Long established Medicare (Original Fee-for-Service Medicare) is the type of health insurance plan which lists what benefits it pays for in a schedule of benefits, allows the insured freedom of choice such as what doctors to see and what treatments to take, and Includes both deductibles and coinsurance. (In insurance talk, it is a traditional indemnity type health insurance policy.)

While Medicare is a benefit provided by the federal government, Medicare benefits are administered by private companies.

Medicare is divided into three parts:

• Part A -- Hospital - The federal government pays Part A premiums for most Medicare beneficiaries. Part A includes hospice (end-of-life) care.
• Part B -- Medical - Part B is considered voluntary in that each beneficiary pays for it. The cost for Part B coverage depends on your income. (To learn more, see: Original Fee-For-Service Medicare: Premiums).
• Part D - Drugs

There are also Medicare Advantage plans, which cover at least the benefits provided by Original fee-for-service Medicare, and possibly more benefits. The trade-off is that choice is limited. (For information about Medicare Advantage plans, click here.)

In the private insurance world, indemnity policies don't pay more than "Usual and Customary" charges in your area. Medicare refers to the limitation on what it pays as the "Medicare Approved Amount."

The benefits provided by Original Medicare are generally subject to:

• An annual deductible which you have to pay before Medicare pays any benefits
• Your paying part of the costs of each service rendered,  either as a dollar amount  or a percentage of the cost of the care.

As you will see below, there is assistance available to help pay the costs of Medicare coverage.

When to enroll in Medicare depends on your circumstances. If you are on Social Security Disability Insurance (SSDI) for 24 months, you will automatically be enrolled in Medicare. You can disenroll to move to Medicare Advantage or for any other reason.

When Medicare coverage is effective depends on whether you sign up when you are first eligible due to age, or during another enrollment period.  

Original Medicare Fee-for-Service requires your doctor or other health care provider to file a claim directly with Medicare. Financial experts advise keeping track of your medical bills to make sure all charges are reviewed and proper payment is made, especially if you have Medicare and another health insurance plan.

• If you have continuing access to the internet, Medicare posts bills and their status on www.MyMedicare.gov .  However, mistakes can happen so it is a good idea to keep your own records. For a simple method of keeping track, click here.
• If you don't have continuing access to the internet, or want to be smart consumer, you can set up your own, preferably easy-to-use, system.
• If you'd prefer, ask a friend or family member to help keep track of your medical bills. You can also hire a claims professional. See Medicare Claims: Professional Assistance. 

There are tips to consider for maximizing the use of Medicare.

If you already have health insurance, do the math to determine whether to keep your private coverage and pay for Medicare. As a general matter, for someone with a serious or chronic health condition, financial advisors suggest taking both if you can afford it.

For more information, see:

• Original Medicare: Benefits
  • Parts A and B:  see Original Fee-For-Service Medicare: Schedule Of Benefits.
  • Part D: For information about Part D benefits, click here.
  • Hospice Care  
  • Depression
• Premiums  
• Original Fee-For-Service Medicare: How Do I Enroll?   
• When Will Medicare Coverage Be Effective?  
• How To Disenroll To Join Medicare Advantage  
• Should I Take Part B Coverage?
• How To Maximize Use Of Original Medicare

For individual questions about Medicare, consider contacting:

• The Medicare Rights Center 
• A State Health Insurance Assistance Program (SHIP). For contact information for your state's SHIP, click here .

NOTE:

• It is advisable to take advantage of Medicare coverage of one free wellness visit to a doctor each year, as well as its long list of preventive services with no deductible, coinsurance or copay. Just because you have a health condition, it doesn't mean that you won't get another one. 
• Medicare covers care for depression. We mention this specifically because depression generally occurs at some point after diagnosis of a serious health condition. 

In most cases, a person with a history of a serious health condition who has Original Medicare will want to enroll in Part B Medicare.

It is advisable to take Part B if:

• Medicare will be your only health insurance plan.
• You intend to purchase a Medicare Supplement policy (Medigap).
• You plan to enroll in a Medicare HMO. See Medicare HMO.
• Your other coverage is a group health plan that integrates with Medicare Part A and Part B "…whether or not you are enrolled in both."

You may not need Medicare Part B if you have another health insurance plan and:

• The other insurance does not attempt to subtract from its normal benefits any amounts paid by Medicare. Generally group policies follow Coordination of Benefits and individual health policies subtract Medicare benefits from their payment. (See Medicare and Coordination of Benefits)
• AND
• The plan covers the same things that Medicare Part B covers such as doctors and lab tests
• AND
• Your plan only integrates or considers what coverage you actually have. It won't integrate with Part B unless you're actually enrolled in Part B.

