Medicare is a federal health insurance program for people age 65 and older, certain people with disabilities under age 65, and people of any age who have permanent kidney failure. A person receiving Social Security Disability Insurance (SSDI) becomes eligible for Medicare after a 24 month waiting period from the date SSDI payments started. There are three main parts to the Medicare program: Part A covering hospital services; Part B for medical services; and Part D for Prescription Drug coverage.
Medicare Part A helps to cover costs for inpatient care in hospitals, short-term skilled nursing facility care costs, some home health care, and hospice care in some instances. Part A coverage starts automatically after the 24 month waiting period. Coverage for in-patient hospitalization includes a semi-private room, meals, nursing care and other health care services.
If you aren’t sure if you have Part A coverage, look at your red, white and blue Medicare card. If you have Part A coverage, “Hospital (Part A)” is printed in the lower left hand corner of your card. Most people do not pay a premium for Part A coverage. Most do have to pay deductibles and co-insurance.
Medicare Part B helps to cover your doctors’ visits, services and outpatient health care. It can also cover clinical lab services, short-term home health care in some instances, durable medical equipment, and mental health care. This coverage is optional and the 2016 premiums vary from $107-$134 per month. Social Security determines each individual’s Medicare cost at the beginning of the year, as it depends on a number of factors. In addition to this monthly premium, most individuals also pay deductibles and co-insurance. If you have limited income, your county may be able to help you pay some or all of these costs, as well as the Part B premium. (For information on help paying Medicare costs, click here: Medicare Savings Programs)
If you decline Part B coverage when it is first offered to you and later want that coverage, there may be a penalty that you need to pay each month in addition to the premium. Also, many county programs require that you take Medicare Part B in order to be eligible for additional health care assistance. You should carefully research the impact of turning down Part B coverage with your county office and the Social Security Administration.
Routine or yearly physical exams (except one time, preventative physical exam within the first 6 months that you have Medicare Part B):
The Minnesota Work Incentives Connection has two flyers with information about the Medicare Prescription Drug Program:
In an effort to manage costs, increase coverage, and allow choice, Medicare offers special plans that can be elected in place of the Original Medicare Plan. The Medicare Advantage plans help cover additional services like dental care, dentures, hearing aids, eye care and some prescription drugs. The premiums, deductibles and co-insurance may be different for these programs than for the Original Medicare Plan. All Medicare Advantage plans must offer the same coverage as the Original Medicare Plan, plus provide some additional services. They can limit the doctors you are able to see and can require that you only see providers in their plan. The costs of Medicare Advantage may be less for you than the Original Medicare Plan, depending upon your medical needs and out-of pocket medical expenses. Some Medicare Advantage plans offer coverage similar to Medigap policies at a much lower cost.
Call Minnesota's Linkage Line at any of these phone numbers.
1-800- MEDICARE (1-800-633-4227)