C.M.R. 10, 144, ch. 332, app 144-332-A
Medicare (Title 18 of the Social Security Act) is a health program administered by the Centers for Medicare and Medicaid Services (CMS). Coverage is available to nearly everyone over age 65 and those who have been receiving Social Security Benefits as disabled for twenty-four consecutive months.
Medicare Part "A" provides hospital, hospice and skilled nursing facility benefits. It is available without charge to individuals who have worked a certain number of quarters where FICA deductions are mandated. People who are not eligible automatically may enroll by paying a monthly premium.
Medicare Part "B" is optional medical insurance for which everyone enrolling must pay a monthly premium. Most individuals pay the same amount but when enrollment in Part B is postponed, individuals pay a different rate. There is an increase in the premium for each year of delay in enrolling in Medicare Part B. Part "B" assists in payments for doctors, outpatient hospital care, therapy, ambulance and laboratory services.
Both parts of Medicare have deductibles and coinsurance charges which are the responsibility of the individual, although private insurance plans (Medigap) may be purchased which cover these payment gaps.
The following groups of individuals and couples are provided with additional benefits by Medicaid when enrolled in Medicare:
Payment of Part A | Payment of Part B | Payment of Medicare Deductible & Co-Ins. | |
SSI and State Supplement Recipients | X | X | |
Pickle Amendment | X | X | |
Qualified Medicare Beneficiaries (QMB) | X | X | X |
Qualified Disabled and Working Individual (QDWI) | X | ||
Specified Low Income Medicare Beneficiaries (SLMB) | X | ||
Qualifying Individuals (QI) Part 1 | X |
Aside from Medicare Parts A and B there is Medicare Part D which is a prescription drug benefit through private insurance companies. People who are enrolled in Medicare Buy-In have reduced costs for their medications under Medicare Part D.
The state payment for Medicare premiums is done with a monthly data exchange between the State and Federal governments. There is usually a delay between the time an individual is eligible for the buy-in and the time the buy-in begins. During this time, the individual continues to have the premium deducted from their Social Security or Railroad retirement check. Once the buy-in begins, the individual receives the gross Social Security Benefit. They are reimbursed by Social Security or Railroad retirement for the premium collected during any delay period.
C.M.R. 10, 144, ch. 332, app 144-332-A