WHAT IS MEDICARE?
Medicare is a Federal health insurance program for persons 65 years of age and older and disabled persons. Medicare has two parts – Hospital Insurance (Part A) and Supplemental Medical Insurance (Part B). Supplemental Medical Insurance, usually referred to as Part B, is the part of Medicare that covers services such as physician services, durable medical equipment, independent ambulance service, prosthetics, orthotics, and independent laboratories.
ELIGIBILITY
Eligibility for Medicare is determined by the Social Security Administration. An individual may be entitled through Social Security based on his or her earnings or that of a spouse, parent, or child. Anyone entitled to premium free hospital insurance (Medicare Part A) is automatically enrolled. Medicare Part B is an optional program for which the insured pays a monthly premium; therefore, individuals who do not want coverage may refuse Medicare Part B enrollment. Premium ($58.70 per month in 2003) are usually deducted from the beneficiary’s monthly Social Security check or paid to Social Security on a quarterly basis. To be eligible for Medicare Part B, an individual must be a U. S. citizen and/or;
- 65 years of age or older; or
- Under age 65 with end stage renal disease (ESRD); or
- Under age 65 and disabled.
HOW TO DETERMINE IF YOUR PATIENT IS
ENTITLED TO MEDICARE BENEFITS
A Medicare card issued to every person who is entitled to Medicare benefits and may be identified by its red, white and blue colors. This card identifies the Medicare benefiary and includes the following information:
- Name (exactly as it appears on the Social Security records)
- Medicare Health Insurance Claim (HIC) number
- Beginning date of Medicare entitlement for hospital and/or medical insurance
- Sex
- A place for beneficiary’s signature
The Medicare card should be checked at least once every year because the Medicare numbers and suffixes can change according to the beneficiary’s record of entitlement. This is especially important in the case of female benefiaries, since their name, HIC number, and suffix can change according to marital status.
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