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Medicare Open Enrollment is a Good Time to Review Medicare Basics

Published October 10, 2011


Horizons in Hemophilia, October 2011 

By Robert H. Gillespie, LMSW, Social Worker

Medicare open enrollment starts early this year.  Beginning October 15, Medicare participants may elect a supplemental provider, if desired.  Open enrollment closes December 7.  If you have questions about your Medicare benefit, please contact your HoG Social Worker. 

Medicare Basics 
As a social worker I am often asked questions about Medicare and Medicaid.  It is not uncommon for people, even those who work in the medical field, to confuse the two programs.  Although the programs sound similar, their benefits are significantly different.  Due to the complexity of Medicare, this article will be published in two to three parts spanning several newsletters. 

The idea for Medicare was originally floated in 1945 by President Harry Truman who envisioned affordable health care coverage for elderly individuals.  It was not until July of 1965 that Medicare, as well as Medicaid, came into existence with President Lyndon B. Johnson’s signature on the Social Security Act.  Medicare was expanded from its original goal to provide insurance to elderly individuals to also include adults who become disabled or have certain other medical conditions.

The criteria for a person to be eligible for Medicare state that the individual must be a permanent resident of the United States and have at least a 10 year work history in the United States.  Another requirement for Medicare says the recipient must meet one (or both) of the following:  be 65 years or older or permanently disabled.  People with end stage renal disease needing a kidney transplant and/or dialysis are also eligible for Medicare. 

Approval for Medicare is achieved when a person either reaches the age of 65 and meets the other requirements, or if a person is deemed disabled by the Social Security Administration.  Once approved for Social Security Disability (SSDI) the disabled individual will eligible for Medicare 24 months after the date of the first SSDI check.

Medicare is divided into four parts: A, B, C, & D.  Medicare Part A is traditionally known as hospital insurance, but home health, hospice, and skilled nursing facilities are also included under part A.  Under Medicare part A the recipient does not pay premiums since a Medicare tax was paid while the individual worked, i.e. prior to turning 65 years of age or becoming disabled.  The other three parts of Medicare are considered optional.   We will cover Medicare parts B and C in the November issue of Horizons in Hemophilia.