Home Health Care Fraud Medicare

Medicare Basics

Medicare is a program that was created by Congress in 1965.

In FY2009, the program will cover an estimated 45 million persons (38 million aged and 7 million
disabled) at an estimated total cost of about $492 billion, accounting for over 3% of GDP. (Source: Medicare Primer)

Medicare is the federal health insurance program for:

• People 65 and older
• Some people with disabilities under 65
• People with end-stage renal disease (ESRD)
• Administered by the Centers for Medicare and Medicaid Services (CMS)
• Not intended to pay 100% of medical bills

Eligibility

You are a U.S. citizen or have your resident visa and have lived in the U.S. for 5 consecutive years and:

• You are 65 and older and have sufficient Social Security Quarters or are eligible for Railroad Retirement Benefits (or a spouse of someone who meets the above criteria); or
• You have been getting disability benefits for at least 24 months; or
• You have kidney failure, End-Stage Renal Disease (ESRD); or
• You are approved for Social Security Disability with a diagnosis of ALS (Lou Gehrig’s disease)

Enrollment

Enrollment is handled through the Social Security Administration or Railroad Retirement Board.

1. Automatic Enrollment

• Your Medicare card will be mailed to you automatically if:you have been receiving Social Security benefits before you turn 65; or you have a disability and have been receiving SSDI for at least 24 months.

2. Initial Enrollment

• You can enroll during a 7-month period starting 3 months before your birthday month, including your birthday month, and ending 3 months after.
• You should enroll 1 to 3 months before your birthday month to make sure your coverage begins by the time you turn 65.

3. Special Enrollment

You are eligible if either you or your spouse is actively working, has health coverage from the job and:

• The company has 20 or more employees, if you’re 65 and older.
• The company has 100 or more employees, if you’re a person with a disability.
• You should enroll when you retire or lose your health coverage.
• You have a special 8-month enrollment period but should enroll early to avoid gaps in coverage.

4.  General Enrollment

• If you miss initial or special enrollment periods, you can enroll between January and March of each year.
• Coverage will start July 1.
• You may have to pay a 10 percent Part B premium penalty if you delayed enrollment

For More Information

• Medicare: A Primer. From the Henry J. Kaiser Family Foundation, this primer explains key elements of the Medicare program, which now provides health coverage to 47 million people -- including 39 million people age 65 and older and another 8 million younger adults with permanent disabilities. It looks at the characteristics of the Medicare population, what benefits are covered, how much people with Medicare pay for their benefits and the program’s overall costs and future financing challenges.