The "Basics" of Medicare

“Medicare 101—The Basics” 

People often confuse Medicare with Medicaid—two programs that sound very much alike, and which often serve the same people, but are different. So what is Medicare?

Medicare is health insurance for people age 65 and older, and for people under age 65 with certain disabilities or health conditions. In short, eligibility for Medicare is based on age, and/or certain health conditions.

Medicaid helps pay medical costs for persons of any age who have limited income and resources. Medicaid is funded jointly by the federal and state governments but is administered by the state, which determines eligibility based on the income and resources limits it sets. A person who is eligible for Medicare may also be eligible for Medicaid, based on income.

As with most health insurance, there are monthly premiums, annual deductibles and co-payments or co-insurance associated with Medicare. Medicare Part A is premium-free if you have worked and paid taxes for at least 40 quarters (the equivalent of 10 years), but you are responsible for meeting a deductible for each benefit period, $1,184 in 2013, and paying co-insurance for Medicare-covered care. For Part B, the monthly premium for 2013 for most beneficiaries is $104.90, the annual deductible is $147, and you generally pay 20% of Medicare-covered services. For Parts C and D, in addition to paying the monthly Part B premium, you also pay monthly premiums in addition to deductibles and co-insurance, all of which vary by plan.

There is a lot to know and think about when it comes to Medicare, and how to make the most of its many benefits. Fortunately, there is a lot of good information and help available, at your fingertips and in your community. Resources include the “Medicare & You” handbook, mailed to all Medicare beneficiaries; the Medicare website, www.medicare.gov; 1-800-MEDICARE (633-4227)—TTY users call 1-877-486-2048; the Social Security website, www.socialsecurity.gov, and Social Security toll-free number 1-800-772-1213 (TTY users call 1-800-325-0778). In addition, the West Virginia State Health Insurance Program can provide personalized help in your community—call 1-877-987-4463 to get the help you need.