Medicare

Medicare is a federally-funded health insurance program available to people who are age 65 or older, and have certain disabilities. Medicare offers two basic plans: Part A and Part B.

Medicare Hospital Insurance (Part A)

This insurance is offered to those who qualify, and cover

• Inpatient hospital services
• Skilled nursing facilities
• Some home health services

Medicare Medical Insurance (Part B)

You must pay a premium for Part B. This insurance covers

• Outpatient hospital services
• Physician services
• Medical equipment and supplies
• Some other medical services that Part A does not cover (like some home health care)
• Part of the cost of anti-rejection drugs for the life of your transplanted organ, effective as of December 21, 2000, IF your transplant was covered by medicare AND if you are age 65 or older OR disabled according to Medicare for reasons other than ESRD

You must continue to pay under your Part B premiums. Please check with your local Medicare office to see if these benefits apply to you.

To receive full Medicare benefits for a transplant, you must go to a Medicare-approved facility (one that meets Medicare standards for the number of transplants they perform and the quality of patient outcomes). You may have to meet certain Medicare conditions, such as the medical reason you need a transplant. If you have both employer group health insurance and Medicare, Medicare would be the secondary payer (your group insurance pays first) for the first 30 months that you are eligible for Medicare coverage. Medicare then becomes the primary payer and your group insurance pays second.

“Medigap” Supplemental Policy

Did you know that there are some costs that Medicare does not cover? This is where the Medigap Policy comes into play. A Medigap policy is a health insurance policy sold by private insurance companies to fill the “gaps” in the Original Medicare Plan. Medigap policies help you pay some of the health care costs that the Original Medicare Plan doesn’t cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare will pay its share and your Medigap policy will pay its share of your health care costs.