Medicare Basics are three core parts to Medicare Parts A, B, and D. Medicare Part A (hospital insurance) and Part B (supplemental medical insurance) were the original parts to Medicare; as a result, they are referred to as “Original Medicare.” Medicare Part D (prescription coverage) was established in 2006. You may be wondering, “What about Part C?” Part C is a way for beneficiaries to get their Part A and B benefits, and even Part D, through a private health insurance company. This unit will provide details about each part of Medicare, but keep in mind CWICs aren’t expected to be experts on what Medicare does or doesn’t cover. When beneficiaries have questions about Medicare coverage, CWICs must be prepared to refer to the State Health Insurance Assistance Program (SHIP). SHIP is a national program that offers one-on-one counseling and assistance to people with Medicare and their families. Through federal grants directed to states, SHIPs provide free counseling and assistance via telephone and face-to-face meetings. SHIP counselors may be paid employees or volunteers and complete a thorough training to help address a number of Medicare coverage questions. Details about SHIPs are provided further on in this unit. NOTE: The annual CMS publication “Medicare and You” provides an easy-to-understand overview of the parts of Medicare. This publication is an invaluable reference guide for CWICs on Medicare program rules. You can ask Medicare to mail you a copy by calling 1-800-MEDICARE or download it at: The following outlines the parts of Medicare: Medicare Part Overview Out of Pocket Expenses Part A: Hospital Insurance (HI) Inpatient hospital care Post-acute rehabilitation Deductibles, plus co- insurance based on length of stay Part B Supplemental Medical Insurance (SMI) Doctor’s services and outpatient care Typically 20% of approved customary outpatient charges after an annual deductible
will act as a secondary insurance to Medicare and the types of costs Medigap would normally cover. Another consideration is that Medicare beneficiaries may also reduce their out-of-pocket costs by enrolling in a Medicare Advantage Plan. For some beneficiaries, this may be a better option than purchasing a Medigap policy, depending on their specific health care needs. Beneficiaries can go to to find interactive electronic that compare various Medicare and Medigap plans. CWICs can also refer beneficiaries to a SHIP counselor for help deciding whether a Medigap plan would be useful. For additional information on Medigap policies, including how to decide if a Medigap policy makes sense, and what Medigap policies cover, CWICs are advised to read the publication titled “Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare,” which can be found online at: Medicare Eligibility specific groups of people are eligible for Medicare: Individuals age 65 and who are insured for retirement benefits under Social Security, either through their own work or through a spouse’s work. Individuals receiving Social Security Disability Insurance (SSDI) who have met the 24-month qualifying period for Medicare. Individuals receiving benefits as a Childhood Disability Beneficiary (CDB) who have met the 24-month qualifying period. Individuals who meet the Social Security disability standards and who are either entitled to Disabled benefits (DWB) or Medicare on a deceased worker’s record and who have met the qualifying period. Individuals who lost Title II disability benefits due to work and are in the Extended Period of Medicare Coverage (EPMC). Individuals with disabilities who have exhausted their Extended Period of Medicare Coverage (EPMC) and are eligible to purchase Medicare Parts A, B, and D coverage through Premium-HI for the Working Disabled. Individuals who have Renal Disease (ESRD) who
centers, nearly 1,400 community-based outpatient clinics, community living centers, and Vet Centers. Together these health care facilities and the more than 53,000 independent licensed health care practitioners who work within them provide comprehensive care to more than 8.3 million veterans each year. After a service member leaves active military service, the VHA becomes responsible for providing medical care for service-related injuries or conditions. At this point, the Department of Defense is no longer responsible for providing care for service-related conditions. The VHA offers a number of different programs as part of the Veterans healthcare system. The most important one is the Medical Benefits Package, which is a standard set of health services the VHA provides to veterans who qualify for VA healthcare benefits. Other VA programs include Readjustment Counseling services, dental care, and home healthcare for homebound veterans. In most cases, VA facilities such as VA hospitals and VA Medical Centers provide the medical services. Civilian medical facilities generally don’t provide care under the VA to veterans. Understanding VA Healthcare Benefits Because primarily work with veterans rather than active members of the military, we will begin our discussion of healthcare options with the VA healthcare benefits. Applying for VA Healthcare Benefits The VA offers veterans a number of ways to for healthcare benefits. Veterans may apply online by filling out the online application and submitting it electronically to the VA for processing. The online application VA Form EZ, Application for Health Benefits, is found online here: va.gov/healthbenefits/apply/ Veterans may also apply in person by going to the local VA health care facility and completing the same VA Form 10-10EZ, Application for Health Benefits. It’s also possible to apply by phone with a VA representative by calling 1-877-222-VETS (8387), 8 a.m. to 8 p.m. Mon-Fri, EST. Finally, applications may be submitted by mail. Detailed information about the application process may be found here: