Federal Links: www.medicare.gov/ OR www.cms.gov/medicare/

• What is it
• Who qualifies
• What it covers
• What it costs
• Impact for YOUTH
• Guides
• Resources

What is it:

Part A: Hospital Insurance: One half of the Original Medicare Plan is known as hospital insurance. Under certain conditions, it also covers home health agency (HHA) care, hospice care, inpatient psychiatric care, blood transfusion and limited stays in nursing homes (known as skilled nursing facilities, or SNF).

Part B: Medical Insurance: Medicare Part B helps cover doctors' services and outpatient hospital care. It also helps cover some other medical services that Part A does not cover, such as some of the services provided by physical and occupational therapists and some home health care. Part B helps pay for these services and supplies when they are medically necessary. Most people pay a monthly premium for Medicare Part B.

ABOUT ORIGINAL MEDICARE - The Medicare program provides health insurance for people 65 years of age and older, certain disabled people and people with kidney failure. People qualify if they or their spouse has 40 or more quarters (10 years) of Medicare-covered employment.

The Original Medicare Plan is a fee-for-service plan that is available nationwide. With the Original Medicare Plan, you may go to any doctor, specialist, hospital, or other health care provider that accepts Medicare. Generally, a fee each time is charged each for a service from a provider (set amount out-of pocket co-pays to reach deductible.) Once the deductible is satisfied, Medicare pays its share, and you pay your share (coinsurance or copayment).

Who qualifies: People 65 and older, younger people with disabilities and people with end-stage renal disease. The Social Security Administration (SSA) oversees eligibility and enrollment.

• Upon turning 65, or
• After receiving 24 months of Social Security cash benefits (SSI/SSDI) if under the age of 65 and disabled.
• If an individual is under age 65 and has Lou Gehrig's disease (ALS), the individual receives his or her Medicare benefits the first month he or she receives disability benefits from Social Security or the Railroad Retirement Board, whichever is later.

What it covers: Plan pays for Hospitalization charges with charges individual with some co-pays.

• May cover the cost of some services—such as home healthcare and doctors' visits—provided in such a facility.

• Medicare Part B - Durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers)
• The beneficiary pays nothing for the Medicare-approved services and 20% of the Medicare-approved amount for durable medical equipment.

What it costs:

• Part A is premium-free for a beneficiary or his/her spouse who has worked and paid Medicare taxes for at least 10 years.

• Part B (monthly premiums of $66.60 in 2004) In some cases, the insurance can be purchased even if no Medicare taxes have been paid.

Impact for YOUTH: Under Social Security Disability Insurance (SSDI), there is a benefit to adult children with disabilities existing before age 22. When such a person's parent becomes disabled, retires, or dies, a payment based on this parent's earnings becomes payable to the adult child.

• Adult children are required to apply for this benefit within 30 days of the parent's disability, retirement, or death.

• SSDI then becomes the new primary income maintenance program for adult children who have previously participated in SSI. The SSDI payment is based on the deceased parent’s income. If the SSDI payment is low, an adult child may continue receiving a reduced SSI payment as well.

• Because SSI is intended to be a program of last resort, individuals must have first applied for all other public assistance to which they may be entitled, and must apply in the future for any to which they become entitled.

• A person no longer covered by SSI when their primary cash benefit source is switched to SSDI cannot lose Medicaid coverage.

LAW: The Employment for Disabled Americans Act of 1986 (Public Law 99-643) requires states to continue Medicaid coverage when an individual who became disabled before age 22 and received SSI becomes eligible for SSDI or has an increase in SSDI benefits. Such disabled adult children continue to be considered SSI recipients for Medicaid purposes . Disabled adult children c. 175 § 108 2(a)(3) c. 176A §8(d); c. 176B § 6(c)

How to Apply: Contact State Medicaid/Medicare Office.
MEDICARE www.cms.hhs.gov/medicare/
MEDICAID www.cms.hhs.gov/medicaid/consumer.asp

Youth who are determined to be disabled according to SSA criteria and have no work history will receive SSI Benefits. In non-209 B states this is automatically qualifies for Medicaid. After receiving SSI benefits for 24 months, the individual can qualify for Medicare.

If the youth who receives SSI works but does not exceed income limits (Substantial Gainful Activity (SGA) $800 in 2004, for 40 quarters, SSI converts to SSDI and then qualifies for Medicare.

