Medicare

 

What is Medicare?

Medicare is health insurance for people ages 65 or older, some disabled people, and people of all ages with end-stage renal disease (ESRD). Medicare is an “entitlement” program because people pay into it through taxes.  Whether or not a person receives Medicare is not determined by his or her income, but by how much a person has worked (social security work credits). ESRD is the only chronic disease covered for people under the age of 65.

There are 4 parts to Medicare:

After the deductible, Medicare will pay 80% for most doctor services, outpatient therapy, preventive therapy, and durable medical equipment. You will have to pay the other 20% through your retirement/pension plan, private insurance, or out of pocket.

If you meet certain eligibility and income requirements, you may be eligible for Medicaid as well. People on both Medicaid and Medicare are called “dual eligibles”. You can check your eligibility for Medicaid by calling your local Department of Social Services office (In North Carolina, call the CARELINE at 1-800-662-7030).

Medicare & You 2011 Booklet

Medicare Information for Family & Friends

Medicare and ESRD Booklet

 

 

Medicare Preventive Services

Preventive services are an importnat part of staying healthy and preventing or delaying chronic diseases. Within the first six months of enrolling, Medicare will provide a "Welcome to Medicare" physical exam. When you enroll in Medicare, be sure to tell you doctor you wish to have this exam. This exam is only covered once, and is only covered during the first 6 months of enrollment.

There are other preventive screenings that are covered more often. Please click HERE for a printable checklist of preventive services covered by Medicare. Use this sheet to track the preventive benefits you use each year and remind you of benefits thatyou are eligible for.

 

Medicare End-Stage Renal Disease (ESRD) Program

Patients who have end-stage renal disease, which requires dialysis or kidney transplant, can be eligible for Medicare at any age if they meet certain requirements:

Patients can receive Medicare Part A benefits (Hospital Insurance) at any age if their kidneys no longer work, they need regular dialysis or have had a kidney transplant, and:

Just like with traditional Medicare, the patient has a premium and deductible (see Medicare section above) and they must pay 20% of the costs through a retirement/pension plan, private insurance, or out of pocket.

Medicare will only cover transplant patients for three years (36 months) after transplant.

Most ESRD patients will sign up for both Parts A and B of Medicare (if you are eligible for A, then you are eligible for B), as many services are not covered under just Part A. You must go to your local social security office to apply for the Medicare ESRD Program. You can find out where your local office is by calling this toll-free number:  1-800-772-1213, or click HERE.

The Centers for Medicare and Medicaid Services (CMS) has written a book all about Medicare coverage for kidney dialysis and kidney transplant services. Click HERE for a copy. This booklet is also available in Spanish.

 

Medicare for Children with End Stage Renal Disease

Your child is eligible for Medicare based on End-Stage Renal Disease if:

  1. You (or your spouse) meet certain work requirements—You or your spouse must have earned at least six credits within the last three years under Social Security, the Railroad Board, or as a Federal government employee. When you work and pay Social Security taxes,
    you get credits based on the amount you earn. In 2004, you get one credit for every $900 you earn. This amount can change every year. You can get up to four credits each year. Either you or your spouse must meet the work requirements. Both parents can’t combine their credits to meet the requirements.
  2. He or she meets certain medical requirements—Your child can only get Medicare for ESRD if they are on dialysis or if they have had a transplant.

In order to receive benefits, your child must be classified as a "dependent"—usually an unmarried person under age 22 who is your

Someone who is age 22 or older is considered a dependent child if they have a disability that began before they turned age 22. Someone between age 22 and age 26 is a dependent child if they received at least one-half of their support from you or your spouse from the time they turned age 22.

* For more information about eligibility for your grandchild or stepgrandchild, call the Social Security Administration at 1-800-772-1213. TTY users should call 1-800-325-0778.

Click HERE for a booklet on Medicare for Children with Kidney Disease

Source: Centers for Medicaid and Medicare Services


Quicklinks:

 

National

Centers for Medicare & Medicaid Services
Official Site for Medicare Beneficiaries
Medicare Rights Center

State

NC Division of Medical Assistance
NC Division of Social Services