2. Medicare Eligibility
• Individuals or spouses
worked at least 10 years
in Medicare-covered
employment
• Individual’s minimum
age 65
• Citizen or permanent
resident of US
• Can qualify if younger
than 65 & have
disability or ESRD
3. Medicare Benefits
Medicare Part A
• Inpatient hospital critical
care
• Skilled nursing facility stays
• Hospice care
• Some home health care
Medicare Part B
• Doctor’s services
• Outpatient hospital care
• Durable medical equipment
• Some medical services not
covered by Part A
4. Medicare Enrollment
• Automatically covered
in Part A if individual or
spouse had Medicare
taxes taken in last 10
years with no premiums
due
• Depending on length of
time worked with
Medicare taxes,
premiums are $461 or
$254/mo.
• Medicare Part B
monthly premiums
based on annual
income
• Deductible of $155.00
annually
6. Medigap Coverage
• Medicare Supplementary Insurance
(MSI)
• Supplements Medicare benefits by
paying for services that Medicare
doesn’t cover
• Offered by Commercial Health Insurance
Companies
7. Advance Beneficiary Notice (ABN)
• Written document
provided to Medicare
beneficiaries prior to
service being rendered
that indicates the
service is not likely to
be a covered service
and unpaid by Medicare
8. Primary or Secondary Payer?
Primary Payer
• Employee eligible for group
plan but declined or
dropped coverage
• Also covered by TRICARE
• Under 65, disabled, ESRD or
has been eligible for
Medicare for more than 30
months
• Has both Medicare and
Medicaid coverage
Secondary Payer
• Employee participates in
group health plan
• Third-party liability policy
• Worker’s Compensation
coverage
• VA preauthorized services
• Federal Black Lung program
9. Medicare Websites
• Centers for Medicare and Medicaid Coverage
• Medicare Regional Administrative Service
• Medicare.gov
• Website assignment: Use the website
www.medicare.gov to obtain the following
information: List and briefly describe
preventive services that are covered by
Medicare. Due Tuesday Nov. 16.