• After receiving SSI for 24 months of Social Security cash benefits (SSI/SSDI) if under the age of 65 and disabled.
• If an individual is under age 65 and has Lou Gehrig's disease (ALS), the individual receives his or her Medicare benefits the first month he or she receives disability benefits from Social Security or the Railroad Retirement Board, whichever is later

Guides:

Centers for Medicare and Medicaid Services
CMS-Medicare Enrollment Data
cms.hhs.gov/statisti cs/enrollment/sage/default.asp
Medicare Enrollment by State, Age Group, and Entitlement for Years 2001, 2000, 1999, 1998

CMS-Medicare Enrollment: National Trends
1966 - 2001
cms.hhs.gov/ statistics/enrollment/natltrends/hi_smi.asp
Medicare Enrollment by year/Persons (Aged and Disabled) Hospital and/or Supplementary Medical Insurance.

CMS-National Medicare Training Course
cms.hhs.gov/partnershi ps/tools/materials/medicaretraining/d epsdtefault.htm
The online course, designed for independent study, will enhance your knowledge of the Medicare Program as it relates to beneficiaries. The classroom materials used in the national Train-the-Trainer workshops can be downloaded and/or printed from this site

CMS-Medicare Savings Programs - Screening Tool for Professionals
www.cms.gov/dualeligibles/scrprof.pdf
A screening tool professionals can use when they interview clients to find out if an individual may qualify for the Medicare Savings Programs. Each state has specific income and resource criteria for enrollment. Prior to beginning the screening, please inform the individual of the following: “This is a preliminary, voluntary screening to see if you might be eligible for State programs that are part of the medical assistance program that help pay Medicare expenses. It is not an application for these programs. The information you provide will assist us in determining if you may be eligible for these programs.

CMS-Medicare Personal Plan Finder
www.medicare.gov/
Medicare's Personal Plan Finder helps you narrow down your Medicare health plan choices and choose the plan that's best for you. The tool will ask you a few questions that will help the Medicare Personal Plan Finder give you a personalized report of the health plans available in your area.

SOCIAL SECURITY ADMINISTRATION
Red Book on Work Incentives
A Summary Guide To Social Security And Supplemental Security Income
Work Incentives For People With Disabilities
Medicare Qualifying Period --SSDI ONLY
rsvp.icdi.wvu.edu/Training/APmanual/Module3/RED3M3.HTM#SEC4
The first 24 months of disability benefit entitlement is the waiting period for Medicare coverage. During this qualifying period for Medicare, an SSDI beneficiary may be eligible for health insurance through a former employer. The beneficiary should contact the employer for information about health insurance coverage.

Continuation of Medicare Coverage
rsvp.icdi.wvu.edu/Training/APmanua l/Module3/RED6M3.HTM#SEC3
SSDI beneficiaries can receive at least 39 months of hospital and medical insurance after the trial work period. This provision allows health insurance to continue when a person goes to work and is engaging in SGA.

Medicare For People With Disabilities Who Work
rsvp.icdi.wvu.edu/Training/APmanual/Module 3/RED6M3.HTM#SEC4
Certain people who have returned to work may purchase continued Medicare coverage, after premium-free Medicare coverage ends, due to work as long as he/she remains medically disabled. If the person becomes medically disabled again within 5 years (7 years for widow(ers) and disabled adult children) after the prior period of disability ends, he/she does not have to serve another 5-month waiting period to get benefits or Medicare.

The Medicare Rights Center (MRC)
www.medicarerights.org/aboutmrcframeset.html
MRC was established in 1989 to provide free counseling services to people with Medicare questions or problems. Since its founding, MRC has helped more than one million people with Medicare-related issues. MRC has conducted training programs and presentations for organizations as diverse as the U.S. HHS, the Administration on Aging, Ceridian Performance Partners, American Public Health Association, AARP, the Practising Law Institute, Families USA, AFSCME and Visiting Nurse Service.

DOCTORS WHO ACCEPT MEDICARE
63.241.27.115/Physician/Search/PhysicianSearch.asp
Welcome to our physician search tool. This tool will provide you with a list of physicians in the specialty and geographic area you specify, along with detailed physician profiles, maps and driving directions. Just enter/select the required information in the steps below and click the "Find a Physician" button that will appear when you are done.

Resources:

ALLIANCE FOR HEALTH REFORM
Medicare: Key Facts
www.allhealth.org/ch6issues.asp
Listing of bullet facts and links to related sources.