If you do not need Part B coverage now, by postponing it, you protect your right to purchase a Medigap policy on a guarantee issue basis. See Medicare -- Info -- Medigap Policies.

NOTE: It is important that you be sure before you turn down Medicare Part B. If you later need Part B and do not qualify for a Special Enrollment Period, you may be penalized by having to wait to enroll until the Open Enrollment and forced to pay a penalty in addition to each premium payment.

Premiums:

• Part A: There is no premium for Original Fee-For-Services Medicare Part A unless you do not have sufficient eligibility.
• Part B:  The amount you pay per month for Part B varies according to the amount of your income. In 2015, most people pay $147 a month.  If you are receiving a Social Security benefit, payment for Part B will be deducted from the payment. Otherwise, you have to pay Medicare dierectly.
• Part D:   You pay Medicare directly.
• Financial assistance to help pay premiums: There is help available for paying Original Fee-For-Service Medicare premiums. To learn more, see: Medicare: Financial Assistance
• The amount of Medicare premiums varies from year. To learn the current costs, go to: Medicare.gov .  Click on "Your Medicare Costs"

How You Pay For Medicare:

• If you are receiving SSDI or Retirement: If you receive Medicare when you receive a Social Security benefit, such as a Retirement benefit or Social Security Disability Insurance, the Part B Medicare premium is automatically deducted from your monthly benefit check. 
• If you are eligible for Medicare and not receiving a monthly Social Security benefit, then you must make arrangements with Social Security to submit the payments periodically.  This could happen if:
  • You were born before 1938, and defer your retirement benefits past age 65.
  • You were born after 1938. You will be eligible for Medicare at age 65, but your Normal Retirement Date won't be until sometime later.
  • You complete your Trial Work Period under Social Security Disability Insurance (SSDI) and continue working. Your SSDI benefits will stop even though you're still eligible for Medicare.
• To make payment arrangements, call Social Security at 800.772.1213 or go in person to your local Social Security office. Generally, Social Security will want you to submit your payments for Part B Medicare in quarterly payments for three months of premiums.

NOTE: Watch to make sure you stay current on your payments. If you do not, your Part B coverage will be terminated and you will be forced to wait until the next Open Enrollment to get it back. 

You will automatically be enrolled in Original Fee-For-Service Medicare if you're receiving Social Security or Railroad Retirement benefits when you become eligible for Medicare.

You may enroll at age 65. The earlier you enroll, the sooner coverage starts.

You can enroll over the telephone or at your local Social Security office.

Automatic Enrollment

Enrollment in Medicare is automatic if you are already receiving Social Security or Railroad Retirement benefits at the time you become eligible for Medicare. For example: If you took early retirement, you will be automatically enrolled in Medicare when you turn 65. If you are collecting Social Security Disability Insurance (SSDI), you will automatically be enrolled in Medicare when you have collected SSDI benefits for 24 months.

If your enrollment is automatic, you will receive your Medicare card about two months before it will be effective. Medicare will automatically enroll you in both Part A and Part B. Payments for Part B premiums will be deducted from your Social Security benefit. If you decide that you do not want Part B, a form accompanies the card that you can complete and return. Medicare will then issue you a card for Part A only. See Should I Take Part B Coverage?

How To Enroll In Medicare

You may enroll in Medicare at age 65 even if you are not enrolling in Social Security Retirement benefits until later. (If you took early retirement, you'll get Medicare at 65 automatically.)

To be sure you obtain Medicare at the earliest moment, enroll in Medicare approximately three months before you become eligible for it.

Call or go to your local Social Security Administration office and tell them you wish to apply for Medicare. If you are requesting retirement benefits at the same time, make sure you complete the application for retirement benefits as well. Social Security's number is 800.772.1213.

The Medicare application is not available on line.

Since coverage is determined by age or eligibility for Social Security Disability Insurance benefits, very little information is required other than identifying information.  

NOTE:

• To learn about eligibility for Medicare, see: Original Fee-For-Service Medicare: Eligibility.
• For effective date of enrollment, see: Original Fee-For-Service Medicare: Effective Date Of Coverage. 

The effective date of Original Medicare depends on whether you enroll during the period when you can first sign up (the Initial Enrollment Period), or during a general or special enrollment period.

Initial Enrollment Period

To be effective on the date of eligibility you must apply before your first month of eligibility.

