiary chooses to buy a Supplemental or Medigap policy (CLICK HERE for details)

Medicare will pay for care that is medically "reasonable and necessary" for the treatment of an illness or injury. Medicare does not pay for services that are "routine or custodial" or inpatient care that can be provided by persons without professional skills/training.  To find out what medical services & supplies that Medicare would cover under the Original Medicare, go to the following link:  http://www.medicare.gov/Coverage/Home.asp

Medicare Advantage Plans  

Medicare Advantage (MA) is the new name for what has been known as Medicare + Choice plans in the past. With Medicare Advantage, you have a variety of choices that include Managed Care Plan (HMO), Preferred Provider Organization Plans (PPO) or Special Needs Plans (SNP).   Click here for details on all these plans under Medicare Advantage. 

For additional information on Medicare:

• Visit www.medicare.gov. Select "Publications" and you will be able to read, print or order booklets regarding Medicare. Also available is a comparison of Medicare health plans, Nursing Homes, answers to your questions, a list of participating physicians and more . . . . .
• The Center for Medicare Advocacy (Willimantic CT) can answer patients rights and benefits eligibility questions. Visit them at www.MedicareAdvocacy.org or call them at 1-800-262-4414.
• Interested persons can also call 1-800-MEDICARE (633-4227) for information
• CHOICES program at your local Area Agency on Aging. It is the designated State Health Insurance Program (SHIP), and is funded by the Federal Center for Medicare and Medicaid Services.  Information is free of charge.  Services include direct phone contact, mailing of printed materials, assistance with enrollment in Medicare Part D and referral to community counselors.  

         Phone:  (800)-994-9422  or  (203)333-9288         

         E-mail:   MWong@SWCAA.org  or GDiaz@SWCAA.org  or JPeterson@swcaa.org