Definition
Medicare is a federal health insurance program established under Title XVIII of the Social Security Act. It is designed to provide basic health insurance coverage primarily to three groups of people:
- Individuals who are 65 years old or older.
- Individuals of any age who have permanent kidney failure requiring dialysis or a kidney transplant.
- Individuals under 65 who have been receiving Social Security disability benefits for at least 24 months.
Medicare is one of the five main programs under the Social Security System and is administered by the Health Care Financing Administration (HCFA), now known as the Centers for Medicare & Medicaid Services (CMS). Applications and beneficiary assistance for Medicare are managed by the Social Security Administration (SSA).
Examples
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John, Age 68: John, newly retired at age 68, enrolls in Medicare to cover his hospital and medical expenses. He receives comprehensive healthcare benefits, including hospital stays and outpatient services.
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Lily, Age 52 with Kidney Failure: Lily has been on dialysis due to permanent kidney failure. Regardless of her age, she qualifies for Medicare to help cover the costs associated with her medical condition.
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Mike, Disability Recipient: Mike, a 58-year-old with a severe disability, has been receiving Social Security disability benefits for the past 24 months. As a result, he is also eligible for Medicare benefits to manage his ongoing healthcare needs.
Frequently Asked Questions (FAQs)
What are the different parts of Medicare?
Medicare is divided into four parts:
- Part A: Hospital Insurance – Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
- Part B: Medical Insurance – Covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
- Part C: Medicare Advantage Plans – A type of Medicare health plan offered by private companies that contract with Medicare to provide Part A and Part B benefits.
- Part D: Prescription Drug Coverage – Adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans.
How do I enroll in Medicare?
Individuals can enroll in Medicare through the Social Security Administration:
- Online at the SSA website.
- By visiting a local Social Security office.
- By calling the SSA at their national helpline.
Is there a cost to enroll in Medicare?
Medicare Part A is generally premium-free if you or your spouse paid Medicare taxes while working. Part B requires a monthly premium. Costs for Part C and Part D vary by plan and provider.
Can I have other health insurance with Medicare?
Yes, you can have additional insurance coverage, such as employer-provided insurance or Medigap policies, to supplement your Medicare coverage.
What does Medicare not cover?
Medicare does not cover everything. Routine dental care, most vision care, hearing aids, and long-term care are typically not covered under Medicare.
Related Terms
- Social Security: A federal program that provides retirement, disability, and survivor benefits. Medicare is a part of the Social Security System.
- Medicaid: A joint federal and state program that provides health coverage to low-income individuals and families.
- Medicare Advantage Plan: An alternative to traditional Medicare offering Part A and Part B benefits through private insurance companies.
- Medigap: Supplemental private health insurance designed to cover some of the costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles.
Online References
- Medicare Official Website
- Social Security Administration
- Centers for Medicare & Medicaid Services (CMS)
- Medicare Interactive
Suggested Books for Further Studies
- “Medicare For Dummies” by Patricia Barry - Comprehensive guide on understanding Medicare and making the most out of the benefits.
- “Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs” by Philip Moeller - In-depth advice on navigating the complexities of Medicare.
- “Medicare and You” (Official U.S. Government Medicare Handbook) - Annual publication containing the latest information and guidance on Medicare.
Fundamentals of Medicare Basics Quiz
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