Medicare is a federal health insurance program that started in 1965. It now covers 43 million Americans. The program serves everyone regardless of income or medical history. Medicare was never intended to pay 100 percent of health care costs, but forms a foundation against catastrophic health care costs.

Learn More About Medicare
There are several ways to learn more about the Original Medicare plan, Medicare Advantage plans, Medigap and Medicare Prescription Drug plans. You can call Medicare at 1-800-MEDICARE (1-800-633-4227); TTY users should call 1-877-486-2048. Contact the Medicare Medicaid Assistance Program at 1-800-803-7174 or visit www.medicare.gov. Also, "Medicare and You 2009" is a handbook with information about Medicare benefits and costs.

Who is eligible?
You are automatically eligible for Medicare once you reach age 65. Persons under the age of 65 who are disabled and have been receiving Social Security payments for two years are generally able to receive Medicare. If you have a certain disability or disease, such as end-stage renal disease or ALS (Lou Gehrig's disease), the waiting period to receive Medicare is significantly reduced.


What does Medicare Cover?
Medicare has two parts. Medicare Part A is Hospital Insurance and covers inpatient hospital services, skilled nursing facility care, home health visits following a related hospital or nursing facility stay, and hospice care. 

Medicare Part B is Medical Insurance, and covers physical and outpatient hospital services, plus provides many preventive benefits.  For a list of covered services under Medicare Part A and Part B, see Section One of "Medicare and You 2009."

What does Medicare Part A cost?
Medicare Part A is free for individuals and spouses of individuals with 40 quarters of covered employment, or who have made payroll contributions for 10 years or more. Persons with less than 40 quarters of employment could pay up to $443 each month in 2009.    

What does Medicare Part B cost?
In 2009, the monthly Part B premium is $96.40 for individuals whose yearly income was less than $85,000 and filed an individual tax return, or less than $170,000 and filing a joint tax return. This amount is deducted from your social security check.  The Part B premium amount gradually increases up to $308.30 for individuals who have an annual income above $213,000, or couples with an annual income exceeding $426,000.

What are the Medicare plan choices?
Depending on where you live, you may be able to get your health care in one of two ways.  Your Medicare plan choices include the following:

The Original Medicare Plan
The Original Medicare plan is also known as a "fee-for-service" plan.  Under the Original Medicare plan, you will generally pay deductibles and coinsurance for health care services and supplies. This plan is managed by the Federal Government and is available nationwide. You will have Original Medicare unless you choose to join a Medicare health plan. If you are in the Original Medicare plan, you use your red, white and blue Medicare card when you get health care. Under this plan, you will have your choice of doctors, hospitals, and other providers. For a list of what the Original Medicare plan covers and deductibles and coinsurance amounts, see "Your Medicare Benefits."

To help cover the costs the Original Medicare plan doesn't cover, you may want to get a Medigap policy (Medicare Supplemental Insurance Policy). 

Medigap, or Medicare Supplemental Insurance Policy.
A Medigap policy is a health insurance policy designed to supplement the Original Medicare plan coverage.  It helps pay some of the health care costs or "gaps" that the Original Medicare plan doesn't cover (like copayments, coinsurance, and deductibles). Medigap policies are sold by private insurance companies. Insurance companies can only sell you a "standardized" Medigap policy. There are 12 Standardized Medigap policies that are identified by letters (A through L). Each of the 12 standardized Medigap policies must offer the same basic coverage, no matter what insurance company sells it. Cost is usually the only difference between Medigap policies sold by different insurance companies. 

The following provides a list of things you need to know when buying a Medigap policy:

• Generally, you must have Medicare Parts A and B to buy a Medigap policy.
• You pay a monthly premium for your Medigap policy to the private insurer. In addition, you will also have your Part B premium deducted from your Social Security check.
• A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you each must buy separate Medigap policies.
• It's important to compare Medigap policies since the costs can vary and may go up as you get older.

For more information about Medigap policies, see "Choosing a Medigap Policy:  A Guide to Health Insurance for People with Medicare."

Or, call 1-800-MEDICARE (1-800-633-4227); TTY users should call 1-877-486-2048. The Medicare Medicaid Assistance Program (MMAP) can also help you select a Medigap policy.  Call 1-800-803-7174 to talk with a representative from the MMAP program. 

