Senior Resource Center
Medicare Frequently Asked Questions
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Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). The different parts of Medicare help cover specific services:
Medicare Part A (Hospital Insurance) Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Medicare Part B (Medical Insurance) Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.
A Medicare Advantage Plan (Part C) is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include HealthMaintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren't paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.
Medicare Part D (prescription drug coverage)
Part D adds prescription drug coverage to Original Medicare, someMedicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare.Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.Not sure what kind of coverage you have?
• Check your red, white, and blue Medicare card.
• Check all other insurance cards that you use. Call the phone number
• on the cards to get more information about the coverage.
• Check your Medicare health or drug plan enrollment.
Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
Information obtained from www.medicare.gov
Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. If you are not 65, you might also qualify for coverage if you have a disability or with End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant).
Here are some simple guidelines. You can get Part A at age 65 without having to pay premiums if:
•You already get retirement benefits from Social Security or the Railroad Retirement Board.
•You are eligible to get Social Security or Railroad benefits but have not yet filed for them.
•You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay premiums if:
•You have received Social Security or Railroad Retirement.
•Board disability benefit for 24 months. You are a kidney dialysis or kidney transplant patient.
While you don’t have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it. It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t get any of the above payments, Medicare sends you a bill for your Part B premium every 3 months.
If you have questions about your eligibility for Medicare Part A or Part B, or if you want to apply for Medicare, please call Social Security at 1-800-772-1213 or visit or call your local Social Security office. TTY users should call 1-800-325-0778. You can also get information about buying Part A as well as Part B if you don’t qualify for premium-free Part A.
By contacting the phone number on this website you will be directed to a licensed agent.
Medicare is a health insurance program for:
•people age 65 or older,>
•people under age 65 with certain disabilities, and>
•people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
Medicare Has:
Part A Hospital Insurance - Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.
Part B Medical Insurance - Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers 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.
Prescription Drug Coverage - Most people will pay a monthly premium for this coverage. Everyone with Medicare can get this coverage that may help lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.
Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Everyone with Medicare can get this coverage that may help lower prescription drug costs and help protect against higher costs in the future. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.
This informatiom comes from www.cms.gov
Fill out an Authorization Form if you want your family or friends to call Medicare on your behalf. Medicare can't give personal health information about you to anyone unless you give permission in writing first.
Make a "Welcome to Medicare" Preventive Visit appointment with your doctor during the first 12 months you have Medicare. This free, one-time comprehensive "Welcome to Medicare" preventive visit puts you in control of your health and your Medicare from the start.
Sign up for MyMedicare.gov, our secure online service where you can access your personal Medicare information 24 hours a day, every day. You can:
• Track your health care claimsView your "Medicare Summary Notices" (MSNs)
• Order a replacement Medicare card
• Check your Medicare Part B deductible status
• View your eligibility information
• Track your preventive services
• Find information about your Medicare health plan or Medicare Prescription Drug Plan (Part D), or search for a new one
• Keep your Medicare information in one convenient place
Learn what Medicare covers. You’ll get a list of tests, items, and services that are covered no matter where you live. If your test, item, or service isn’t listed, talk to your doctor or other healthcare provider about why you need certain tests, items, or services, and ask if Medicare will cover them.
And, don’t forget to give us a call with your questions.
This information came from www.medicare.gov
And, don’t forget to give us a call with your questionsHow do Part D Prescription Drug Plans Work?
You can sign up for Part D Prescription Drug Plans, which helps cover prescription drug costs, along with other components of Medicare starting three months before your 65th birthday.
It's important to do this on time because there's a permanent premium surcharge for enrolling more than three months after your 65th birthday if you don't have equivalent drug coverage from another source, such as a retiree plan.
(Let us help you with when to enroll).
If you are already enrolled in a Part D "standalone" plan or a Medicare Advantage plan that incorporates drug coverage, you can switch plans during the open-enrollment period, which runs from Oct. 15 to Dec. 7 every year.
Making Part D work
Most Prescription Drug Plans have a coverage gap called a donut hole. This means there's a temporary limit on what the drug plan will cover for drugs. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. For 2016, you're in the coverage gap once you and your plan have spent $3,310 on covered drugs. People with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.
Once you reach the coverage gap in 2016, you'll pay 45% of the plan's cost for covered brand-name prescription drugs. You get these savings if you buy your prescriptions at a pharmacy or order them through the mail. The discount will come off of the price that your plans have set with the pharmacy for that specific drug.
