Generally, Medicare is available for people age 65 or older, younger people with disabilities, and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). People under 65 and disabled must be receiving disability benefits from either Social Security or the Railroad Retirement Board for at least 24 months before automatic enrollment occurs. In 2005, Medicare provided health care coverage for 42.5 million Americans. Enrollment is expected to reach 77 million by 2031, when the baby boom generation is fully enrolled.

The "Original Medicare" program has two parts: Part A (Hospital Insurance), and Part B (Medical Insurance). Neither Part A nor Part B pays for all of a covered person's medical costs. The program contains premiums, deductibles and co-pays (payments due from the covered individual). Only a few special cases exist where prescription drugs are covered by Original Medicare, but as of January 2006, Medicare Part D provides more comprehensive drug coverage. Medicare Advantage plans are another way for beneficiaries to receive their Part A, B and D benefits.

Part A: Hospital Insurance

Part A covers hospital stays. It will pay for nursing home stays as well if certain criteria are met:

The hospital stay must be of at least 72 hours with the count starting at the first midnight after admission and not counting any hours of the discharge date.

The nursing home stay must be for something found wrong during the hospital stay or for the main cause of hospital stay. For instance, hospital stay for broken hip and then nursing home stay for physical therapy would be covered.

If the patient is not receiving rehabilitation but has some other ailment that requires skilled nursing supervision then the nursing home stay would be covered.

The care being rendered by the nursing home must be skilled. Medicare part A does not pay for custodial, non-skilled, or long-term care activities, including activities of daily living (ADLs) such as personal hygiene, cooking, cleaning, etc.



The maximum length of stay that Medicare Part A will cover in a skilled nursing facility per ailment is 100 days. The first 20 of those days would be paid for in full by Medicare with the remaining 80 days requiring a co-payment (currently as of 05/21/2006, $119.00 per day). Many insurance companies will have a provision for skilled nursing care in the policies they sell.

Most people do not pay a monthly Part A premium, because they (or a spouse) have had 40 or more quarters where they paid FICA taxes. For Medicare eligible beneficiaries who do not have 40 or more quarters of Medicare-covered employment, Part A may be purchased for a monthly premium of:

$216.00 per month (in 2006) for people having 30-39 quarters of Medicare-covered employment.

$393.00 per month (in 2006) for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.



Part B: Medical Insurance

Part B helps cover doctors' services, outpatient hospital care, and some other medical services that Part A does not cover, such as durable medical equipment (DME). Medicare's DME coverage included payment for canes, walkers, wheelchairs, and mobility scooters for those with mobility impairments, depending on medical necessity.

Part B is optional coverage and may be deferred if the beneficiary or their spouse is still actively working. There is a lifetime penalty (10% per year) imposed for not taking Part

Everyone with Medicare Part B pays an insurance premium for this coverage, which for 2006 is $88.50 per month. It is common for this premium to be automatically deducted from a beneficiary’s monthly Social Security check. Some people may qualify to have other governmental programs pay this premium for them.

Part C: Medicare Advantage plans

With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the Original Medicare plan (Parts A and B). These programs were known as "Medicare+Choice" or "Part C" plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the compensation and business practices for insurers that offer these plans changed, and "Medicare+Choice" plans became known as "Medicare Advantage" (MA) plans. In addition to offering comparable coverage to Part A and Part B, Medicare Advantage plans may also offer Part D coverage.

Part D: Prescription Drug plans

Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D. It was made possible by the passage of the Medicare Prescription Drug, Improvement, and Modernization Act. In order to receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually administered by private health insurance companies.

For more information, go to:http://www.Wikipedia.com/medicare