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 2009.
Part A
Deductible: $1,068 per benefit period (1-60 days)
Coinsurance:
$267/day (days 61-90 in each period)
$534/day (days 91-150 in each period)
Premium: $443/month (for less than 30 quarters of coverage); $244/month (for those with 30-39 quarters of coverage)
Part B
Deductible: $135/year
Coinsurance: 20%
Premium: $96.40/month
Note: Persons with Medicare who may need assistance with paying their Medicare Part B premiums can receive assistance through Medicaid.
Further questions regarding claims/billing with Medicare Part B, please contact First Coast Service Options at 1(866) 454-9007. For all Part A claim/billing inquiries please call 1(888)664-4112.
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).