Although you'll only pay 45% of the price for the brand-name drug in 2016, 95% of the price will count as out-of-pocket costs which will help you get out of the coverage gap.
In 2017, you'll pay 58% of the price for generic drugs during the coverage gap. What you pay for generic drugs during the coverage gap will decrease each year until it reaches 25% in 2020. The coverage for generic drugs works differently from the discount for brand-name drugs. For generic drugs, only the amount you pay will count toward getting you out of the coverage gap.
Choosing a plan
It pays to review your Part D coverage every year, especially if you have started taking new drugs.
Start at Medicare.gov. You can find the basics about the benefit and Part D plans at Medicare's website. There's a link to the Medicare Part D Plan Finder, which allows you to compare offerings and coverage options in your area and includes a helpful formulary finder that allows you to compare plans based on their coverage of your personalized list of drugs. It will even show you your monthly out-of-pocket drug cost for the year.
Learn more. We recommend consulting the website of the nonprofit Medicare Rights Center. There you can find in-depth information on Medicare Part D.
Getting financial help
Individuals with annual incomes of less than $17,820 and financial resources of less than $13,640, or married couples with incomes of less than $27,250, might qualify for Extra Help from Medicare to pay their Part D premiums and out-of-pocket drug costs.
Download Medicare's instructions on applying for the Extra Help program.
Additionally, read about the six ways to lower your drug costs on Medicare.gov.
This information was obtained from www.medicare.gov
• When you first become eligible for Medicare, you can sign up during your initial Enrollment Period
• If you have Part A coverage and you get Part B for the first time during the General Enrollment Period, you can also join a Medicare Advantage Plan at that time. Your coverage may not start until July 1st
• Between October 15-December 7, anyone with Medicare can join, switch, or drop a Medicare Advantage Plan. Your coverage will begin on January 1st, as long as the plan gets your request by December 7th
If you drop a Medigap policy to join a Medicare Advantage Plan, you might not be able to get it back. Rules vary by state and your situation.
During “Open Enrollment” you can
• Change from Original Medicare to a Medicare Advantage Plan
• Change from a Medicare Advantage Plan back to Original Medicare
• Switch from one Medicare Advantage Plan to another Medicare Advantage Plan
• Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage
• Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage
• Join a Medicare Prescription Drug Plan
• Switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan Drop your Medicare prescription drug coverage completely
• If you stay with the same plan, any changes to coverage, benefits, or costs for the new year will begin on January 1st. Medicare Advantage Open Enrollment Period
Between January 1-March 31 each year, you can make the following changes:
• If you’re in a Medicare Advantage Plan (with or without drug coverage), you can switch to another Medicare Advantage Plan (with or without drug coverage)
• You can drop your Medicare Advantage Plan and return to Original Medicare. You’ll also be able to join a Medicare Prescription Drug Plan (PDP).
During this period, you can’t:
• Switch from Original Medicare to a Medicare Advantage Plan
• Join a Medicare Prescription Drug Plan (PDP) if you’re in Original Medicare
• Switch from one Medicare Prescription Drug Plan to another if you’re in Original Medicare
You can only make one change during this period, and any changes you make will be effective the first of the month after the plan gets your request.
• Health Maintenance Organization (HMO) Plans
• Preferred Provider Organization (PPO) Plans
• Private Fee-for-Service (PFFS) Plans
• Special Needs Plans (SNP)
• HMO Point-of-Service (HMOPOS) Plans
• Medical Savings Account (MSA) Plans
Contact one of our Medicare Specialists for more information on these plans.
Know Your Rights and Protect Yourself From Fraud
- Be treated with dignity and respect at all times
- Be protected from discrimination
- Have personal and health information kept private
- Get information in a format and language they understand from Medicare, health care providers, Medicare Plans, and Medicare contractors
- Have questions about Medicare answered
- Have access to doctors, other health care providers, specialists, and hospitals for medically necessary services
- Learn about their treatment choices in clear language that they can understand, and participate in treatment decisions
- Get Medicare-covered services in an emergency
- Get a decision about health care payment, coverage of services, or prescription drug coverage
- Request a review (appeal) of certain decisions about health care payment, coverage of services, or prescription drug coverage
- File complaint (sometimes called “grievances”), including complaints about the quality of their care.