for Medicare when they turn 65. You have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. This period is 3 months before you turn 65, the month you turn 65, and 3 months after. If you are already drawing Social Security benefits when you turn 65, you will automatically be enrolled
12–9. MEDICARE. Medicare is a four part federal health insurance program managed by the Centers for Medicare and Medicaid Services (CMS). Social Security works with CMS by enrolling people in Medicare. Original Medicare consists of Part A and Part B. Most people become eligible
PART A — HOSPITAL INSURANCE
YOU/YOUR INSURANCE CO. PAYS
SERVICES
BENEFIT
MEDICARE PAYS
First 60 days 61st to 90th day 91st to 150th day Beyond 150 days First 20 days Additional 80 days Beyond 100 days
All but $1,556 All but $389 per day All but $778 per day Nothing
$1,556 $389 per day $778 per day All costs
Hospitalization (Semi-private room, board, and general hospital services)
100% of approved amount All but $194.50 per day Nothing
Nothing Up to $194.50 per day All costs
Skilled Nursing Facility Care (Following hospital stay)
100% of approved amount; 80% of approved amount for durable medical equipment.
Nothing for services; 20% of approved amount for durable medical equipment.
Home Health Care (Part-time care and equipment)
Unlimited as long as Medicare conditions are met.
All but limited costs for outpatient drugs and inpatient respite care.
Hospice Care (Support services for the terminally ill)
For as long as doctor certifies the need.
Limited costs for outpatient drugs and inpatient respite care.
Blood (Furnished by the hospital or nursing facility during covered stay)
Unlimited if medically necessary.
All but first three pints per year.
First three pints per year.
PART B — MEDICAL INSURANCE
Medical Expenses (Doctor’s services, in and out patient medical and surgical services, and diagnostic tests)
80% of approved amount after $233 deductible; reduced to 60% for most outpatient mental health services.
$233 deductible, plus 20% of approved amount and limited charges above approved amount.
Unlimited if medically necessary.
Clinical Laboratory Services (Blood tests, urinalysis, and more)
Unlimited if medically necessary.
Generally 100% of approved amount.
Nothing for services.
100% of approved amount; 80% of approved amount for durable medical equipment.
Nothing for services; 20% of approved amount for durable medical equipment.
Home Health Care (Part-time care and equipment)
Unlimited as long as Medicare conditions are met.
Outpatient Hospital Treatment (Services for diagnosis/treatment of illness or injury)
A coinsurance amount which varies according to the service (after $233 deductible).
Services you get as part of a doctor’s care.
Medicare payment to hospital based on hospital cost.
Unlimited if medically necessary.
All but first three pints per year.
First three pints plus $233 deductible.
Blood
Flu Shots
One per flu season.
100% of approved amount.
Nothing.
Source: www.medicare.gov
CHAPTER 12: SOCIAL SECURITY & MEDICARE
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