Social Security: Medicare Benefits

Medicare coverage can begin when you reach age 65 whether you are retired or still working. Your spouse also qualifies for Medicare at age 65 based on your work record if you are eligible for monthly Social Security benefits, even if you are not yet age 65.

You may also qualify for Medicare before age 65 if you have been entitled to Social Security disability benefits for two years or if you have end-stage renal disease (kidney failure).

Beneficiaries can stay in the Original Medicare Plan or opt to receive healthcare services from one of several types of Medicare+Choice plans, most of which are managed care plans. Currently, most beneficiaries are in the Original Medicare Plan, described below.

Hospital Insurance (Part A)

This program pays for:

1. Hospital benefits. When vou are admitted to a hospital, you will have to pay an initial deductible of $768. After the first 60 days, you will have to pay $192 per day. After 90 days, you can choose to pay $384 per day for up to 60 "lifetime reserve" days (or else pay the full charges yourself and "save" the 60 days for possible use later).
2. Skilled nursing facility benefits are available only after a hospital stay of at least three days. You pay nothing for the first 20 days, except for any charges that Medicare does not allow. For the next 80 days, you pay charges up to $96 per day. No benefits are available after 100 days in a skilled nursing facility.
3. Home health services, such as part-time or intermittent skilled nursing care, physical therapy, medical social services, medical supplies, and some rehabilitation equipment, may be paid for in full when you are confined at home. You are not required to have a hospital stay before home health services are covered.

Supplementary Medical Insurance (Part B)

In 1999, the standard monthly premium is $45.50. Coverage is voluntary. After the patient has paid $100 of charges from doctors and other healthcare professionals that are allowed by Medicare in any year, Part B pays 80% of additional allowed charges. For charges higher than those allowed by Medicare, the payrrent is based only on the allowed charge.

Exclusions

Some of the items not covered by Medicare are:

• most prescription drugs and medicines taken at horne;
• services not reasonable or medically necessary;
• most services outside the U.S.;
• routine physical exams, eye exams, glasses, hearing aids, and dental care;
• routine foot care and orthopedic shoes, except for diabetics;
• custodial care;
• most immunizations (pneumococcal vaccine and flu shots are covered); and
• extra charges for a private room (unless medically necessary).

The several cost-sharing payments shown above are substantial.

Additional Benefits: Life Insurance | Disability | Long Term Care
Social Security Information: Retirement | Disability | Survivor | Medicare