Medicare Defined

Medicare is health insurance offered by the federal government to most people 65 and older and to some younger people with disabilities.

There is often the mistaken impression Medicare will pay for complete nursing center care. Actually, Medicare does pay for a limited amount of skilled nursing care. It may be divided into Medicare Part A and Medicare Part B.

Admission to a nursing center with a specific area for Medicare patients is determined on an individual basis by diagnosis, nursing or therapy needs, and the number of days of Medicare eligibility remaining.

Medicare requires patients to have had a three-day inpatient hospital stay prior to admission. Patients must also meet specific nursing and therapy criteria. Patients qualifying under these guidelines may be covered under Medicare Part A for up to 100 days or less if criteria are not continually met. Constant assessments of patient condition is required and progress may result in a denial of coverage at any time.

Medicare has three parts:

• Hospital insurance, called Medicare Part A (helps pay for hospital bills)
• Medical insurance, called Medicare Part B (helps pay for doctor bills)
• Prescription drug coverage, called Medicare Part D

Who can get Medicare?

Most people who are 65 and older, some younger people with disabilities and people with kidney failure can get Medicare. Call the Social Security Administration at 1-800-772-1213 if you are not certain of your eligibility. You'll need to provide your social security number and date of birth when you call.

When can I get Medicare?

If you are nearing 65, there is a seven-month period during which you can get Medicare. This is the case whether Medicare signs you up or if you need to sign up for Medicare yourself. This seven-month period includes:

• the three months before your 65th birthday;
• the month of your 65th birthday; and
• the three months after your 65th birthday.

The best time to sign up for Medicare is during the three months before your 65th birthday.

I'm 65. How do I sign up for Medicare?

You are automatically signed up for Medicare when you turn 65 if you are getting social security or railroad retirement payments. You'll receive a package of Medicare information, including your Medicare card, in the mail. Call the Social Security Administration at 1-800-772-1213 if you do not get your information package by your 65th birthday.

However, you need to sign up for Medicare yourself if you do not get social security or railroad retirement payments. You can sign up by calling or visiting the Social Security office nearest you, which you can find by visiting the Social Security Administration website. You cannot apply for Medicare online at this time.

Should I enroll in Medicare Part B (doctor bills)?

When you sign up for Medicare, you will get Part A, which covers hospital bills. Most people do not have to pay a monthly cost (premium) for Part A. That is because they or their spouse paid Medicare taxes while they were working.

Signing up for Medicare Part B, which pays for doctor bills, is your choice. You will have to pay a monthly premium for Part B. You can sign up when you first go on Medicare, turn down the coverage, or wait to sign up at a later date.

Why would I wait to sign up for Part B?

If you are working and already have group health insurance from your employer or your spouse's employer, you might not need Part B right away. However, you need to be aware that if you wait to sign up for Part B, the premium could go up by 10 percent for each year you could have had Part B. You will have to pay that extra cost as long as you remain on Medicare.

You won't have to pay the penalty for waiting if

• you sign up for Medicare Part B while you are still working and covered by group health insurance, or
• you sign up for Medicare Part B within eight months after you are no longer covered by group health insurance.

Time Limitation

If you are 65 or older when you sign up for Part B, you have six months to buy any Medicare Supplemental (Medigap) policy you choose, regardless of your health. This is called your open enrollment period. You only have this period once in your life. After this six-month period, you may not be able to buy the Medigap policy you want.

If you are 65 or older, are working and have group health coverage from you or your spouse's employer, you can save your open enrollment period until you need it. Get all the facts first from Medicare and your State Health Insurance Assistance Program (SHIP) before making a final decision about when to sign up for Part B.

Medicare generally doesn't pay for routine long-term care. Medicare also doesn't pay for help with activities of daily living or other care most people can do themselves. Some examples of activities of daily living include eating, bathing, dressing, and toileting. Medicare will help pay for skilled nursing or home health care if you meet certain conditions.

Don't foget to sign up for our monthly e-newsletter!