Friday, March 12, 2010

Who Is Eligible For Medicare?

A Reminder of How Medicare Works in Three Weekly Installments

The Kaiser Family Foundation has a recent report “Medicare a Primer 2010,” which explains the Medicare program in terms that lay people can understand.  It highlights key elements of the Medicare program, which now provides health coverage to 47 million people (people age 65 and older and younger adults with permanent disabilities.)  Medicare is an estimated 12 percent of the federal budget and 20 percent of total national health expenditures. It is often a significant part of discussions about how to moderate the growth of both federal spending and health care spending in the U.S.  The Kaiser report looks at the characteristics of the Medicare population, what benefits are covered, how much people with Medicare pay for their benefits and the program’s overall costs and future financing challenges. 

This short article highlights (1)  What is Medicare?, (2)  Who is Eligible? and (3)  Medicare’s Future Financing Challenges. 

WHO IS ELIGIBLE?  Taken from page 2 of the Kaiser Family Foundation “Medicare a Primer 2010.”.

              Source:  Kaiser Family Foundation (February 2010)

Read the primer:  http://www.kff.org/medicare/7615.cfm

WHO IS ELIGIBLE FOR MEDICARE?

Most people age 65 and older are automatically entitled to Part A if they or their spouse are eligible for Social Security payments and have made payroll tax contributions for 10 or more years (40 quarters).

Individuals age 65 and over qualify for Medicare if they are U.S. citizens or permanent legal residents.  Individuals do not need to meet an income or asset test to qualify for Medicare, and qualify without regard to their medical history or preexisting conditions. Adults under age 65 with permanent disabilities are eligible for Medicare after receiving Social Security Disability Income (SSDI) payments for 24 months, even if they have not made payroll tax contributions for 40 quarters. People with end-stage renal disease (ESRD) or Lou Gehrig’s disease are eligible for Medicare benefits as soon as they begin receiving SSDI payments, without having to wait 24 months. Individuals who are entitled to Part A do not pay premiums for covered services. Individuals age 65 and over who are not entitled to Part A, such as those who did not pay enough Medicare taxes during their working years, can pay a monthly premium to receive Part A benefits.

Individuals entitled to Part A and others age 65 and older may elect to enroll in Part B.

Part B is voluntary, but about 95 percent of beneficiaries with Part A are also enrolled in Part B. For most individuals who become entitled to Part A, enrollment in Part B is automatic unless the individual declines enrollment. Individuals age 65 and older who are not entitled to Part A may enroll in Part B. With the exception of the working aged (or their spouses) who may delay enrollment if they receive employment based coverage, those who do not sign up for Part B when they are first eligible typically pay a penalty for late enrollment, in addition to the regular monthly premium, for the duration of their enrollment in Part B.

Individuals are eligible for Part C, or Medicare Advantage, if they are entitled to Part A and enrolled in Part B.

Beneficiaries may generally elect to enroll in a Medicare Advantage (MA) plan on an annual basis between November 15 and March 31 of the following year.

Individuals are eligible for prescription drug coverage under a Part D plan if they are entitled to benefits under Part A and/or enrolled in Part B.

To get Part D benefits, beneficiaries must enroll in a stand-alone prescription drug plan (PDP) or Medicare Advantage prescription drug (MA-PD) plan. The enrollment period runs from November 15 to December 31 of each year for stand-alone prescription drug plans, and from November 15 through March 31 of the following year for Medicare Advantage drug plans. Similar to Part B, there is a permanent premium penalty for late enrollment for individuals who go for an extended period of time without drug coverage that is at least comparable to the Part D standard benefit (“creditable coverage”).

Stayed tuned for part 3 WHAT ARE MEDICARE'S FUTURE FINANCING CHALLENGES? Coming Friday March 19th.