9.1.4 Medicare

Louisiana Statewide Transition Project and Louisiana: Healthy and Ready to Work Fact Sheet Series

 

08/17/00

 

I. WHY IS THIS IMPORTANT?

 

Most people consider health insurance coverage to be a necessity.   Even individuals who are not chronically ill or who do not have ongoing or special health care needs desire the safety net that health insurance provides in the event of illness or disability.  However, health insurance can be very costly.  In addition, individuals with disabilities or pre-existing medical conditions frequently are unable to obtain private health insurance.

 

Our government system recognizes the need for citizens to have access to quality medical care, as well as the difficulties some individuals have in obtaining adequate health care insurance coverage.  Therefore, several government health insurance programs have been established to assist eligible individuals regarding medical coverage.  One of these programs is Medicare.  Unlike Medicaid that requires a federal and state partnership, Medicare is strictly a federal program.

 

II. KEY POINTS

 

(NOTE: This Fact Sheet represents a very brief summary of an extremely complex subject.  The information provided should only be used as an overview and general guide to Medicare.  It is not intended to fully explain all of the provisions or exclusions of the laws, regulations, and rulings of the Medicare program.  Please refer to the “Resources/Contacts” section for information on how to obtain more detailed information about Medicare.)

 

Because it is a federal program, Medicare is basically the same everywhere in the United States.  It is administered by the Health Care Financing Administration (HCFA), a federal agency in the Department of Health and Human Services.  The Social Security Administration (SSA) assists HCFA by enrolling eligible individuals and collecting premiums.  Eligibility requirements for Medicare and application forms can be obtained at local Social Security Administration offices.

 

Medicare provides health insurance for the following:

·        people 65 years of age and older who have worked and paid Social Security taxes (FICA);

·        younger people with disabilities who have received Social Security Disability Insurance (SSDI) cash benefits for 24 consecutive months; and

·        people with permanent kidney failure.

 

Enrollment in Medicare is handled in two ways: 1) by application (Individuals who are not receiving Social Security benefits must apply for Medicare three months before they turn 65.) or 2) automatic enrollment (Individuals who are disabled are automatically enrolled in Medicare beginning in the 25th month of disability; individuals who have been disabled since childhood and receive SSDI payments on a parent’s record as an “adult child” are also automatically enrolled in Medicare.).

 

Medicare provides benefits in two parts: Part A and Part B.

·        Hospital Insurance (Part A) provides coverage of inpatient hospital services, skilled nursing facilities (i.e., nursing homes), home health services, and hospice care.

·        Medical Insurance (Part B) helps pay for the cost of physician services, outpatient hospital services, medical equipment and supplies, and other health services and supplies.

 

While Medicare covers many health care expenses, there is some cost to covered individuals.  In addition, certain medical services are not covered my Medicare.  Finally, Medicare recipients pay coinsurance, deductibles, and premiums.

              

III. ROLES/NEXT STEPS

 

Students/Young Adults:

Because individuals with disabilities may qualify for both Medicare and Medicaid, it is important to learn about both programs, including the differences between the two programs.  Young adults who think that they may be eligible for SSDI payments and, as a result, Medicare should contact the SSA.  Personnel in local or district offices can provide information about eligibility and the application process, including the information and documentation requirements.  If support or assistance is wanted or needed, young adults should contact the nearest Social Security office or ask a family member or friend for help.

 

Young adults who are working or would like to work should talk with family members and agency personnel and ask for information about how working will affect SSDI benefits.  They should learn about Work Incentives and ask adults supporting them in their transition to help them access these programs.  Young adults should consider having representatives from SSA become members of their transition planning teams.

 

Families:

Because individuals with disabilities may qualify for both Medicare and Medicaid, it is important to learn about both programs, including the differences between the two programs.  Families who think their sons or daughters may be eligible for SSDI payments and, as a result Medicare, should provide needed assistance when applying for benefits at the nearest Social Security office.  Personnel in these offices can provide information about eligibility and the application process, including the information and documentation requirements.

