Archive for the ‘part d’ Category

Medicare Program Overview

Friday, December 9th, 2011

This is the first of a multi-part discussion of Medicare Insurance. While everyone has heard of Medicare, and many of us know something about it, very few people have a firm understanding of all the facets of the program. Even those who do have a clear grasp of the program may not be aware of recent changes or modifications.

Medicare first came into being as part of the Social Security Act of 1965, signed into law by President Lyndon B. Johnson. Its purpose in 1965 was the same as present Medicare goals, to provide health coverage to Americans aged 65 and over. The insurance is also currently available to individuals under 65 who have a permanent physical disability, and certain other special circumstances.

Before the enactment of the Medicare legislation, only about 50% of people over 65 years old had health care coverage, and almost 30% of senior citizens lived below the poverty level. Current Medicare insurance provides health care coverage for approximately 47 million Americans.

Individuals qualify for Medicare if:

ü  They are 65 years old or older and eligible to receive Social Security,

ü   and are a U. S. citizen or have been a permanent resident for 5 continuous years,

ü   and they or their spouse has paid Medicare taxes for at least 10 years.


ü  They are people of any age with End-Stage Renal Disease (ESRD) – permanent kidney failure requiring dialysis or a kidney transplant.


ü  They are under 65, permanently disabled, and have been receiving either Social Security SSDI benefits or Railroad Retirement Board disability benefits for at least 2 years.


ü  They are eligible for Social Security Disability Insurance.

Medicare consists of 4 basic parts:

  • Part A (Hospital insurance)
  • Part B (Medical insurance)
  • Part C (Medical Advantage plans)
  • Part D ( Medicare prescription drug coverage)

When a qualified individual turns 65 years old, they are automatically enrolled in Medicare parts A and B. For most Medicare recipients, Part A does not require a monthly premium, but there is a Part B monthly premium. The cost of this premium is deducted from the individual’s monthly Social Security check.

Part C, known as a “Medical Advantage” plan, is managed by private insurance companies. These plans offer all of the coverage that is included in parts A and B, and most plans include drug coverage. They usually offer extra coverage such as vision, hearing, dental, and/or health and wellness programs.

Part D is the Medicare Prescription Drug Coverage plan. It is generally available to everyone with Medicare. It is offered by companies that are approved by and under contract with Medicare. There is usually a premium for prescription drug coverage and the drug coverage is added to the original Medicare plan. If individuals choose a Medical Advantage plan that includes drug coverage, then paying for Part D is unnecessary.

This is just a general overview of Medicare. More detailed information will come as we explore each part of Medicare in detail.


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