Medicare Basics
OVERVIEW OF MEDICARE AND ITS STRUCTURE
Medicare was created in 1965 as the federal health insurance program for all people age 65 and older, without regard to income or medical history. In 1972 the program was expanded to include people under the age of 65 with certain permanent disablities and for anyone with End-Stage Renal Disease. In 2000 Medicare eligibility was extended to individuals with ALS (Lou Gehrig’s disease). Individuals may qualify for Medicare through either their own work history or the work history of a spouse or a former spouse.
MEDICARE IS ORGANIZED INTO FOUR PARTS:
- Part A: pays for inpatient hospital care, skilled nursing facilities, home health and hospice care.
- Part B: pays for physician visits, outpatient care, home health visits and preventative services.
- Part C: Medicare Advantage programs; individuals enroll in a private managed care plan (HMO, PPO) and the plan provides combined coverage of Part A, B and D.
- Part D: outpatient prescription drug benefit provided by private plans which contract with Medicare.
COSTS
- Part A coverage is free if you, your spouse or a former spouse worked for at least 10 years and paid Medicare taxes during that time.
- Part B premiums are based on your annual income. This amount is deducted from you Social Security check, if you are receiving SS benefits, or a bill is mailed to you every three months.
- Part D is covered as part of your UC/Medicare coordinated medical benefits.
It is very important to keep in mind that traditional Medicare coverage does not cover all health care expenses and there is a signficant out of pocket cost for individuals with traditional Medicare only. Your UC medical benefits help close that gap.