If you apply before the month that you turn 65, coverage will be effective on the first of the month that you turn 65. [If you were born on the 1st of the month, Social Security will consider you turn 65 on the last day of the prior month. If you were born on May 1, Social Security will consider that you turned 65 in the April before your 65th birthday.]

If you apply during the month that you turn 65, coverage is effective on the first of the following month. [In the example above, if you enrolled in April, your coverage would begin May 1.]

If you apply after you turn 65:

• If you apply in the month after you turn 65, coverage is effective on the first of the third month after you turn 65. [If you enrolled in May, your coverage would begin July 1, the third month from April.]

• If you apply in the second month after you turn 65: coverage starts the fifth month after your birthday.
• If you apply in the third month after you turn 65: coverage starts in the sixth month after your birthday

If you're already receiving Social Security benefits, you will be sent a notice and automatically enrolled unless you dis-enroll. If you're not already receiving benefits, you must file an application. 

General enrollment period

If you enroll during the period January 1 to March 31, coverage will be effective  July 1 of that year.

Special enrollment period

• If you enroll during a special enrollment period because you were previously covered by an employer or union group health plan, or because you did not take Part B before, coverage begins the first of the month after you enroll.
• If group coverage ends before the end of a month, and you enroll during that month, coverage will be effective on the first of that month (to avoid a gap in coverage).

NOTE: To learn more about eligibility for Medicare, see: Original Fee-For-Service Medicare: Eligibility.  For information on enrolling, see: Original Fee-For-Service : How To Enroll. 

• The goal of hospice care is to care for a terminally ill person in the final months of life, not to cure the illness.
• Hospice care is usually provided at home with care from a Medicare certified hospice agency. In special circumstances, hospice may be provided on an inpatient basis.
• Hospice Care Is Covered Under Medicare Part A. If you start on hospice care, you can return to regular medical care at any time. 
• You always have the right to stop getting hospice care and go back to your regular doctor or health plan. That will not prevent you from rejoining the hospice program at a later date.  

What is hospice care?

When the treatment goals change from cure to care, a hospice can:

• Manage the patient's pain and symptoms so that the patient can have as good quality of life as possible in the time remaining.
• Deliver palliative care in the patient's home, or in a home-like setting, and supplement family caregiving.
• Provide practical, emotional, and spiritual support to the patient and the family.

Generally, hospice care is provided in your home with a family member or close friend coordinating the care between the hospice team and volunteers.

Your doctor and a nurse from the hospice will evaluate your situation and work with you and your family to set up a plan of care that meets your needs. Benefits are approved for a 90-day period and may be renewed for another 90-day period. If more care is required, the physician may re-certify you for an unlimited number of 60-day periods.

The plan of care includes the hospice services you need that are covered by Medicare. The care is meant to help patients make the most of the last months of life by giving comfort and relief from pain. The focus is on care, not cure.

• Volunteers are trained to help with everyday tasks, such as shopping and personal care services, like bathing and dressing.
• A family member or other person who cares for you will be with you every day and members of the hospice team will make regular visits.
• A nurse and a doctor are on-call 24 hours a day, 7 days a week to give you and your family support and care when needed.
• If you should need care in a hospital for your illness, the hospice team will help arrange your stay.

Eligibility For Hospice Care Under Medicare

You are eligible for Medicare hospice benefits when all of the following occur:

• You are eligible for Medicare Part A.
• Your doctor and the hospice medical director certify that you are terminally ill and probably have less than six months to live. The certification is based on the doctor's clinical judgment regarding the normal course of your illness. The law understands that such certifications are not always exact. (Clinical information and other documentation supporting the medical prognosis must accompany the written certification).
• You sign a statement choosing hospice care instead of routine Medicare covered benefits for your terminal illness. In essence, you consent to pain and symptom relief (palliative care) rather than curative care.
• You receive care from a Medicare-approved hospice program.

What Does The Medicare Hospice Benefit Cover?

Medicare hospice benefit covers nearly 100% of the cost of:

• Doctor services
• Nursing care
• Medical equipment such as wheelchairs and walkers
• Medical supplies such as bandages and catheters
• Drugs to control symptoms and pain relief
• Sort-term care in the hospital, including respite care. (Respite care is care given to a hospice patient by another caregiver so that the usual caregiver can rest. During a period of respite care, you will be cared for in a Medicare-approved facility, such as a hospice facility, hospital or nursing home.)
• Home health aide and homemaker services
• Physical and occupational therapy
• Speech therapy
• Social worker services
• Dietary counseling
• Bereavement counseling to help you and your family with grief and loss.

