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Minnesota Department of Human Services Community-Based Services Manual (CBSM)
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Medicare

Page posted: 10/01/03

Page reviewed: 06/02/10

Page updated:

Legal Authority

Title XVIII of the Social Security Act

Definition

Medicare: Federal program that provides health insurance coverage to people age 65 and over or who meet other special criteria.

Program Descriptions

Medicare is administered by the U.S. Department of Health and Human Services under the Centers for Medicare & Medicaid Services (CMS). Medicare provides health care coverage for persons:

  • • Age 65 or older
  • • Of all ages who have permanent kidney failure (End-Stage Renal Disease treated with dialysis or a transplant)
  • • Under age 65 with certain disabilities
  • Medicare Part A (Hospital Insurance)

    Most people get Medicare Part A automatically when they turn age 65. People often do not pay for Part A because they or a spouse paid Medicare taxes while employed.

    Medicare Part B (Medical Insurance)

    Enrollment in Medicare Part B is optional. There is a premium for Part B.

    Medicare Parts C and D
    Medicare provides Medicare Advantage (Part C or MA Plans) as well as Medicare Prescription Drug Coverage (Part D). Both plans offer varying amounts of coverage and each plan charges premium depending on the level of coverage.

    Eligibility for Medicare

    Persons age 65 and older
    Persons age 65 years or older generally are eligible for Medicare if :

  • • They or their spouse worked at least 10 years in Medicare-covered employment and
  • • They are a citizen or permanent resident of the United States
  • For persons receiving Social Security or Railroad Retirement benefits, part A will automatically start the first day of the month those persons turn 65.

    Persons under age 65
    Persons under age 65 and disabled are automatically enrolled in Medicare Part A and Part B beginning their 25th month of entitlement when they:

  • • Have been entitled to disability benefits under Social Security or
  • • The Railroad Retirement Board for 24 months
  • To determine eligibility, click Medicare Eligibility Tool and complete the required questions.

    For more information about eligibility or enrolling in Medicare, call Social Security at 1-800-772-1213, TTY 1-800-325-0778 or visit Social Security Online. For general Medicare questions, call 1-800-633-4227, TTY 1-877-486-2048 or visit the Medicare Web site. Another resource is Where to Get Your Medicare Questions Answered (PDF).

    Covered Services

    Medicare may pay 100% of an approved amount for some services and require a deductible and/or co-pay for other services.

    For more information, see Medicare Support Center, What types of services are covered under Medicare?, or Your Medicare Coverage.

    Non-Covered Services

    For a list of non-covered services, see Medicare Support Center, What is not paid for by Medicare Part A and Part B.

    Appeal Rights

    Medicare decisions may be appealed. See How to File a Medicare Part A or Part B Appeal (PDF) or contact the Ombudsman's Office for assistance.

    Related Resources

    Home Health Care intermediary for Minnesota Medicare Part A handles questions about Medicare coverage and billing for home health care and hospice care. Social Security at 1-800-772-1213 or SSA Online.

    Medicare Part A intermediary for Minnesota handles claims processing, questions about hospital bills, fraud and abuse. Noridian Mutual Insurance -- Part A Medicare Carrier at 1-800-330-5935

    Medicare Part B carrier for Minnesota handles Part B claims processing, questions about Part B bills, fraud and abuse. Wisconsin Physicians Services at 1-800-633-4227

    Medicare contacts
    Official US Government Site on Medicare
    .

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