What is Medicare?

Medicare is a federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people of any age with End-Stage Renal Disease. It ensures that all seniors have basic hospital insurance (Part A) at no cost to them. It also provides the option of medical insurance (Part B). Part A & Part B make up what is called Original Medicare.

Medicare eligibility begins for most people at age 65. Individuals who have been entitled to Social Security disability for at least 24 months also qualify.

Many people confuse their Medicare Eligibility date with their Social Security date. They are different. A person can apply for full retirement income benefits at age 66. However, this does not affect the age at which they qualify for Medicare. Everyone who has worked at least 40 quarters (10 years) in the United States during their lifetime can qualify for Medicare at age 65.

If you are already receiving Social Security or Railroad Retirement Benefits, then you will also automatically receive Part A and Part B starting the first day of the month you turn 65. If you're automatically enrolled, you will receive your Medicare card in the mail 3 months before your 65th birthday, or the 25th month of disability benefits.

If you are not receiving Social Security or Retirement Benefits, or if you have End-Stage Renal Disease, you will need to sign up for Part A. There are many ways to do so, whether in person, over the phone, or online. If you are not automatically enrolled, and are eligible to sign up for Part A, you can enroll anytime once your Initial Enrollment Period starts. You can only sign up for Part B during your initial enrollment period, general enrollment period, or special enrollment period.

Original Medicare, also known as Part A and Part B, is managed by the federal government and provides Medicare eligible individuals with coverage for and access to doctors, hospitals, or other health care providers who accept Medicare. Part A includes hospital coverage, as well as some short term post-hospital care. Part A does not cover long-term care. Part B is your medical insurance, including doctors visits, laboratory testing, and some preventative care. Part A and Part B do not include certain services, such as dental services. In addition, they do not cover Prescription drug plans. If you are on Original Medicare, you will need to sign up for a Part D plan in order to receive prescription drug coverage.

Original Medicare is a fee-for-service plan, meaning that the person with Medicare usually pays a fee for each service. Medicare pays its share of an approved amount up to certain limits, and the person with Medicare pays the rest.

Most beneficiaries will pay nothing for Medicare Part A. We all pay taxes during our working years that are specifically for our future healthcare coverage during retirement. These taxes go to offset the cost of Part A later on. As long as you have worked for 10 years (40 quarters) in your lifetime in the United States, you will generally pay nothing at all for Part A. If you or your spouse have not worked 10 years in the U.S., the monthly premium for part A is up to $422/month in 2018. People with less than 40 quarters work experience but more than 30 quarters can get a pro-rated premium.

The majority of Americans will pay the standard monthly amount set by the government. In 2018, this is $134.00/month for most people (or higher depending on your income). However, you may owe more if your income is above a certain level.

If you enroll late into Part B, you may also have to pay a penalty for life. It’s important not to miss your enrollment window whenever you retire and lose access to your employer group health insurance.

You will pay a percentage of the costs of your medically-necessary Part B services. Generally, these costs are:

• the annual Medicare Part B deductible (in 2018, this is $183)
• 20% of the remaining costs, with no limits or cap
• any excess charges that a provider or facility may charge beyond what Medicare reimburses

Tribal members who are enrolled in Medicare Part A & B make it possible for IHS to be reimbursed for services provided at Indian Health Service Health Care Facilities. If a tribal member needs to be referred to a non-IHS provider for a procedure and no funding is available, they either have to go without or pay the Medicare deductible and/or coinsurance (depending on the services). In 2018 the Medicare Part A deductible is $1,340 per benefit period. The Part B deductible is $183 with a 20% coinsurance after the deductible is met. If funding is available and the procedure is high priority then IHS may cover the deductible and/or coinsurance.