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MEDICAREMedicare is a U.S. federal health insurance program for Americans when they become eligible for Social Security benefits (currently age 65) and for certain disabled persons and those with end-stage renal disease. Detailed information is available from the federal government in -- "The Medicare Handbook," Center for Medicare and Medical Services (previously the Health Care Financing Administration), Publications, N1-26-27, 7500 Security Blvd., Baltimore, MD 21244-1850. Medicare "Part A" covers hospital services and is free for Medicare eligible people. Medicare "Part B" (also known as "supplementary medical insurance") covers physician services, supplies ordered by a physician, and selected other services. Part B premiums are subsidized by Medicare, but enrollees pay part of the premiums. Although there have been many proposals for Medicare to cover prescription drugs, Medicare does not cover prescription drugs at this time. Also, Medicare generally does not pay for nursing home care. Medicare only pays for a few days under certain circumstances. Medicare traditionally has been a FFS insurance program that allows seniors wide flexibility in choice of providers. In some locations, seniors now have the option of enrolling in a Medicare-contracted HMO instead of traditional FFS Medicare. Generally these Medicare HMOs offer more generous coverage (such as coverage for prescription drugs), lower out-of-pocket costs for seniors, or both additional coverage and lower costs. Coordination of benefits applies with Medicare if you or your spouse have health insurance through your employer. If you are under 69 and still working and your employer has 20 or more employees, then your employer must offer you the same insurance that other workers get. You can select whether Medicare or your company's insurance will be your primary insurance. Generally it is better to select your employer's insurance as primary so that you do not have to pay Medicare Part B premiums. "Medigap" insurance (also called "Medicare Supplemental" or "Medisup" Insurance) is private insurance that pays for some of the out-of-pockets costs for services that Medicare covers and/or for some of the services that Medicare does not cover at all. There are ten standard Medigap policies that are labeled "A" through "J". Plan "A" is offered in all areas, but not all other policies are offered everywhere. Medigap policies all cover daily coinsurance for inpatient hospital stays and 90% of hospital charges that would have been paid by Medicare if it had not been exhausted. Some Medigap policies also pay for Medicare deductibles, preventive care, prescription drugs and home care. Medigap insurance can not duplicate Medicare benefits. Generally, Medigap does not pay for long term care. Two booklets can help you to select one of the ten standardized Medigap policies. The first is -- "Guide to Health Insurance for People with Medicare" available at the Center for Medicare and Medicaid Services (CMMS), Publications, N1-26-27, 7500 Security Blvd., Baltimore, MD 21244-1850. CMMS was once the Health Care Financing Administration. The second is -- "The Consumer's Guide to Medicare Supplement Insurance" provided by the Health Insurance Association of America, 555 13th St., N.W., Suite 600 East, Washington, D.C. 20004. You can also visit the U.S. government's consumer website for Medicare.
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