Medicare is a national health insurance program funded by the federal government. It was first created under the Social Security Act of 1965 to provide basic health care for people aged 65 or older and for individuals who are disabled. Unlike Medicaid, eligibility for Medicare is not based on income or asset limitations.
Medicare is designed to provide only basic health care. Medicare will not pay for custodial or long-term life skills care, such as someone who assists with dressing, toileting and feeding. Medicare will cover up to 100 days of skilled care, including full coverage for the first 20 days and the remaining days covered with some amount of co-insurance.
Why is there a Medicare Part A and Part B? What is the difference between them?
There are two parts to Medicare: Part A and Part B. Medicare (Part A) is designed to cover in-patient hospital care, include semi-private rooms, medications given to you while in the hospital, operations and recovery services, lab tests, x-rays, meals, nursing services, radiology services, and use of appliances such as wheelchairs. It also pays for some home health services and hospice care.
Medicare (Part A) will not cover most nursing home care, routine checkups and routine tests, immunization shots, prescription drugs, dental care and dentures, eyeglasses or hearing aids.
Medicare (Part B) covers two types of services: Medically necessary services such as services or supplies needed to diagnose or treat a medical condition, and preventive health care services to detect or prevent illness.
You are eligible for Medicare (Part A) when you turn 65.
You are also automatically qualified for Medicare if you have been receiving Social Security disability benefits for at least 24 months.
If you have kidney failure which requires maintenance dialysis or a kidney replacement, or if you are a government employee not covered by Social Security, and you’ve paid the Medicare section of your Social Security tax, you likely also qualify. Medicare hospital insurance (Part A) is available to you if you have paid for it out of your employment taxes.
If you are currently eligible for free Medicare hospital insurance (Part A), you may also enroll in Medicare (Part B) by paying the monthly premium. Medicare (Part B) is optional and will cost you an extra amount per month. There are a number of rules associated with Medicare enrollment, including penalties you may incur if you do not enroll in Medicare (Part B) as soon as you are eligible to do so.
To explore your options, you may wish to speak with an attorney at Hook Law Center. We can help you navigate the Medicare maze.