 

When discussing the transition to employment with agency personnel, families should ask about various Work Incentives for which their sons/daughters may be eligible.  If incentives are identified, they should help their sons/daughters apply so that wages and salaries received from employment do not interfere with their sons’/daughters’ SSDI eligibility.

 

Agencies:

Transition personnel in Local Education Agencies (LEAs) and adult service agencies should become familiar with the SSDI program, including Medicare, so that information and assistance can be provided to adolescents and young adults with disabilities and their families. In addition, Social Security offices have brochures and other printed materials about programs that can be shared with young adults and their families.  These materials can also be accessed through the SSA’s website.  Finally, representatives from SSA should be invited to participate as members of transition planning teams as appropriate.

 

Agency representatives can offer informational workshops on SSDI, Medicare, and other Social Security topics for young adults and families.  Personnel in local or district Social Security offices can be contacted to provide information about programs.

 

As requested, personnel from the SSA should attend meetings at which transition to employment, financial needs, and health insurance coverage are discussed.  They can also serve on local or regional interagency transition teams.  By providing information to LEAs, families, and young adults, SSA personnel can help young adults with disabilities plan for employment, financial needs, and health insurance coverage without the fear of losing needed benefits prematurely.

 

IV. RESOURCES/CONTACTS

 

Health Care Financing Administration (HCFA)

http://www.hcfa.gov

 

Families Helping Families Resource Centers

Acadiana:   800-378-9854

Bayouland:  800-331-5570

At the Crossroads:  800-259-7200

Greater Baton Rouge:  888-511-5299

Greater New Orleans:  800-766-7736

Northeast LA:  888-300-1320

Northshore:  800-383-8700

Text Box: The development and dissemination of this document were supported in part by funds from the U.S. Department of Education (Cooperative Agreement #H158A6007, “The Louisiana Statewide Transition Project: A Multi-Constituency Model”) and the U.S. Department of Health and Human Services, Maternal and Child Health Program (Grant MCJ-22HRW6, “Louisiana: Healthy and Ready to Work”). The opinions expressed herein are solely those of the authors and do not necessarily reflect the policy or position of the U.S. Department of Education or the U.S. Department of Health and Human Services, and no official endorsement by either of these two agencies should be inferred. The LSUMC does not discriminate on the basis of race, color, national origin, sex, religion, age, or disability in employment or the provision of services. This document may be duplicated and disseminated in its original form without obtaining permission. Alternate forms of this document are available upon request at 1-888-942-8104 or TDD 1-504-942-5900.

Northwest LA:  888-989-0315

Southwest LA:  800-894-6558

http://www.fhfla.org

http://www.projectprompt.com

 

Senior Health Insurance Information Program (SHIIP)

Louisiana Department of Insurance

1-800-259-5301 or 504-342-5301

(Requests to be included on their newsletter mailing list can be made.)

 

Social Security Administration

1-800-772-1213 (voice) or 1-800-325-0778 (TTY)

(Persons calling these numbers can get information about SSDI and Medicare and can request that an appointment be made at a SSA office near them.)

http://www.ssa.gov

Social Security and You Teacher’s Kit

This is a set of materials designed for high school students that explains the Social Security system. It includes five lessons, fact sheets, student handouts, and quizzes. The handouts are in large print suitable for use as blackline masters for transparencies or overhead projectors. It can be obtained by mail or downloaded from the SSA’s website. (See previous contact information.) A 25-minute videotape is also available. If you would like a copy, send a blank 60-minute VHS videotape with your mailing information to: Social Security, 4-J-8 WHR, Baltimore, MD 21235. Be sure to indicate that you want the Teacher’s Kit tape duplicated. This service is free.

 

V.  REFERENCES

 

“Overview of the Medicare Program”, HCFA publication, September 16, 1997.

 

“Your Medicare Handbook: Introduction to Medicare”, HCFA publication, 1997.            

 

Social Security Administration Office of Disability. (January, 1996). Graduating to Independence. [available via Internet: http://www.ssa.gov]

 

Social Security Administration. (January, 1999). Social Security Update 1999. [available via Internet: http://www.ssa.gov]