Medicare & Other Benefits

Medicare (Off Site) is a federal health insurance program that covers most individuals ages 65 and over and people under 65 who receive Social Security cash payments due to disability. People with end-stage renal disease are entitled to Medicare regardless of age. Eligibility for Medicare is determined by the Social Security Administration (Off Site).

Medicare consists of four parts:

• PART A - Hospital Insurance. It covers inpatient hospital, skilled nursing facility, hospice and home health care. For most people, Part A is free, meaning there will be no monthly premium imposed; however there are costs associated with Part A such as deductibles and coinsurances.
• PART B - Medical Insurance. It covers physician and outpatient hospital care, lab tests, ambulance service, medical supplies and home health. There is a monthly premium for this part of Medicare, which changes annually. Other costs associated with Part B may be annual deductibles and co-insurance charges.
• PART C - refers to managed care plans that provide Part A and B benefits to enrollees. Formerly called “Medicare + Choice” now called “Medicare Advantage.”
• PART D - refers to the new outpatient prescription drug benefit that will be implemented in 2006. More information on the Medicare Prescription Drug Benefit.

Medicare Supplement
Because of gaps in Medicare’s coverage (deductibles and coinsurance costs), most seniors have some form of supplemental coverage. In Minnesota, there are four common ways to supplement Medicare coverage:

• A Medigap policy from a private insurance company
• A Managed Care plan
• A Medicare + Choice (Medicare Advantage) Private Fee for Service plan
• Medicare supplemental coverage through an employer retiree health plan

Any of the above options will pay most or all of the co-insurance and deductible amounts. There is a premium (annual or monthly) for Medicare supplemental insurance, which varies dependent on coverage purchased. This premium is in addition to the Medicare premium.

If a person cannot afford to purchase Medicare supplemental insurance, there are health care programs in Minnesota for low to moderate income seniors and persons with disabilities. Medical Assistance is an entitlement program funded by the federal and state government and fills in Medicare gaps and also covers prescription drugs and long-term care. To qualify for Medical assistance, an individual must meet financial criteria. Because Medical Assistance supplements Medicare benefits, people enrolled in both programs are known as dual-eligible.

While many Medicare beneficiaries who participate in Medical Assistance receive full Medical Assistance benefits, other low-income beneficiaries may receive assistance primarily limited to Medicare premiums through three related programs called the Medicare Savings Programs.

Qualified Medicare Beneficiary (QMB) Program
This program pays premiums, deductibles and coinsurances. To be eligible for this program, monthly income must be less than or equal to 100 percent of the federal poverty level.

Service Limited Medicare Beneficiary (SLMB) Program
This program pays for Part B premiums. In order to meet the eligibility requirement, monthly income must be between 100 percent and 120 percent of the federal poverty level.

Qualified Individual 1 (QI-1) Program
This program pays the Medicare Part B premiums for persons with Medicare with monthly incomes between 120 percent and 135 percent of the federal poverty level.

All three programs have the same asset limits. The asset and income limits vary depending on whether a person is single or married.

Updated 07/13/2007