Even if you choose hospice care, Medicare will still pay for covered benefits for any health problems that are not related to your terminal illness.

The cost of hospice care is minimal to you. You will have to pay:

• No more than $5.00 for each prescription drug and other similar products. The hospice can charge up to $5.00 for each prescription for outpatient drugs or other similar products for pain relief and symptom control.
• 5% of the Medicare payment amount for inpatient respite care. For example, if Medicare pays $100 per day for inpatient respite care, you will pay $5.00 per day. You can stay in a Medicare-approved hospital or nursing home up to 5 days each time you get respite care. There is no limit to the number of times you can get respite care.

What Doesn't The Medicare Hospice Benefit Cover?

• Treatment to cure your terminal illness. As a hospice patient, you can get comfort care to help you cope with your illness, not cure it. Comfort care includes drugs for symptom control and pain relief, physical care, counseling and other hospice services. Hospice uses medicine, equipment, and supplies to make you a s comfortable and pain-free as possible. It is advisable to talk with your doctor if you are thinking about potential treatment to cure your illness. (As a hospice patient, you always have the right to stop getting hospice care and go back to your regular doctor or health plan.)
• Care from another hospice that was not set up by your hospice.You must get your hospice care form the Medicare-approved hospice that you and your doctor chose to provide the services.
• Care from another provider that is the same care that you must get from your hospice.  Once you are part of a hospice program, all of your care must come through the hospice setting and be authorized by the physician coordinating your care.  

How Long Does The Hospice Care Benefit Last?

• Hospice care is authorized for two 90 day periods followed by an unlimited number of 60 day periods.
• Once the first 180 days are up, a doctor or nurse practitioner must have a face-to-face meeting with the hospice patient to determine whether the patient continues to be eligible for hospice. The recertification must be passed on to Medicare.
• The patient does not have to recertify a choice to use hospice care. 

What If The Hospice Care Benefit Is Terminated?

Congress created special appeal rights for beneficiaries who are at risk of discharge or termination of services from a hospice. A notice triggers your right to request an expedited determination -- you have the right to have an independent agency review the hospice program's discharge decision.

Hospice programs are permitted to discharge patients only in 3 situations:

• You move from the hospice's service area or you transfer to another hospice 
• The hospice determines that you are no longer terminally ill 
• The hospice determines that your behavior is disruptive, abusive or uncooperative to the extent that delivery of care to you or the ability of the hospice to operate effectively is seriously impaired.. 

The hospice must advise you that a discharge for cause is being considered and make a serious effort to resolve the problem. 

For More Information About The Hospice Care Benefit:

Medicare has a booklet on Medicare Hospice Benefits (HCFA 02154). You may get a copy at: www.medicare.gov/Publications/Pubs/pdf/02154.pdf   or by calling 1.800.MEDICARE (800.633.4227). 

A serious medical condition is often accompanied by depression. Original Medicare covers the treatment of depression both by professionals and with medication. 

MEDICAL SERVICES

Medicare pays for treatment of depression and for other mental health services in individual and group therapy in a doctor's, psychologist's or social worker's office, a clinic or outpatient hospital programs.

Medicare also covers:

• Family counseling to help with your treatment.
• Activity therapies such as art, dance or music therapy.
• Occupational therapy.
• Prescription drugs that you cannot administer yourself, such as injections that a doctor must give you.
• Treatment costs for a resident of a long-term-care facility who is suffering from depression. 

Medigap can pick up the costs of mental health care not covered by Medicare.

Nonmedical doctors such as psychologists and certified social workers must take "assignment" - they must accept Medicare's approved amount as payment in full.  Medical doctors, such as psychiatrists, do not have to take assignment. Depending on the law of the state in which you live, such doctors can charge you up to 15% above the Medicare approved rate.  

MEDICATIONS

Virtually all brand name and generic drugs in the benzodiazepine category used to treat anxiety (among other uses) are available on the Part D drug formulary. The category includes medications such as Ativan, Valium, and Xanax. 

TO LEARN MORE

• About Medicare coverage of depression: see the booklet: Medicare And Your Mental Health Benefits, available at www.medicare.gov .
• About depression and practical tips for dealing with depression, click here.

If you wish to leave Original Medicare to join a Medicare private plan, your enrollment in the private plan will automatically dis-enroll you from Original Medicare. 

If you want to dis-enroll from Medicare for any other reason, contact your local Social Security office.