Medicare is a federal health insurance program that is usually the main insurance program for people over 65 and some groups of people with disabilities or people with health problems. As a rule, Medicare covers 80% of outpatient services (medical services provided by the local community) and all hospitalization services (minus the uninsured minimum).
Medicare includes three parts: Part A, Part B, Part D and Part C.
Part A covers hospitalization, hospital stays, home care, and hospice care. Most people do not have to pay a monthly insurance premium for Part A, because either the individual or spouse paid tax to Medicare when they worked. There are uninsured minimums and joint payments, for the payment of which the patient is responsible for each period of the benefit. The period of validity of the privilege begins from the moment you are admitted to a hospital or specialized care institution and ends after 60 calendar days from the moment of discharge. In 2004, for each period of the benefits, one had to pay:
- $1,024 per hospital stay for 1-60 days;
- $256 for each day of hospital stay per day between 61 and 90;
- $512 per day for stays from 91 to 150 days;
nothing to pay for the first 20 days of care in a specialized care facility;
- $128 per day from day 21 to day 100 at a specialized care facility.
Part B covers the costs of medical and doctor services, durable medical equipment and various medical outpatient services. Each year, in addition to a monthly contribution of $66.60, insured persons must first pay $100 of approved medical benefits before payment begins with Part B.
Part C is also known as Medicare Advantage. If you have Part A and Part B, you can join the Medicare Advantage health plan. With this plan, you won’t need additional Medigap insurance because Medicare Advantage plans offer the same benefits as Medigap additional insurance. This includes, for example, paying extra hospital days after you used Medicare paid days.
Medicare Advantage plans are:
- coordinated care plans;
- plans using contracted healthcare facilities and doctors;
- private plans (fee-for-service);
- specialized plans.
If you sign up for Medicare Advantage, you will show the Medicare Advantage health card that your plan will send you when you get health care. You may have to pay a premium for Medicare Advantage because Medicare Advantage offers additional benefits.
Part D is a new Medicare discount for prescription drugs. Since 2006, Medicare members can enroll in prescription drug plans offered by private organizations. Inclusion in the plan is voluntary, not automatic, but if people receiving Medicare want to participate in the program, they must choose a new prescription drug payment program (also known as Medicare, Part D) for the year ahead. The law provides for fines and restrictions (mostly vague) for late filing.
- Participants must pay a monthly fee of $35;
- Participants must pay an annual uninsured minimum of $250;
- Participants receive a discount in the form of 75% of the cost of medicines (a list of paid drugs has not yet been determined) up to $2250;
- Participants must pay 100% of all drug costs, ranging from $2,250 to $5,100 (“donut hole”);
- Participants receive 95% of their drug costs if they exceed $5100 per year (this is called “catastrophic coverage”);
- The annual limit in cash is $3,600 ($5,100 – $2,250 + $250 of an uninsured minimum; monthly payments are not taken into account when calculating the “limit”).
Prescription drug costs not included in the officially approved drug list are NOT taken into account when calculating the “donut hole” paid in cash.
Participants with low income and limited funds are exempted from monthly fees and not insured minimum. Persons to whom this applies must pay a co-payment for each prescription.
Who is eligible for Medicare?
- Persons 65 years of age and older who are eligible for Social Security benefits or Railroad Retirement benefits;
- Persons 65 years of age who are eligible for Social Security Disability Insurance benefits or Railroad Retirement Disability benefits for 24 months;
- Persons of any age with advanced renal failure.
Is there a limit on income and resources?
No, there are no restrictions on income and resources.
Is US citizenship required?
All applicants for Medicare must be either US citizens or eligible residents who have resided continuously in the United States for at least 5 years.
When can I apply for Medicare?
What documents are required for an interview?
- Certificate of age, e.g. birth certificate, baptism certificate, etc.;
- US citizenship or legal entry certificate;
- Social security number.