GENERAL MEDICARE INFORMATION

WHAT IS MEDICARE?

Medicare is a health insurance program for the following people:

• People age 65 and older
• People under age 65 with certain disabilities
• People of any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant, sometimes called ESRD)

WHO IS ELIGIBLE?

Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years or older and a citizen or permanent resident of the United States. You may also qualify for coverage if you have a disability or ESRD (even if you are younger than 65 years old).

WHAT ARE THE MEDICARE COVERAGE CHOICES?

With Medicare, you can choose how you get your health and prescription drug coverage.

Original Medicare

• Run by the Federal government; provides Part A and Part B coverage.
• You can go to any doctor or hospital that accepts Medicare.
• You can join a Medicare Prescription Drug Plan to add drug coverage.
• You can buy a Medigap (Medicare Supplement Insurance) policy to help with costs not covered by Part A and Part B.

Medicare Advantage Plans (like a HMO or PPO)

• Provides Part A and Part B coverage. You can buy extra coverage and prescription drug coverage, costs can vary by plan.
• If you want drug coverage, you must get it through the plan.

Other Medicare Health Plans

• Plans that aren’t Medicare Advantage Plans but are still part of Medicare may be available: Medicare Cost Plans, Pilot Programs, and Programs of All-inclusive Care for the Elderly (PACE).

WHAT DOES MEDICARE COVER?

Medicare Part A (Hospital Insurance) covers the following:

• Inpatient care in hospitals
• Inpatient care in skilled nursing facilities (not custodial or long-term care)
• Hospice care
• Some home health care

Medicare Part B (Medical Insurance) covers the following:

• Doctors’ services
• Outpatient hospital care
• Other medical services that Part A doesn’t cover (like physical and occupational therapy)

Medicare Part C (Medicare Advantage Plans – like a HMO or PPO):

• A health coverage option run by private insurance companies
• Includes Part A, Part B, and usually other coverage like prescription drugs

Medicare Part D (Medicare Prescription Drug Coverage)

• A prescription drug option run by private insurance companies approved by and under contract with Medicare

HOW MUCH DOES MEDICARE COST?

Medicare Part A

Most people don’t have to pay a monthly premium for Part A because they (or a spouse) paid Medicare taxes while they were working.

Medicare Part B

Everyone must pay a monthly premium for Medicare Part B. You will pay a monthly fee for Medicare Part B. This amount may be higher if you don’t sign up for Part B when you first become eligible. Plus you will be responsible to pay a deductible amount every year.

GETTING HELP TO PAY FOR SOME OF YOUR HEALTHCARE COSTS

You may qualify for help to pay your Medicare expenses (such as the monthly premium, deductible and co-insurance). Medicaid is a joint Federal and State program that helps pay medical costs for some people with limited income and resources. Most health care costs are covered if you qualify for both Medicare and Medicaid.

Medicare Savings Programs pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare with a low income and limited assets.

To qualify for the Medicare Savings Program, you must have the following:

• Medicare Part A (Hospital Insurance).
• A monthly income below a certain amount for an individual, or for a married couple.
• Assets of a limited amount for an individual, or for a married couple.

HOW DO I SIGN UP?

• You can enroll in Medicare by visiting you local Social Security office or by calling Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
• To apply for Medicaid, you will need to fill out an Assistance Application (DHS-1171) and return it to your local Department of Human Services (DHS) office. You can call your local DHS office to request an application be sent to you, or it can be found and printed online at www.michigan.gov/dhs. You will need to click on the link “Assistance Programs” and then “Medical Services” to get to the downloadable form “Assistance Application (DHS-1171)”.

FOR MORE INFORMATION

For more information about your Medicare plan choices, you can visit www.medicare.gov on the web. You can view or download a copy of the “Medicare & You” handbook.

The information provided here was obtained from the Medicare website and the “Medicare and You” handbook. This information is meant to be a general overview and may not contain the most recent updates; for more detailed and up-to date information you should visit the Medicare website www.medicare.gov or call 1-800-325-0778. For questions relating to Medicaid, please call 1-800-642-3195 or visit the Michigan Medicaid website at www.michigan.gov/dhs.

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