Medicare is health insurance for people 65 or older. You’re first eligible to sign up for Medicare 3 months before you turn 65. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease). Medicare provides coverage for items and services for over 55 million beneficiaries. The vast majority of coverage is provided on a local level and developed by clinicians at the contractors that pay Medicare claims. However, in certain cases, Medicare deems it appropriate to develop a National Coverage Determination (NCD) for an item or service to be applied on a national basis for all Medicare beneficiaries meeting the criteria for coverage. This page provides general information on various parts of that NCD process, resources of both a general and historical nature, and summaries and support documents concerning several miscellaneous NCDs.
Medicare Part A (Hospital Insurance) – Part A helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits. Most people don’t pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working.
Medicare Part B (Medical Insurance) – Part B helps cover doctors’ services and outpatient care. It also covers some other medical services that Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. Most people pay a monthly premium for Part B.
Medicare Part D (Prescription Drug Coverage) – Medicare prescription drug coverage is available to everyone with Medicare. To get Medicare prescription drug coverage, people must join a plan approved by Medicare that offers Medicare drug coverage. Most people pay a monthly premium for Part D
In the last census baby boomers, those 65+, accounted for 13% of the population. This age group grew at a faster rate than the population under age 45. Happily, aging is different now than it was for our parents and grandparents. Today, there are more people living longer than at any other time in history. In fact, boomers will number 78 million by 2030. “This generation, associated with social change including the civil rights and anti-war movements in the 1960s, has another important cause” staying healthy,” says soon-to-be 65-year-old Arthur Hayward, MD, a geriatrician and clinical lead physician for Kaiser Permanente. “We need to become activists in promoting healthful behaviors and try our best to remain active and healthy the rest of our lives.”
- Certain life events can trigger a Medicare special enrollment period (SEP).
- An SEP can begin when a change in your residence affects your coverage.
- SEPs also apply when you lose coverage, have a chance to get new coverage, or become eligible for certain special programs.
- The time you have to choose new coverage varies depending on the event that triggered the SEP.
Life happens. When a major change in your circumstances takes place, you may need to make a change to your Medicare Coverage.
Medicare’s special enrollment periods (SEPs) allow you to make changes to your Medicare plan in between general enrollment periods.
What are special enrollment periods?
Medicare has set aside certain months of the year when people can add or change their Medicare coverage. These periods are:
- Initial enrollment. This period is when you first become eligible for Medicare.
- Open enrollment. The open enrollment period goes from October 15 through December 7 each year.
- Medicare Advantage (Part C) open enrollment. This period is from January 1 through March 31 each year
Sometimes changes in your life circumstances make it necessary to change your healthcare coverage at other times during the year.
Medicare does allow you to change your Medicare coverage in certain special circumstances. When one of these qualifying events happens in your life, it triggers an SEP.
What changes can I make during a special enrollment period?
Depending on the life event that has made you eligible for an SEP, you may be able to:
- Switch from a Medicare Advantage (Part C) plan to original Medicare (parts A and B).
- Switch from original Medicare to a Medicare Advantage plan.
- Switch to a different Medicare Advantage plan.
- Add, drop, or change your prescription drug coverage.
- Drop your Medicare coverage and opt for an employer-provided plan.
This growing elderly population will have an increasing need for health care and related services, an effect that will ripple through society as we grapple with the implications of caring for our elders. The increased proportion of older adults in the population need not present major problems if we can provide appropriate resources for adequate quality of life for older adults, such as specialized health care that includes attention to the management of chronic illness, support for family caregivers, and the financial constraints of older adults. Even today, when the number of older adults is smaller, critical health and quality of life issues remain unresolved, issues that may grow worse as the population of older adults increases.
The presence of strong elder bias in many cultures prevents the application of new scientific knowledge and ways of thinking to clinical practice in the care of older persons. Older adults may have a variety of risk profiles for poor health, from the robust to the frail elderly. Yet, most of the stereotypes of aging picture the frail and disabled. Thus, many health care providers do not think interventions to teach techniques for self-management of symptoms are worthwhile in older adults because they will not live long enough to justify the effort.
Though quality of life is a complex and personal concept for each older adult, four crucial issues were discussed in this paper that affect the quality of life of many older people: insufficient resources to help individuals and families manage multiple chronic conditions, the lack of health care providers educated in broad-based geriatric care, the high cost of health care, and the lack of attention paid to the needs of older adults in American society. There are no easy answers to solving the problems associated with these issues, as the solutions would require establishing new priorities in the value system of American society. The challenge is not to increase the number of health care providers who are focused on diagnosing medical problems in older adults. Instead, the challenge is to place value on the full spectrum of helping older adults enjoy quality of life in old age. This change of values will only occur with a commitment to embrace the importance of aging issues by universities that educate primary health care providers, by health care organizations that decide what health care will be received by elders and their families and how much that care will cost, and by legislators who determine the budgets for national health priorities.