People of all ages with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant)
Medicare has two basic parts:
Part A Hospital Insurance
(Most people don’t pay a premium for Part A), and
Part B Medical Insurance – usually out of the hospital
(Most people pay a monthly premium for Part B - $78.20 in 2005)
The cost of Part B may go up 10% for each full 12-month period that you could have had Part B but didn’t enroll and your Part B coverage as a late enrollee will start on July 1 of the year you enroll. This additional cost is permanent.
People who are already getting benefits from Social Security or the Railroad Retirement Board are automatically enrolled in Part A starting the first day of the month they turn age 65.
If a person under age 65 qualifies for Social Security or Railroad Retirement Board disability payments, they will be automatically enrolled in Medicare after they have received those payments for 24 months.
Even though some people are now scheduled to initially become eligible to receive Social Security benefits after age 65, they will still be eligible for Medicare at age 65.
For each episode of care in a hospital you pay $912 for a stay of up to 60 days, $228 per day for days 61-90 of a hospital stay and $456 per day for days 91-150 of a hospital stay. You are responsible for charges beyond 150 days for a hospital stay.
Part A also covers certain types of skilled nursing care but not custodial long term care. You pay nothing for the first 20 days and $114 per day for days 21-100. You are responsible for all costs beyond 100 days.
Home health care is limited to medically necessary part-time skilled nursing care and home health aide services as well as physical therapy, occupational therapy, and speech-language therapy which are ordered by your doctor.
Also covered are medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers, medical supplies, etc). You pay 20% of the Medicare approved amount for these services.
Hospice care is care for people with a terminal illness, including drugs for pain relief and other services from a Medicare-approved hospice, including some services that would not otherwise be covered by Medicare.
Hospice care is usually given at home, however, Medicare covers some short-term hospital and inpatient hospice care for respite purposes.
You pay up to $5 for outpatient prescription drugs that are part of a Hospice Program and 5% of the Medicare approved amount for hospice inpatient respite are.
If you waited to enroll in Part B because you or your spouse were working and had group health plan coverage as an active employee, you are eligible for a special enrollment period for Part B.
This time period can be any time you or your spouse are still covered as an active employee by an employer or union group health plan or during the eight months following the month that the employer or union group health plan coverage ends, or when the employment ends, whichever is first.
Most people who sign up for Medicare during a special enrollment period don’t pay an extra premium.
Coverage under COBRA is not considered coverage as an active employee.
If you elect COBRA when you leave your employer’s plan, you should also consider electing Part B if you haven’t already done so since your special enrollment period will end eight months after you lose coverage as an active employee.
Heart, lung, kidney, pancreas, intestine, and liver transplants under certain conditions and in Medicare-certified facilities only, and bone marrow and cornea transplants (under certain conditions.) Oral immunosuppressive drugs if the transplant was paid for by Medicare, or paid by an employer group health plan that was required to pay before Medicare. You must have been entitled to Part A at the time of the transplant and entitled to Part B at the time you get immunosuppressive drugs, and the transplant must have been performed in a Medicare-certified facility.
Some of these services will be covered under Part A and some under Part B
Those who are eligible for both Medicare and Medicaid will now receive their drug coverage through the Medicare Prescription Drug Plan rather than Medicaid.
Medicare Beneficiaries with limited savings and incomes below 135% of FPL will pay no monthly premium for their drug coverage, no deductible, and only $2 for generic and preferred drugs and $5 for other drugs, with no coverage limit.
Beneficiaries who are eligible for both Medicare and Medicaid and those with incomes below the federal poverty level will have copays of only $1 for generic and preferred drugs and $3 for other drugs, with no coverage limit.
Nursing home residents who are eligible for both Medicare and Medicaid will have no co-pay.
Other seniors with limited savings and incomes below 150% of FPL will pay reduced monthly premiums on a sliding scale, a $50 deductible, and 15% cost-sharing with no coverage limit.