Lesson 6: Health Insurance

Medicare

Persons who qualify for Social Security Disability (or who are 65 and older) qualify for health insurance under Medicare after a 24-month qualifying period. Medicare Part A covers in-hospital care, such as surgeries or skilled nursing care, and part B covers doctor's visits and other outpatient procedures. Participants pay a premium, usually deducted from their Social Security check, for Part B.

Recently Medicare has begun to offer prescription drug benefits with participating pharmacies. Anyone who receives Medicare is eligible to enroll in a prescription drug plan. Plans vary in the monthly premium you pay, the drugs that are covered, the deductibles and co-pays, so it is important to scrutinize them against your current and future needs. Enrollment periods run from 11/15 to 12/31 each year, though people may sign up in 2006 through May 15. (Source: http://www.medicare.gov/pdphome.asp.)

Medicare works one of three ways: as an indemnity plan where recipients pay 20% of customary and reasonable expenses; as a Medicare Choice Plan, where recipients enroll in an HMO and receive services managed by that provider; as Medigap, where recipients purchase supplemental insurance to pay for care (such as 20% of the physician's charge) that Medicare doesn't cover. You should explore each option at the time you first enroll. More information is provided in www.medicare.gov . Search the publications link (under Search Tools) for complete information, including an 88-page pamphlet, Medicare & You, 2006.