What Is Medicare?

Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with permanent kidney failure (called “End-Stage Renal Disease”). You must have entered the United States lawfully and have lived here for 5 years to be eligible for Medicare.

Medicare has two parts:

Medicare Part A (Hospital Insurance)

Medicare Part A helps pay for inpatient care you get in a hospital, skilled nursing facility, or hospice, and for home health care if you meet certain conditions. Most people don't have to pay a monthly premium for Medicare Part A because they or a spouse paid Medicare taxes while working in the United States. If you don't automatically get premium-free Part A, you may still be able to enroll, and pay a premium.

Medicare Part B (Medical Insurance)

Medicare Part B helps pay for medically-necessary doctors' services and other outpatient care. It alsopays for some preventive services (like flushots) to help keep you healthy and someservices that keep certain illnesses fromgetting worse. Most people pay the standard monthly Medicare Part B premium ($96.40 in 2008).

You have choices about how you get your Medicare coverage. Here are the two main options:

Original Medicare

Managed by the Federal government, it provides your Medicare Part A and Part B coverage. (You can choose to have either one, or both parts.) You have to pay a deductible, and you are usually charged coinsurance each time you get services.

  • You can add Medicare prescription drug coverage (Part D) by joining a Medicare PrescriptionDrug Plan. Costs and benefits vary by plan.
  • You can also choose to buy a Medigap (Medicare Supplement Insurance) policy to help pay someof the health care costs' “gaps” (like copayments, coinsurances, and deductibles).

Medicare Advantage Plans (called Part C)

You must have both Part A and Part B to join one of these plans. The plans provide all of your Part Aand Part B services and generally provide additional services. You usually pay a monthly premium, and copayments that will likely be less than the coinsurance and deductibles under Original Medicare. Inmost cases, these plans also offer Part D prescription drug coverage. These plans are offered by private insurance companies approved by Medicare. Costs and benefits vary by plan.

Note: Help is available. If you have limited income and resources, you may qualify for help paying your Medicare health care and/or prescription drug coverage costs. For more information, call Social Security at 1-800-772-1213, visit www.socialsecurity.gov on the web, or apply at your State Medical Assistance (Medicaid) office.

If you have a question about Medicare or the Medicare health and prescription drug plans in yourarea, visit www.medicare.gov on the web, or call 1-800-MEDICARE (1-800-633-4227). TTY user sshould call 1-877-486-2048.

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