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Medicare Determination of Benefits

Medicare is a health insurance program that began in 1965 as part of the Social Security Act. Originally designed to supplement insurance for United States citizens ages 65 or older, the program is funded through payroll taxes paid by both employees and their employers. Premiums are also subtracted from Social Security checks. Since its inception, the program has changed and expanded.

  1. Benefit Qualifications

    • Medicare is paid for through payroll taxes.

      Initially, only people 65 or older qualified to receive Medicare benefits. However, younger individuals who meet certain criteria now also receive benefits. According to the Social Security Administration, those with certain disabilities or who suffer from permanent, disabling kidney disease may qualify, as may those who have amyotrophic lateral sclerosis. ALS is also known as Lou Gehrig's disease.

    Part A/Part B

    • Medicare Part A may cover skilled nursing home care.

      Part A of Medicare is also known as hospital insurance. This benefit helps cover the cost of inpatient care in a traditional hospital or hospice setting, at an assisted living facility or at a skilled nursing home following hospitalization. Some home health care may also be covered. According to the Centers for Medicare & Medicaid Services, certain conditions must be met. Part B is the medical insurance that requires a paid premium, and covers physician care and outpatient procedures.

    Prescription Drug Coverage/Part D

    • Part D of Medicare is the premium prescription drug service.

      Since 2006, everyone who receives Medicare can also get prescription drug coverage, known as Part D. This premium paid service is provided through private enterprise. If you do not sign up for this benefit when you become eligible for Medicare, you may incur a penalty when you sign up in the future. Beginning in fall 2010, those who pay for this feature and find themselves in the so-called "doughnut hole" will receive a one-time $250 rebate. The doughnut hole is when expenses exceed payments through Medicare, and you must pay bills using out-of-pocket money. In 2011, participants will get a 50 percent discount when purchasing covered medications.

    New Benefits

    • Beginning in 2011, Medicare is adding new preventative care services. These services include free mammograms and colorectal cancer screens. In addition, an annual physical will be available for free under the coverage. For further information on existing and changing services, contact CMS at 1-800-MEDICARE or go to the website at medicare.gov.

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