medicare

 What you need to know

Medicare is a health insurance program for:

• People aged 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 Medicare Part B (Medical

Insurance) helps cover doctors services, outpatient care, labs and diagnostics. It also covers some other medical services that Part A does not cover, such as some physical and occupational therapist services and

some home health care services. 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. Starting

January 1, 2006, new Medicare prescription drug coverage will be available to everyone with Medicare.

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.

This information comes from: www.cms.gov

Generally, you are eligible for Medicare if you or your spouse contributed 40 quarters, which is about 10 years of work contributing to your Medicare-covered employment and you are 65 years old 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, End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant), or Amyotrophic lateral sclerosis (Lou Gehrig’s disease).

Here are some simple guidelines. You can get Part A at age 65 without having to pay premiums if:

• You already get retirement income from Social Security or the Railroad Retirement Board
  
• You are eligible to get Social Security or Railroad income 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 income
  
• Board disability benefit for 24 months, you are a kidney dialysis or kidney transplant patient or Amyotrophic lateral sclerosis (Lou Gehrig’s disease)

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. It can be deducted from your Social Security, Railroad Retirement, or Civil Service Retirement income. If you don’t receive any of the above benefits, while Medicare will send you a bill for your Part B premium every 3 months. 

If you have questions about your eligiblity for Medicare Part A or Part B, or if you want to apply for Medicare, please call the Social Security Administration at 1-800-772-1213 or visit your local Social Security Administration office. TTY users should call 1-800-325-0778.

Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You'll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.

Different types of Medicare Advantage Plans are:

• Health Maintenance Organization (HMOs)
• Preferred Provider Organizations (PPO)
• Private Fee-for-Service Plans
• Special Needs Plans

Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must offer emergency coverage outside of the plan’s service area (but not outside the U.S.). Medicare Advantage Plans cover all Medicare services. Most Medicare Advantage Plans also offer extra coverage, like vision, hearing and dental coverage.

When you enroll in a Medicare Advantage Plan, you use the Health Insurance Card received from the Health Plan of your choice. In most of these plans, there generally are extra benefits and lower co-payments than in Original Medicare Plan. Most Medicare Advantage Plans are Managed Care Plans, usually a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO), and you may have to be treated by Doctors and Hospitals in the Plans network.

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay a monthly premium for Medicare Part B. In addition to your Part B premium, you may pay one monthly premium for the services included in a Medicare Advantage Plan. Each Medicare Advantage Plan has different premiums and costs for services, so it’s important to compare plans in your area and understand plan costs and benefits before you join.

When can I enroll?

Keep in mind that Medicare limits when you can join, switch, or drop a Medicare Advantage Plan. You can join a plan when you first become eligible for Medicare.

For example, if you're eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

• Begins 3 months before the month you turn 65
• Includes the month you turn 65
• Ends 3 months after the month you turn 65

If you are disabled and have Social Security Disability Insurance, you can join an advantage plan three months before to three months after month 25 of your disability.

You can switch or drop your Medicare Advantage Plan during the annual enrollment period (AEP) October 15th to December 7th, if you qualify for Medicaid- Medicare Savings Plan (MSP) or Low Income Subsidy (LIS), and you can change it at anytime, if you move from the service area of your plan or if your plan leaves the area.