Medicare

Content Provided by: A Guide for Families and Friends of People with Developmental Disabilities ; New York State Developmental Disabilities Planning Council

Medicare is a federal health insurance program primarily for persons age 65 and over and for certain persons with disabilities. Unlike Medicaid, Medicare benefits do not vary from state to state and Medicare beneficiaries do not have to meet any income or resource standards. It is administered by the Centers for Medicare and Medicaid Services (CMS), which is part of the U.S. Department of Health and Human Services. The claims, however, are processed by private insurance companies under contract with CMS. 

Medicare insurance benefits are provided for:

  • Persons age 65 who are eligible to receive Social Security or Railroad Retirement benefits.
  • Persons who have received Social Security or Railroad Retirement disability benefits for 24 months and have reached the age of 20; certain persons suffering from end-state renal disease.
  • Medicare-qualified government employees.

Many individuals with disabilities will qualify for Medicare as an additional benefit if they receive SSA disability benefits based on a parent’s work record. Medicare is divided into Part A and Part B.

Medicare Part A

Medicare Part A is also called hospital insurance; it covers inpatient hospital care, post hospital care in skilled nursing facilities, certain home health care and hospice care for terminally ill patients. For insured persons, there is no monthly premium.

Medicare Part B,

Medicare Part B is also called Supplementary Medical Insurance; it covers physicians’ services, diagnostic tests, durable medical equipment (canes, walkers), ambulatory surgical services, rural health clinic services and ambulance services.

Persons receiving Part B must pay a monthly premium. When someone becomes eligible for Part A, they are offered the option of enrolling in Part B. While this involves paying a monthly premium, it is strongly suggested that Part B enrollment be accepted. If at a later date the person decides to enroll in Part B, the premium will be much higher. In many instances, low-income individuals with disabilities have their premiums paid for by the State. Most people with disabilities who work will continue to receive at least 93 consecutive months of hospital and medical insurance under Medicare. The 93 months begin the month after the last month of the trial work period. The individual must work and perform SGA, but not be medically improved. There is no Part A premium paid during the 93 months. After premium free Medicare Part A coverage ends due to work, it is possible for an individual to buy continued Medicare coverage as long as she/he remains medically disabled and is under 65 years old.

For more information on Medicare, call the toll free number 1-800-633-4227 or visit the website at www.medicare.gov.

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Resources:

Medicare

Official Medicare Site

Eligibility Requirements

Medicare and You 2009 PDF