Medicare Overview
Medicare eligibility: under 65
1. Individuals under 65 are eligible for Medicare if they have been receiving Social Security disability insurance (SSDI) for 24 months. Individuals are Medicare eligible the first day of the 25th month of receiving SSDI. Exception: those who receive SSDI because they have amyotrophic lateral sclerosis (ALS) become eligible the first month of their SSDI benefits start. 2. Individuals are also eligible for Medicare if they have an stage renal disease (ESRD)
Medicare eligibility: 65+
1. They either receive or qualify for Social Security retirement cash benefits. 2. they currently reside in the United States and are either A US citizen or A permanent US resident who has lived in the US continuously for five years prior to applying.
What is Medicare?
Health insurance for people 65 and older and people with disabilities. Covers most healthcare services and items. Eligibility not based on income.
Social Security retirement in eligibility
Individual can start collecting Social Security retirement benefits at age 62 or they can delay until age 70.
Medicare Eligibility: 65+
Individuals are Medicare eligible the first day of their 65th birth month.
Dual-eligibles
Individuals who have Medicare and Medicaid. Medicaid cover some Medicare excluded services. Medicaid can also cover out-of-pocket expenses for Medicare covered services.
Medicare eligibility
Medicare eligibility begins at age 65, regardless of when Social Security retirement benefits start. It is important for individuals to sign up as soon as they are eligible otherwise they may face a penalty.
Medicare and work history
Medicare eligibility is not based on work history. Work history affects Medicare costs, but not eligibility. Work history equals the number of years or quarters, individual has worked and paid Social Security taxes. Part A is premium-free if beneficiary or spouse worked equivalent of at least 10 years in the US.
Medicare versus Medicaid
Medicare is federal health insurance whose eligibility is based on age or disability status, not income. Medicaid is either federal or state funded, state administered health insurance. Eligibility is based on state income and asset limits.
What are the two ways beneficiaries can access Medicare benefits?
Original Medicare: traditional Medicare program administered by the federal government. Medicare advantage: Medicare private health plans managed by private insurance companies that contract with the federal government.
Parts of Medicare: original Medicare
Part A - hospital insurance Part B - medical insurance + Part D- prescription drug coverage (Can only get part D through private insurance companies)
Parts of Medicare: Medicare advantage
Part C - (private insurance company) Hospital insurance (part A) Medical insurance (part B) Usually Prescription drug coverage (part D)
Agencies involved in the Medicare program: Social Security administration (SSA)
Shapes and facilitate Social Security benefits and programs. Medicare Social Security disability insurance (SSDI) Supplemental security income (SSA) Part D extra help program Facilitates initial Medicare enrollment Replaces Medicare cards
July 30 1965 Lyndon B Johnson science social security act of 1965 and establishes
Title 18: Medicare Title 19: Medicaid
Agencies involved in the Medicare program: centers for Medicare and Medicaid services (CMS)
US government agency responsible for administering Medicare and Medicaid Medicare Rights coverage rolls. Approves an overseas Medicare advantage plan contracts. Employees payment and program integrity contractors. Medicaid Writes minimum standards. Reviews and approves state Medicaid plans. Undertakes improvement initiatives with local partners.
