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Medicare Basics

Caregivers not yet enrolled in Medicare themselves, often need to learn the essentials of this government program as soon as they start caring for elderly parents.

First, a common point of confusion: the difference between Medicare and Medicaid. Medicare is the federal health INSURANCE plan that most Americans have paid into their entire work life. The basic Medicare program is not related to one's income or assets. Medicaid is the federal/state health SUBSIDY program available only to those with very low income and minimal assets. Some seniors are eligible for both programs.

Medicare Part A is also called "Hospital Insurance."

Part A is paid for by a portion of your Social Security Tax. Generally, those 65 and over and getting Social Security automatically qualify for Medicare Parts A & B.

Part A covers inpatient hospital care, skilled nursing care, hospice care and some other services. Coverage in a skilled nursing facility is time limited and requires a three day stay in a hospital first.

Medicare Part B is also called Medical Insurance. Almost anyone who is 65 or older can enroll for Medicare Medical Insurance by paying a monthly premium, about $100 a month. It covers doctors' fees, outpatient hospital visits, outpatient physical therapy, home health services, durable medical equipment and other services and supplies that Part A doesn't cover.

Medicare Part C is also called Medicare Advantage. It allows you to choose to receive all your health care services through a provider organization, such as an HMO or PPO.

Medicare Part D, the newest component of Medicare, is also called Prescription Insurance.

Even if you are very healthy when enrolling for Medicare, you should also consider Part D or another prescription plan as "insurance." You can't "instantly" get Medicare Part D coverage if you suddenly need it, if you didn't register for it when it was introduced or when enrolling in Medicare initially. You will have to wait for next enrollment period of Nov. 15-Dec. 31 each year and there are penalties for late enrollment.

In 2009, the deductible for prescriptions in Part D is about $300 and the initial coverage Limit is about $2,500. You pay 100% between that amount and your "true out of pocket costs" of $4,050. After that, Medicare is responsible for 95% of your drug costs for the remainder of the year. This is called "catastrophic coverage."

Benefits and costs vary greatly among different plans. Compare and assess based on Coverage (what drugs covered?), Cost (premiums, deductibles, coinsurance and co-pays), Convenience, and Customer Service.

Medicare Part D for prescriptions isn't the only way seniors can get low cost medications, of course. Many will still have health and prescription coverage through a former employer. Eligible veterans or retired military personnel might use VA benefits or TRICOR insurance, which have low co-pays. New Jersey offers its pharmaceutical assistance program, PAAD, which many seniors had before Part D existed. Compare your benefits before making a switch to Part D.

Medigap or Medicare Supplemental Insurance is optional insurance that covers costs NOT covered by Medicare. By using both Medicare and your supplemental insurance you will often have 100% of the costs covered for a specific service, while Medicare alone might have covered only 80%.

There are 12 different government-standardized Medigap plans and each insurance company decides which plan it wants to sell. You pay insurance premiums for the plans and select one that best meets your needs. Each spouse needs his or her own Medigap plan.

One good Medicare publication: Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare, is also available from AARP, which offers it own supplemental health insurance plan.

Depending on income and assets, you might qualify for special Medicare assistance—"EXTRA HELP" program-- to help cover your premiums for Part B or Part D. For example, in the Part D. Drug plans, if you have low income and assets, you might qualify for up to $3,600 towards your premiums. To apply for this financial help, call 800-772-1213 or go online for the form.

Register for Medicare three months before your 65th birthday. If you retire at 62, you can't get Medicare until you reach 65.

To replace a lost Medicare card or change the card holder's address, do it on line at: www.social security.gov/medicarecard/ or by phone at: 800-772-1213.

For the most complete, accurate information always consult directly with Medicare officials.

Web sites: www.medicare.gov; www.aarp.org; www.njpaad.gov
Medicare beneficiary helpline: 1- 800-624-4557
Medicare toll free information: 1-800-633-4227
Medicare enrollment 1-800-772-1213

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