After practicing elder law for 15 years, I have found that my prospective clients and their families continue to be mystified by the Medicare program and what it does and does not cover. As such, this is the first in a series of blog posts that I hope will be useful in explaining the Medicare program.
Medicare was first enacted into law in 1965 and it is the United States government's health care insurance program for people 65 years of age and over. In addition, the program includes coverage for individuals who are permanently disabled, regardless of their age. Unlike Medicaid, Medicare is wholly a federal program, meaning that the states are not involved in its administration.
Medicare is an entitlement program, meaning it is not based on financial need. Even though Medicare is an entitlement, older people who have Medicare coverage still will have health care costs they may need to pay themselves. For instance, there is a monthly premium for Medicare’s coverage. In addition, Medicare recipients may also have to pay for a portion of the costs of the health care services they receive in the form of deductibles or co-insurance amounts. Many seniors purchase supplemental health insurance, or have it as a retirement benefit through their former employer, that may cover all or part of these deductibles and co-insurance amounts. These supplemental health insurance policies are often referred to as “Medigap” policies.
There are some medical services and items that Medicare does not cover, which will be detailed in later blog posts. Two important ones are long-term nursing home care and in-home care. Medicare mainly pays for acute care, which are medical services necessary to treat or diagnosis an injury or illness. This means that the program’s coverage does not include many preventive health care services.
Medicare has four different parts: Medicare part A includes hospital coverage. Medicare part B coverage includes outpatient care, including doctor office visits. Medicare part C, which was intended to provide additional options for health care services. Medicare part D includes prescription drug coverage.
The eligibility requirements for Medicare part A are:
- You must be a United States resident who is age 65 or older and you must be eligible for Social Security. If you are not a U.S. citizen, you must be a legally admitted alien who has resided in the U.S. continuously for at least five years; or
- If you have not attained age 65, you must be a disabled person of any age who has been entitled to Social Security disability benefits for 25 months; or
- individuals who have end-stage renal disease will be eligible for Medicare Part A.
One is eligible for Medicare part B if they are age 65 or older, regardless of Social Security eligibility.
My next post will discuss in more detail the coverage provided under Medicare Part A.