Medicare Basics  

Medicare is a federal health insurance program for people age 65 or older, and certain disabled people. The program is run by the Centers for Medicare & Medicaid Services, an agency of the U.S. Department of Health and Human Services. Local Social Security offices take applications for Medicare and provide general information about the program.

Arkansans can receive their Medicare benefits either through the normal fee-for-service system or through a Medicare Advantage plan. In the normal fee-for-service system, you may choose any doctor, hospital or health care provider that participates in the Medicare program. If the provider has agreed to accept the amount of payment that Medicare has deemed reasonable (called "accepting Medicare assignment"), Medicare will usually pay 80% of the allowed amount. You are then responsible for the remaining 20%. If the provider does not accept Medicare assignment, you will be responsible for the 20% copay amount and possibly up to 15% more.

People who choose a Medicare Advantage plan receive the same benefits provided under regular Medicare. They must continue to pay their Part B monthly premium in addition to the plan's monthly premium.

Medicare has two parts - Part A and Part B:

Part A is hospital insurance that pays the cost of an inpatient stay in a hospital. Under certain conditions, Part A also covers care in a skilled nursing facility, home health services and hospice care. Part A coverage is free to most people with no monthly premium required. You are responsible for meeting the Part A hospital deductible ($1,024 per benefit period in 2008). Then Medicare pays 100% of the allowable hospital charges for the first 60 days. After that, you will be responsible for a $256 daily copayment for days 61-90, and $512 per day for days 91-150. Medicare pays nothing after 150 consecutive days in the hospital.

Days 91-150 are your 60 nonrenewable "Lifetime Reserve" days of Part A coverage. You may choose to use these if you have to stay in the hospital for more than 90 days. You don't have to use them all at once. These days are only given once in a lifetime, so once you use them, you do not get them back.

Part B is medical insurance that pays for doctors' services, outpatient hospital services, durable medical equipment and other medical services and supplies not covered by Part A. Most people will pay a monthly premium ($96.40 in 2008 for most people) for Part B coverage, which is usually deducted from the beneficiary's Social Security check, and a yearly deductible of $135. People with higher incomes will pay a higher Part B premium. People with very low incomes may qualify for help paying their premiums. Part B normally pays 80% of the Medicare approved amount and you are responsible for the remaining 20%, unless you have a Medicare supplemental insurance plan.

Who can get Medicare?

For most Americans, Medicare Part A is free. You or your spouse must have worked at least 40 quarters (three-month periods) during your lifetime. Some people younger than 65 are eligible, including:

• People on continual dialysis for permanent kidney failure
• Those who have had a kidney transplant
• Those with ALS (Lou Gehrig's disease)

If you can get Part A for free, you can also enroll in Part B if you pay the monthly premium ($96.40 in 2008 for most people). Most U.S. residents age 65 or older can enroll in Medicare Part B.

If you have questions about Medicare eligibility and enrollment, visit www.socialsecurity.gov.

What is a "benefit period"?

A benefit period begins the day you are first admitted to a hospital and ends when you have been out of a hospital or skilled nursing facility for 60 consecutive days. If you have to go back into a hospital after being out for 60 days, a new benefit period would begin.

Learn more about Medicare

The Centers for Medicare & Medicaid Services has two Web sites for those with computers and access to the Internet. The best site for people on Medicare is www.medicare.gov. You'll find information about Medicare enrollment, the Medicare card, benefits under Medicare Parts A and B, how Medicare pays its bills, preventive care, Medicare notices, how to file complaints and appeals regarding Medicare decisions and much more. A second, broader site can be found at www.cms.gov. This site is mainly for health care providers, administrators, agencies and others who work with Medicare.

Preventive care information

 The Medicare Preventive Services to Keep You Healthy pamphlet has valuable information.

Help finding a drug plan: Medicare Prescription Drug Plan Finder

The Medicare Prescription Drug Plan Finder tool is available at www.medicare.gov. You'll find information you can use to help you choose a plan and make the most of your coverage. You can choose to enter your personal information and zip code to narrow your plan choices, or do a general search of the plans based on your zip code.

To find out the names of the approved prescription drug plans and Medicare Advantage plan regions in Arkansas go to: www.medicare.gov/medicarereform/map.asp

Help with prescription drug costs

Have limited income? Social Security can help with prescription costs.
Find out more