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Medicare Primer

Links to Information and Resources

What do I need to know?

Medicare is a Federal health insurance program that is designated for those people who are 65 years of age and older. Although directed towards a specific age bracket, Medicare plans are also applicable to certain disabled people. Both you and your spouse automatically qualify for Medicare if you are 65 years of age and you are eligible for Social Security or Railroad Retirement Benefits.

Medicare
Medicare Primer
Equipment Coverage
Resource Links

Prescription Drugs
The right question
Need to know (pdf)
MN Approved Cards (pdf) Resource Links

Medicaid
Medicaid Primer
Medicaid Services
Medicare vs Medicaid
Resource Links

Medigap
Medigap Overview
Standardized Plans
MN Company List (pdf)
Resource Links

Long Term Care Insurance
Overview
Coverage Options
Resource Links

Minnesota Programs
Medical Assistance Elderly Waiver (pdf)

Medicare has two parts:

Part A is hospital insurance and is FREE.

Part B is supplementary medical insurance and has a premium ($58.70/month in 2003)

Medicare Part A Helps Cover:

Hospital Stays
Skilled nursing facility care
Some home health care
Hospice Care

Medicare Part B Helps Cover:

Doctors' services
Outpatient hospital services
Other medical services that Part A doesn't cover (like some home health care)

Recent Medicare Changes - as of July 16, 2004

Obesity Coverage

After 40 years of stating that obesity was a personal problem and not an illness, Medicare has changed its position on the matter, now defining obesity as a medical problem that can be covered under the Medicare program. Under the new definition, surgeries such as those designed to shrink the stomach along with in-hospital diet/exercise programs could be covered under Medicare. Of the 40(+) million Americans on Medicare, approximately 37% are overweight and approximately 18% are obese.

Medicare Modernization Act: Prescription Drug Discount Card

The recent implementation of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 has created a new, voluntary discount card for purchasing prescription drugs, and a low-income Transitional Assistance Program that will be in effect until Medicare’s Part D becomes available in 2006. Estimates suggest that the prescription drug discount card has the ability to save recipients anywhere from 10% - 25% on the cost of covered drugs.

Transitional Assistance Program

If you have an annual income that is less than or equal to 135% of the federal poverty limit, then your prescription drug discount card will come with a credit of $600 to be used for the purchase of covered drugs in 2004. This is an annual credit, meaning another $600 credit will be received in 2005 assuming your income still qualifies you. Co-payments will range from 5% - 10% of the $600 credit, and are again dependent on your exact income. Once you have spent your $600 credit, you are responsible for 100% of the prescription drug costs you incur for the remainder of the year. To apply for the Transitional Assistance Program, you must first report your income on the discount drug card application.

Types of Medicare Health Plans

The Original Medicare Plan (sometimes called fee-for-service) - everyone with Medicare eligible, available nationwide, many people have Medigap policy.
Medicare + Choice Plans
- Medicare managed care plans (like HMOs)
- Medicare Pribate Fee-for-Service plans

*Chart reproduced from www.medicare.gov

Medigap (Medicare Supplement Plans)

What should I know?

Medigap plans are health insurance policies sold by private insurance companies designed to fill in the "gaps" in the Original Medicare Plan. A Medigap policy is not needed in a Medicare + Choice plan.
There are 10 standardized Medigap plans , "A" through "J". Plan A covers only the basic benefits (included in all of the plans), while plan J offers the most benefits.
Medicare SELECT is a type of Medigap policy available in some states. Medicare SELECT policies generally cost less but require you to use specific hospitals and, in some cases, specific doctors to get full insurance benefits.

What it covers

Medigap plans pay most, if not all, of the Original Medicare Plan coinsurance and outpatient co0payment amounts. Medigap may also cover Original Medicare Plan deductibles.

*Chart reproduced from www.medicare.gov

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