Medicare for Dummies

by admin on January 22, 2021 · General Medicare

Don’t be taken in by the title of this article; we are not implying that you are a dummy in any way. In fact, we are certain that you are an intelligent and savvy individual out to make sense of a confusing and poorly documented government health insurance program. With that said, here are the basics of Medicare.

In July of 1965, the Medicare bill was signed into law, and government heath care for elderly and disabled Americans was established. There haven’t been significant changes to the program since 1965, until President Bush signed the Medicare Modernization Act of 2003. This new law added prescription drug coverage. There are now three basic parts to Medicare coverage. These parts are: Part A (hospitalization), Part B (doctor visits), and Part D (prescription drugs).

Medicare Part A

Part A of Medicare covers your inpatient hospitalization, critical access, and skilled nursing expenses. For most people there are no monthly premiums to pay; this part of the coverage is free. You will have to pay a deductible for your hospital visits. The amounts of this deductible change almost every year.

In 2006, for the first 60 days of your hospital stay, you will pay $952 to meet the Medicare deductible. After you meet this deductible, Medicare typically pays 80% of your expenses, which means you will be billed for the other 20%. If your hospital stay lasts longer than 60 days you will need to meet an additional deductible, charged each day. For days 61-90 of your hospital stay you will have to pay $238 each day to meet your deductible. For days 91-150 you will have to pay $476 each day to meet your deductible.

Medicare Continues on Page 2

{ 16 comments… read them below or add one }

Ronald Eaton March 9, 2009 at 12:13 pm

My daughter is SSN disality and soon her current employer”s
Health Plan will expire. she will be able to accept cobra coverage until Medicare kicks in. However, she is now getting treatments for “bi-polar” disorder and her current health plan covers most of the treatments.
My question is what coverage would she ecpect from Medicare ? Would she be able to expect coverage from Medicare? What supplement insureance would she be able to obtain?
I am cocerned that after Cobra , she would need to carry a suolement that would not class her curent treatment s as pre-exsisting and exclude her electro-shock (ECT) .
I would be most thank full for any information or guidance to someone who could help me.
My wife and iI are on SSA and can not afford much in the way of financial support.

Wayne David Lance March 23, 2009 at 5:05 pm

I need help desideing what i need. I need in the way of supplimental insurance. Can you help me.

Gloria Godfrey June 23, 2009 at 10:50 am

I will be employed after I reach age 65 and enrolled in a good health plan through my employer.

1. Do I have to enroll in Medicare?
2. Is there a penalty if I don’t sign up?
3. If I do have to enroll, do I have to pay for premiums on part A?

David Soukup November 9, 2009 at 6:30 am

Our son is 23 years old and works part time.He has documented history of learning disabilities and was being treated for anxiety and attention defecit. He is expperiencing many of the same problems as an adult that he had as a child. How do we go about finding out if there is help available for him. He does not earn much money and many of his problems haunt him in the work environment. I am retired and not in a position to offer a lot of help for him. Thank You

Ellen Rosica November 27, 2009 at 4:23 pm

I have friend who is 67 and has Keystone 65 as her primary and she tells me that Medicare is her secondary health insurance plan. Is it possible to have a supplementary insurance plan as your primary and Medicare as you secondary? I thought Medicare was required to be the primary health insurance at the age of 67?

Katherine St Clair January 12, 2010 at 11:01 am

This is my question – in part. I have signed up for Medicare Part A because it seemed that was necessary before reaching age 65. BUT I will still be working – probably 3 more years with health coverage continuing from my employer. So do I need to sign up for the supplemental parts B and D now as well or can I wait until I actually retire ? I would rather not pay a monthly $98 premium for coverage I already have through my employer

Judie Lemus February 2, 2010 at 10:11 am

Do I have to enroll in Medicare
Is there a penalty if I don’t sign up
If I do have to enroll do I have topay for premiums on part A
Where do I go for supplemental insurance when I will need it
These are questions that I also need answers to.

mmalexa March 16, 2010 at 6:13 pm

I’m having trouble finding the most basic information, like Gloria’s questions. I’m wondering whether:

1. My current coverage will just be automatically cancelled when I turn 65.
2. Whether, if I don’t sign up right away, I can then never sign up.

Toni McDermott June 8, 2010 at 2:51 am

Toni McDermott I am 55 years old and have been disabled over two years. My medicare is avaiilable to me in july/august. I have no idea how this works is there a booklet that can be provided? I also am at a low income and not sure how premium are decided are they by a sliding scale. And have been told by disability that I should be eligible to retain medicaid even now before the medicare kicks in but then the person I spoke to at the medicaid office said no I had to wait till my medicare was effective and then could apply for medicaid help. What My concerns are what handles what I have FMS and poor leg circulation, Copd and heart related problems. Ive been scrimping and scarping the monies need for scripts and medical service. What ever information you can help me retain would be greatly apprciated!

mmalexa September 28, 2010 at 6:30 am

I have learned, since my post in March, that, if you are still working, you don’t have to enroll in Medicare or suffer some penalty later and, at least where I work, can continue under the health insurance coverage that I have. I have a co-worker who turned 65 last February and did nothing about Medicare. He continues with our insurance plan (wasn’t bounced out or made to enroll in special coverage for those over 65). On the other hand, if I were to have continued with the health insurance I had when I retired from local government in Virginia, I would have HAD to sign up for the Medicare plan they offer; I would no longer have been allowed to continue with the coverage I had for 5 years after retirement.

MNydam January 17, 2011 at 1:14 pm

My daughter is 21 and has a heart condition. Her current insurance has told us that she has met her lifetime maximum and I’ve been told by other insurance that noone will accept her because of her condition. Would she be eligible to get medicare?

Catherine Pezely February 22, 2011 at 4:36 pm

My 34 year old daughter was awarded disability in April of 2010 due to Lupus and multiple life threatening disorders. She received notice that she is eligible for Medicare. What is the advantage of having both and what would be the additional cost since she is unable to work and has a spend down of $250 a month.

teresa May 16, 2011 at 2:14 pm

MNYdame….. your 21 yr old daughter would have to quit working and apply to social security: to get SSI or SSDI (if she has 10yrs work experience.) Then, after 2 yrs of getting SS income and Medicaid through your state would she be eligible for Medicare.
C Pezely: it all depends on what state you live in and their Medicaid program. Medicaid is supposed to compliment your Medicare. If she only had Medicare, then you would have to look at the % of the expenditures in the MEDICARE & YOU book. Most care cost nickle and dime you. if the medical care cost more than $250. it’s worth paying otherwise just pay out cost. Not to mention, most medicaid programs need the spenddown paid in order for you to get dental, eye, or mental health care. Keep in mind, it is NOT a must to pay the spenddown ea month, only if she requires medical care costing more than the spenddown.

teresa May 16, 2011 at 2:19 pm

David S…. if your son has established Hx than he is probably eligible for state medicaid. He needs to show that he does not have “gainful employment” or not make over $1000/mo gross. If he does not have GE, than apply for Social Security and than welfare benfits (medicaid). The previous teachers and Drs can help you get needed info to Social Security and Welfare.

teresa May 16, 2011 at 2:25 pm

MMalexa….you are correct. if you have insurance, you do not have to give it up when you get Medicare. It becomes a secondary insurance, compliments your Medicare. In the case of PART D, ESPECIALLY, the part D portion of Medicare. You only have to take it (part D) if your current insurance is equal to or better. If I had insurance coverage for my drugs, I would probably opt out at this time.

teresa May 16, 2011 at 2:27 pm

no premium on part A (hosp)….only Part B (medical). And, if you select a Part D (drug) that has a premium, must pay that.

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