People of
all ages with End-Stage Renal Disease (ESRD)or permanent kidney failure
requiring dialysis or a kidney transplant.
Original Medicare has two parts, Part A and Part B
Part A (Hospital Insurance):
Most people pay for Part A through their payroll taxes when they are
working. Part A covers inpatient care in hospitals, critical access
hospitals,
skilled nursing facilities (not custodial or long-term care), and also
hospice care and some home health care, once certain conditions are met.
Part B (Medical Insurance):
Most people pay a monthly premium for Part B. Medicare Part B helps cover
doctors' services, outpatient hospital care, 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.
Note: There is also Medicare Part C called Medicare
Advantage; however, these plans are not available in the Virgin Islands.
Medicare
Deductible, Coinsurance, and Premium Rates for 2006.
Part A
Deductible:
$952 per benefit period (1-60 days)
Coinsurance:
$238/day (days 61-90 in each
period)
$476/day (days 91-150 in each
period)
$119/day (in an SNF for days
21-100 in each period)
Premium:
$393/month (for those who must pay a premium) and $432.30/month (with
10% increase); $216/month (for those with 30-39 quarters of coverage)
and $237.60/month (with 10% increase)
Part B
Deductible:
$124/year
Coinsurance:
20%
Premium:
$88.50/month
Note: Persons with Medicare who
may need assistance with paying their Medicare Part B premiums can receive
assistance through Medicaid.
Medicare Enrollment
Social Security Administration (SSA) is the agency
responsible for enrolling persons into Medicare. Persons receiving
retirement benefits or disability benefits will be automatically enrolled in
Part B when they become eligible for Part A. For those persons who do not
want Part B, they have the option of turning it down, since there is a
monthly premium attached to Part B.
Initial Enrollment Period (IEP):
Begins 3 months before an individual's 65th birthday and ends
three months after (seven-month period), when first eligible for Medicare
Part A. For individuals who become eligible for Medicare due to disability
or End-Stage Renal Disease (ESRD) or kidney failure, their IEP depends on
the date the disability or treatment started.
General Enrollment Period (GEP):
This period applies to persons who did not enroll in Medicare Part B during
their IEP. This period starts January 1st and ends March 31st
of each year. However, a 10% surcharge will be added to the Part B premium
for each 12-month period an individual was eligible to enroll and did not.
Special Enrollment Period (SEP):
There is SEP for Part B for persons who are 65 years or older are covered
under a group health insurance plan, either through their own or spouse's
present employment. This means that persons may delay enrolling in a
Medicare Part B without having to pay the 10% premium surcharge for late
enrollment.
To enroll in Medicare or to receive more information on
enrollment, contact the Social Security Administration in St Croix at
340-778-5946 or in St. Thomas at 340-774-5247 or toll free at
1-800-772-1213. Or visit SSA's website at
www.socialsecurity.gov.
New Preventive Services
In addition to the current preventive services (i.e.,
cervical/pelvic, breast and mammograms exams, prostate screenings, flu &
pneumococcal vaccinations) covered by Medicare, new preventive services
were added in 2005 as a result of the Medicare Modernization Act of 2003.
The new preventive services are:
An initial
physical ("Welcome to Medicare") exam for people initially eligible for
Medicare in 2005 and thereafter (must have Part B and exam must be
performed by a Medicare provider within the first 6 months of having
Part B).
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