Health Insurance

• Medicare
• Medicaid
• Qualified Medicare Beneficiary

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The information listed below briefly describes government funded and other health insurance programs for parents or older persons. To receive further information on any of these programs contact the Social Security Administration toll free at 1-800-772-1213 or contact your local Social Security office.

Medicare

Medicare is our country's health insurance program for people 65 or older, certain disabled people under 65, and people of any age who have permanent kidney failure. It provides basic protection against the cost of health care, but it doesn't cover all medical expenses.

Medicare has two parts: Hospital Insurance (Part A) and Medical Insurance (Part B). Hospital Insurance helps pay for inpatient hospital care, skilled nursing facility care, home health care, and hospice care. It is paid for by the payroll tax Federal Insurance Contribution Act (FICA) that also pays for Social Security. Medical Insurance helps pay for doctors' services, outpatient hospital services, ambulance services, diagnostic tests, therapies, durable medical equipment, medical supplies, and prosthetic devices. Medical Insurance is financed by monthly premiums paid by people who choose to enroll.

Medicaid

Many people think that Medicaid and Medicare are two different names for the same program. But actually, Medicaid is a State-run program designed primarily to help the elderly and others with low income and little or no resources. Each State has its own rules about who is eligible and what is covered under Medicaid. However, all States cover basic inpatient and outpatient medical services, and various additional services may be provided at the option of the individual States.

Qualified Medicare Beneficiary

If your parent or older person gets Medicare, and has little income or resources he or she may be eligible for the "Qualified Medicare Beneficiary" -- or QMB -- Program. If your parent or older person qualifies,  the State he or she lives in will pay their Medicare premiums, deductibles, and co-insurance. If you think your parent or older person may qualify, contact his or her State or local medical assistance (Medicaid) agency, social services office, or welfare office for information.

Medigap

Medicare provides basic health care coverage, but it doesn't pay all medical expenses, and it doesn't pay for most long-term care. For this reason, many private companies sell insurance to fill the gaps in Medicare coverage. This kind of insurance is often called "Medigap" for short. Contact the Health Care Financing Administration's Medigap Hotline toll free at 1-800-638-6833 for more information on Medigap.

When Individuals Need Help Handling Their Benefits

See the section Financial Matters for an explanation of the representative payee system.

Booklets Available

The Social Security Administration (the organization that provides information about the Medicare program) and the Centers for Medicare and Medicaid Services (the organization that administers the Medicare program) produce many publications and fact sheets designed to help explain these programs to you or your parent or older person.

For a free copy of the following publications, write or call the Social Security Administration at:

Social Security Administration
Public Information Distribution Center
Public Affairs Office, P.O. Box 17743
Baltimore, MD 21235
Toll free 1-800-772-1213

• Medicare - A straight-forward guide to the Medicare program.
• You Should Know About QMB - A guide to the QMB program.
• A Guide for Representative Payees - A guide for representative payees.

To obtain a free copy of the publications, write or call the Health Care Financing Administration at:

Medicare Publications
Centers for Medicare and Medicaid Services
6325 Security Boulevard
Baltimore, MD 21207
Toll Free 1-800-638-6833
8:00 a.m. - 8:00 p.m.
Eastern Standard Time

• The Medicare 1996 Handbook - A handbook of the Medicare program.
• Medicare: Hospice Benefits - A guide to the medical and support services available to Medicare beneficiaries with terminal illnesses.
• Medicare and Advance Directives - A guide to what action elders need to take to make sure that decisions made now - in advance of becoming ill - will be followed in the event they become physically or mentally unable to communicate their wishes about the type of treatment they wish to receive or who can make those decisions.

Medigap Resources

For a free copy of the 1999 Medicare and You, write or call the Health Care Financing Administration at:

Medicare Publications
Centers for Medicare and Medicaid Services
6325 Security Boulevard
Baltimore, MD 21207
Toll Free 1-800-638-6833
8:00 a.m. - 8:00 p.m.

Write to AARP for a free copy of the following publications. Include the title and publication number.

AARP Fulfillment
601 E Street, NW.
Washington, DC 20049

• Medigap: Medicare Supplemental Insurance - A Consumer's Guide - Publication No. D-14042
• Before You Buy: A Guide to Long-Term Care Insurance - Publication No. D-12893.
  
  

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