Medicare is a national health insurance program sponsored by the U.S. Government and managed by the Social Security Administration. It is generally available to those age 65 and older. Younger disabled people, such as those with kidney failure, may also be eligible.

Anyone receiving Social Security or Railroad Retirement when they turn 65 will automatically be enrolled in Medicare. There are no premiums required for Part A, the hospital insurance plan. Part B, which covers certain medical and outpatient services, is optional and requires a monthly premium. In 1996, this premium was $42.50. In addition, you are responsible for paying an annual deductible, which is the first $100 of approved Medicare charges. After the deductible is met, Medicare B will pay 80 percent of Medicare-approved charges for covered services. You are responsible for the remaining 20 percent.

Certain low-income Medicare recipients may be eligible for the QMB (Qualified Medicare Beneficiary) or SLMB (Specified Low-Income Medicare Beneficiary) programs which can assist in paying deductibles and co-pays. For information about these programs, contact Social Security and request the HCFA pamphlet #02184, entitled "Medicare Savings for Qualified Beneficiaries."

Medicare Part B covers doctors' bills wherever you receive a doctor's services. It also helps pay for such services as:

• outpatient hospital procedures,
• X-rays and laboratory tests,
• ambulance transportation,
• diagnostic tests,
• prosthetic devices such as artificial limbs,
• flu and other preventive shots,
• blood transfusions medical equipment such as wheelchairs and oxygen for home use, and
• kidney dialysis.

Medicare Part B does not cover routine physicals, most dental care, routine foot care, dentures, hearing aids, or glasses, unless the lenses are needed after cataract surgery. It also does not cover nursing home care.

There are some specific requirements regarding enrollment in Medicare Part B, and it is a good idea to contact Social Security prior to turning age 65 for information about enrollment and about limitations on Medicare payments for specific services. Depending on what your provider charges, you could be responsible for more than the 20 percent covered in the Medicare co-pay.

For specific answers to questions about Medicare eligibility and coverage, contact the Social Security Administration at (800) 772-1213.

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