Medicare

Medicare is a federal health insurance program for qualified people age 65 and over and certain disabled people under age 65. The program is offered in two parts.

• Medicare Part A is premium-free hospital insurance for those who qualify. It is financed by a portion of the Social Security payroll withholding tax on workers and their employers.
• Medicare Part B is medical insurance for which there is a monthly premium. The premium is usually deducted from the enrollee's monthly Social Security or railroad retirement check.

Medicare Part A: Hospital Insurance

Generally, Medicare Part A is designed to cover medically necessary inpatient care in a hospital, skilled nursing facility, psychiatric hospital, or hospice care facility. Part A also provides some coverage for home health care, durable medical equipment, and blood.

There are deductibles and co-payments under Part A for which you are responsible. Part A is premium free to those who qualify. If you do not qualify for premium-free Part A benefits, you may buy the coverage if you are at least 65 years old and meet certain requirements. You may receive this coverage automatically when you reach age 65, or you may be required to apply for this coverage.

Medicare Part B: Medical Insurance

Medicare Part B typically co-pays for a broad range of medical services that generally includes physician care, outpatient hospital services, certain ambulance services, some services of certain specialty-qualified practitioners, and certain diagnostic tests and x-rays. For the benefits covered, there is an annual deductible and, for most expenses, a patient co-payment. Generally, there is no outpatient prescription drug coverage; however, there are allowances for certain physician-administered drugs.

Because much of today's medical care is administered on an outpatient basis-and to ensure adequate coverage for all of your health needs-it is important to give strong consideration to enrollment in both Medicare Part A and Part B. Part B enrollment is also required if you decide to elect a managed care program.

Other Medicare Options: Managed Care

To make managed care plans available, the federal government contracts with managed care providers such as HMOs to expand the coverage choices such as diagnostic testing and preventive care.

Any Medicare Part B enrollee, regardless of health, can sign up in their area for a managed care program that is enrolling new members as long as the enrollee:

• lives in the area served by the area's managed care plan or program and
• continues to pay Part B monthly premiums

Medicare participants retain the right to return to fee-for-service Medicare after trying another Medicare plan.

For more information on all Medicare programs including:

• managed care options and their availability in your particular area
• the pending changes in Medicare coverage options; and
• consumer protection information

contact

• your regional Social Security office,
• a Medicare Insurance Counselor through your area's Department for the Aging or
• your area's Bureau or Commission of Insurance (see your state or area's listings in For More Information)

If you are a retired railroad worker, it may also be appropriate for you to contact the Railroad Retirement Board.