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Medicare Overview

Medicare is a government-run health care program designed to help care for the elderly and certain disabled individuals. The following Medicare overview is a good place to start if you are new to the program. See FindLaw's Medicare section for additional articles and resources. 

  • Purpose: Medicare was created to help older citizens and some disabled citizens pay their medical bills.
  • Entitlement: Medicare is an entitlement program that you paid for through Social Security contributions made by either you or your spouse.

  • Administration: Medicare is a federal program. You can obtain information about it at your local Social Security office.

  • Program: Medicare is divided into two parts: Part A (hospital insurance) and Part B (medical insurance).

  • Part A Eligibility: Most people age sixty-five or older are entitled to free Medicare coverage based on their work record or that of their spouse. If you are sixty-five or older and do not qualify for free Medicare coverage, you can enroll in it and pay a monthly fee for the coverage.

Note: If you enroll and pay for Part A hospital insurance, you must also enroll and pay for Part B medical insurance. There will be an additional monthly fee for Part B.

  • Part A Coverage: For a benefit period, also known as a "spell of illness," Medicare hospital insurance covers most of the costs of a hospital stay as well as nursing facility and home health care costs that follow a hospital stay. The benefit period begins the day an individual enters the hospital or skilled nursing facility and continues until the individual is out for sixty consecutive days. If an individual is in and out of the hospital or nursing facility several times during a specific period but has not been out for sixty consecutive days, all of the inpatient bills for that time will be considered part of the same benefit period. Medicare Part A hospital insurance contains a deductible. An individual must pay this deductible before Medicare will pay anything. This deductible is increased every year on January 1.

  • Part B Eligibility: Anyone age sixty-five or older who is a citizen of the United States or has been a lawful resident of the United States for five consecutive years is eligible to enroll in Medicare Part B medical insurance. There is a monthly premium for Medicare Part B.

  • Part B Coverage: Medicare medical insurance covers basic medical services provided by doctors, clinics, and laboratories. Nonetheless, when you add up your bill, you will note that Medicare pays, on average, for only half the total. Moreover, Medicare usually pays only about 80 percent of what it decides are the approved charges for medical services. You are responsible for the remaining 20 percent. Learning what and what is not covered by Medicare medical insurance is therefore very important. An individual can get the most out of his/her benefits by fitting his/her medical treatments into covered categories whenever possible.

Medicare Part B pays for:

  • the services of a physician (surgery included) whether provided at a hospital, physician's office, or in your home;

  • basic female tests including mammograms, pelvic exams, PAP smears, and bone density tests;

  • services provided by nurses, surgical assistants, or certain technicians;

  • outpatient hospital treatment;

  • an ambulance, if the trip is required;

  • medicine and drugs administered at a hospital or physician's office;

  • medical equipment and supplies;

  • certain types of oral surgery;

  • part of the cost of outpatient speech and physical therapy;

  • certain limited services provided by podiatrists and optometrists;

  • a limited amount of counseling and care by psychologists, social workers, and daycare personnel;

  • certain preventative cancer screening;

  • certain chiropractic services; and

  • certain home care services such as part-time skilled nursing care, physical therapy, and speech therapy.

Enrollment: You will be automatically enrolled in Medicare Part A at age sixty-five if you are receiving Social Security, Railroad Retirement, or disability benefits. Approximately three months prior to your sixty-fifth birthday, you will be sent an Initial Enrollment Package that contains information about Medicare. If you want Medicare Part B, you must enroll in the program and have the premiums for this coverage deducted from your Social Security check.

 If you still have questions that were not answered in this Medicare overview, consider speaking with a health care attorney. 

Next Steps
Contact a qualified health care attorney to help
navigate legal issues around your health care.
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