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Medicare: Part A & B

Medicare is a national health insurance program sponsored by the U.S. Government and managed by the Social Security Administration. It is generally available to people age 65 and older. Younger disabled people, such as those with kidney failure, may also be eligible.

Medicare is divided into two parts: Part A pays benefits for hospital and skilled nursing home care and Part B helps pay for doctor bills and outpatient services.

Anyone receiving Social Security or Railroad Retirement when they turn 65 will automatically be enrolled in Medicare Part A. If you do not receive social security at age 65, you will need to apply for Medicare 3 months before you turn age 65. People enrolled in Medicare must pay deductible fees. For hospitalization, Medicare Part A has a deductible for each hospital stay during the year. The amount of these deductibles usually increases each year.

Service benefits for Medicare Part A include the following:

• semi-private hospital room and board
• skilled nursing and rehabilitative services
• blood transfusions during hospital stay
• pain relief and symptom management during hospital stay
• physical, occupational, and speech therapy
• medical social services
• skilled nursing facility care
• part-time in-home skilled nursing care
• hospice services and
• no premiums are required for the hospital insurance plan

Medicare Part B is optional and requires a monthly premium. It covers certain medical and outpatient services, including physician care. The premium varies and there is an annual deductible. After the deductible is met, Medicare B will pay 80 percent of Medicare- approved charges for covered services. You are responsible for the remaining 20 percent of the Medicare approved charges.

Medicare Part B covers doctors' services that are received from a Medicare approved facility or a medical practice. Medicare Part B helps pay for many services including:

• outpatient hospital procedures
• x-rays and lab tests
• diagnostic tests
• nursing and physician services
• drugs for pain relief and symptom management
• home health aid
• counseling services
• prosthetic devices such as artificial limbs
• flu and pneumonia shots
• blood transfusions, medical equipment (such as wheelchairs and oxygen for home use)
• kidney dialysis and
• limited ambulance transportation, such as when transportation in any other vehicle could endanger your health (Ambulance equipment personnel must also meet Medicare requirements.)

Medicare Part B does not cover routine physicals, most dental care, routine foot care, dentures, hearing aids, or glasses (unless the lenses are needed after cataract surgery).

There are some specific requirements for enrolling in Medicare Part B. It is a good idea to contact Social Security prior to turning age 65 for information about enrollment and about limitations on Medicare payments for specific services.

Certain low-income Medicare recipients may be eligible for the QMB (Qualified Medicare Beneficiary) or SLMB (Specified Low-Income Medicare Beneficiary) programs. These programs can assist in paying deductibles and co-pays. For information about these programs, contact Social Security and request the HCFA Pamphlet #02184, titled "Medicare Savings for Qualified Beneficiaries."

Last Reviewed 2005

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

HIL File AGIN3390.RF2 VRS# 7856 Data Version 7.0 Copyright 1999-2000, 2002 McKesson Health Solutions LLC. All rights reserved.