The United States Social Security Administration (SSA) administers numerous social insurance programs.

One of these is the Medicare Benefits. Medicare provides health insurance programs for:

a. People 65 years and above;
b. People below 65 years but with disabilities for not less than two years; and
c. People, regardless of age, suffering from End-Stage Renal Disease (permanent kidney failure which requires dialysis and/or kidney transplant)

Medicare provided for by the SSA has four parts

1. Medicare Part A (Hospital Insurance) – this is paid for by Social Security tax. People over age 65 and other covered members automatically qualify for Medicare Part A. Most people do not pay Hospital Insurance anymore because a spouse or a family member has already been paying for it through payroll taxes. This benefit includes, among others:

a. Inpatient care in hospitals
b. Care in skilled nursing facilities
c. Home health services
d. Hospice care
e. Blood Transfusion

2. Medicare Part B (Medical Insurance) – this is paid for by the covered members’ monthly premiums depending on their gross income, as well as by the general funds coming from the US Treasury. People over the age of 65 and other people getting Social Security benefits automatically qualify for Medicare Part B. This part covers all but not limited to:

a. Outpatient care
b. Doctor’s services
c. Preventive services
d. Ambulance services
e. Bone Mass Measurement
f. Cardiovascular, Cancer and Diabetes screenings
g. Occupational and Physical Therapy
h. Eye examination
i. Dialysis
j. Mammograms
k. Clinical Laboratory Screenings and Trials
l. Transplant Services

3. Medicare Part C (Medicare Advantage) – allows the covered member to receive health care and services, at a lower cost, through a provider organization of his choice. Unlike Part A and B, Medicare Advantage is optional, but you must have both Part A and B in order to avail of Part C. Part C includes:

a. Medicare Health Maintenance Organization (HMOs)
b. Preferred Provider Organizations (PPO)
c. Private Fee-for-Service Plans and
d. Medicare Special Needs Plans

4. Medicare Part D (Prescription Drug Coverage) – this is paid for enrollees’ monthly premium and Medicare. Like the Medicare Advantage Plan, it is also optional. However, Medicare will not cover 100% of your medical costs. As a solution, it is better if you should:

a. Inform your other health insurance that you are eligible for Medicare.
b. Obtain a medigap insurance policy. This covers Medicare deductibles.
c. Study the Medicare Handbook to understand properly your Medicare coverage.

When to apply for Medicare Insurance and Benefits

– If you are not yet receiving social security benefits, visit the nearest SSA office before or about three months before you turn 65 years old, and fill up the Medicare Application Form.
– If you are already receiving social security benefits, you will be automatically enrolled in Medicare upon turning 65 years old.
– If you are suffering from a disability, you will be automatically enrolled in Medicare after two years of getting Disability Benefits.

For queries regarding Medicare and other Social Security Benefits, contact a Medicare Customer Service Representative or a Social Security Attorney.

Adapted from an article by Adriane Lauren Luna.
Senior Care Focus (Long-term Care Focus), Issue No. 1, September/October 2008