Health Insurance Guide

This is a general guide on Medicare Part A, B, C, D, Medicaid, Managed Care Options and the Marketplace. 

What is Medicare?

Medicare is a Federal Health Insurance Program administered by the Centers for Medicare and Medicaid Services (SMS) and is for:

  • People 65 years of age and older* who are eligible to collect under Social Security;
  • Certain younger people with disabilities; and
  • People with end-stage renal disease

Medicare is a pay-per-visit arrangement. You can go to any doctor, hospital or other health care provider who accepts Medicare. You must pay the the deductible. Medicare then pays its share and you pay your share (co-insurance). Medicare is divided into two parts: Part A (hospital insurance) and Part B (medical insurance).

  • Eligibility begins on the first day of the month in which you turn 65.
  • If Medicare is approved retroactively, any amounts you paid for services will be reimbursed under Medicare will be refunded.
  • If you’re under 65 and have a disability, you’ll automatically get Part A and Part B after you get disability benefits from Social Security or certain disability benefits from the RRB for 24 months. (If your birthday is on the first day of the month, Part A and Part B will start the first day of the prior month).

Medicare Part A:

Medicare Part a helps pay for care in hospitals, skills nursing centers, hospice care and some home health care. When you have been in a hospital as an impatient for at least three consecutive days (midnights), you must meet the following requirements before your stay in a skilled nursing center will be covered by Medicare Part A.

  • A skilled nursing center is the appropriate place for your care
  • Skilled services are ordered by a physician
  • Nursing and/or rehabilitation services are provided daily
  • The skilled services you receive must be for a condition that was treated while you were in the hospital or one that arose in a skilled nursing center within 30 days from your qualifying hospital visit. Your reason for being at the center must relate to a condition that was treated while you were in the hospital.
  • You must have days available in your benefit period

*An observation day in the hospital does not qualify as an inpatient hospital day. 

Medicare Part A Covers:

  • A semi-private room
  • All meals, including special diets
  • Routine nursing services
  • Drugs, vaccines, lab tests and x-rays
  • Physical, occupational, speech and respiratory therapy
  • Medically-related social services
  • Medical supplies, appliances and certain medical equipment
  • Blood transfusions
  • Housekeeping/laundry (towels, washcloths, gowns)
  • Medication
  • Routine personal hygiene items

*Not an exhaustive list, see Medicare and You Manual or visit http://www.medicare.gov for a complete list of Medicare Part A covered services.