Medicare Advantage plans or Medicare health plans
A Medicare Advantage plan is a way for you to get Medicare health care coverage. As a Medicare beneficiary, you can choose to receive health care coverage from the Original Medicare plan, or from a Medicare Advantage plan that provides service to your area. Medicare Advantage plans are offered in many areas of the country by private companies that sign a contract with Medicare. Medicare pays a set amount of money to these private health plans to manage or oversee your care.

To learn more about Medicare Advantage plans, select a link below:

Types of Medicare Advantage plans
There are different types of Medicare Advantage plans. The most common plans include Medicare Managed Care plans (like HMOs), Medicare Preferred Provider Organization plans (PPOs), and Private Fee-for-Service plans (PFFS).

In a Medicare Managed Care plan, you must see doctors in the plan's network. A primary doctor coordinates your health care. Referrals are usually required to see a specialist.

A Medicare Preferred Provider Organization plan allows you to see any doctor, but it costs less to see doctors in the plan's network. Some plans do not require a referral to see a specialist.

In a Private Fee-for-Service plan, you can see any Medicare-approved doctor that accepts the plan's payment terms for covered services. The private company, not Medicare, negotiates with providers to decide how much it will pay and what you will pay for the services you get. No referrals are necessary when you enroll in this type of plan.

Depending on where you live, you could have several options available.  Before choosing a Medicare Advantage plan, you may want to consider:

• Does my doctor participate in the plan?  (This is important if you absolutely want to keep your current doctor.)
• Can I choose any doctor?
• Is the plan affordable to me?
• Does the plan provide coverage when I'maway from home?

Joining a Medicare Advantage plan
You must have Medicare Part A and Part B to join a Medicare Advantage plan and live in the service area of the plan you wish to join. In most cases, you cannot have end-stage renal disease and enroll in a Medicare Advantage plan. When you join a Medicare Advantage plan, you are still enrolled in Medicare. 

How much do Medicare Advantage plans cost?
Most Medicare Advantage plans charge an additional monthly premium and may charge copayments for certain services. In 2009, the monthly premium amounts for Medicare Advantage plans range from $0 to $297.  In addition, you will also have your Part B premium deducted from your Social Security check.

How do Medicare Advantage plans differ from Original Medicare?
Medicare Advantage plans provide all Medicare Part A and Part B covered benefits, as well as medically-necessary services. They may also provide extra benefits that the Original Medicare Plan does not cover, such as vision or dental. Many Medicare Advantage plans have networks, so you may be limited to seeing doctors who belong to the plan or you may be required to go to certain hospitals to get covered services. Also, some Medicare Advantage plans may require you to get a referral from your primary doctor if you need to see a specialist.

The "Medicare Health Plans" feature under www.medicare.gov allows you to compare Medicare Advantage plans with the Original Medicare plan.  You can also call 1-800-MEDICARE (1-800-633-4227); TTY users should call 1-877-486-2048. Or, you can contact the Medicare Medicaid Assistance Program at 1-800-803-7174 for comparison information.

Does Medicare cover prescription drugs?
Medicare offers prescription drug coverage for everyone with Medicare.  This coverage is called Medicare Part D and may help lower prescription drug costs.  Learn more about assistance avaiable for prescription drug costs.

Medicare drug plans are run by insurance companies and other private companies approved by Medicare. If you join a Medicare drug plan, you usually pay a monthly premium. Joining Part D is optional. If you decide not to join a Medicare drug plan when you are first eligible, you may pay a late-enrollment penalty if you join at a later time. 

There are two ways to get Medicare prescription drug coverage:

Join a Medicare Prescription Drug plan. These plans add drug coverage to the Original Medicare plan.
Join a Medicare Advantage plan. Most Medicare Advantage plans provide prescription drug coverage through their plan. If you join a Medicare Advantage plan and it offers prescription drug coverage, you must take the drug coverage available through the plan. A small number Medicare Advantage plans do not include drug coverage. If you enroll in one of these plans, you must purchase a stand-alone Medicare Prescription Drug Plan in order to receive coverage.

For questions about when you can enroll in a Medicare drug plan, or for help with finding and comparing plans, call Medicare at 1-800-MEDICARE (1-800-633-4227); TTY users should call 1-877-486-2048. Or, contact the Medicare Medicaid Assistance Program at 1-800-803-7174 or visit www.medicare.gov.