You may be eligible for these government health care insurance programs:

Medicare

The federal Medicare program is a health insurance program for the elderly and disabled. Medicare is administered by the Centers for Medicare and Medicaid Services (CMS), which was formerly the Health Care Financing Administration (HCFA).

Medicare provides benefits for:

  • Those who have reached age 65 and are entitled to receive Social Security or Railroad Retirement benefits
  • Disabled individuals of any age who have received Social Security or Railroad disability benefits for at least two years

Other Medicare participants may include:

  • Persons eligible for Social Security benefits who have end-stage renal disease and require kidney dialysis treatment
  • Persons over age 65 who are not eligible for either Social Security or Railroad Retirement benefits who purchase monthly Medicare coverage

Medicare Part A Hospital Insurance Program

This program provides beneficiaries with coverage for mostly hospital-related claims, including:

  • Inpatient hospital care
  • Limited post-hospital skilled nursing facility
  • Home health care
  • Hospice care

Medicare Part B Supplementary Insurance Program

This program focuses on medical costs other than hospitalization, such as:

  • Physician and surgical services
  • Diagnostic tests
  • Home health care
  • Physical, speech and occupational therapy
  • Medical supplies
  • Durable medical equipment
  • Ambulance services
  • Some preventive care services

Enrollment in Part B coverage is optional.

Each program requires different deductible and co-payment amounts.

Medicare Exclusions

Medicare Part A and Part B coverage doesn't include:

  • Custodial nursing home care
  • Most outpatient prescription drugs
  • Routine physical examinations
  • Routine eye examinations and eyeglasses
  • Hearing examinations and hearing aids
  • Routine dental services
  • Routine foot care and orthopedic shoes
  • Most immunizations
  • Personal convenience items
  • Cosmetic surgery

Medicare Part C

Any individual who is entitled to Medicare benefits under Part A and enrolled under Part B may choose from several types of health insurance plans under Medicare Part C (Medicare Choice program) including:

  • Coordinated Care Plans such as health maintenance organizations (HMOs), preferred provider organizations (PPOs), and provider-sponsored organizations (PSOs)
  • Private Fee-for-Service Plans
  • Medical Savings Accounts (MSAs)

Medicare Part D

Medicare Part D is an optional prescription drug benefit. People who are entitled to benefits under Part A or enrolled in Part B are eligible for Part D. They can enroll in a stand-alone drug plan or private health plan that offers drug coverage. Participants pay a deductible, coinsurance and a monthly premium.

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