Medicare is a federal health insurance program for all US citizens and legal residents who have resided in this country for a continuous period of five years who either:
- are age 65 and older, or
- are under age 65 and
- have received Social Security Disability Insurance (SSDI) (and in some cases, Social Security Insurance) benefits for at least two years, or
- have been diagnosed with end stage renal disease (ESRD) and who have received kidney dialysis for at least three months or who have received a kidney transplant (Medicare eligibility begins the month of the transplant), or
- have amyotropic lateral sclerosis (ALS, also known as Lou Gehrig’s disease) and who receive SSDI benefits (Medicare eligibility begins the month of SSDI eligibility).
Individuals who are unsure about whether or not they qualify for Medicare can check with a consumer health insurance assistance program that specializes in Medicare issues.
Consumer health assistance programs that help Medicare beneficiaries are referred to as SHIPs. SHIPs or State Health Insurance Assistance Programs are in all 50 states, the District of Columbia, Guam, Puerto Rico, and the Virgin Islands and provide information, counseling, and assistance to Medicare beneficiaries and their caregivers. Because Medicare beneficiaries can have a private insurance policy that supplements or adds to their Medicare benefits (a "Medigap" policy) and because some low-income Medicare beneficiaries are also eligible for Medicaid ("dual eligibles"), SHIP counselors can help people with Medicare in a variety of ways. SHIPs can also help with prescription drug assistance programs.
Established in 1990, SHIPs are funded by the U.S. Department of Health and Human Services as well as by some states. In some states, SHIPs are called names like HICAP, SHINE, SHEBA, and CHOICES, so your state SHIP may not be known as a SHIP.
Residents of nursing homes, board and care homes, and assisted living facilities can contact a long-term care ombudsman program located in every state, the District of Columbia, Guam, Puerto Rico, and Virgin Islands.
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