Medicare

Questions & Answers

Question

Answer

What is Medicare and who qualifies for it?





What are the different parts of Medicare?

















Does Medicare offer a prescription drug plan?




What about Medicare Advantage?



When do I apply for my Medicare benefits?


























Does Medicare notify me when I am eligible to collect benefits?






















When should I select my coverage plan?





What is Medicare’s Special Enrollment Period (SEP)?














Do Medicare premiums increase if I enroll after age 65?













































Does Medicare provide any help to people with very high prescription drug expenses.















Are there any income limits for the Extra Help programs?











How do I apply for Extra Help from Medicare for

prescription drugs?















Does my state or local government offer help with Medicare Part B premiums, deductibles and co-insurance payments?









Do I automatically get Medicare benefits if I’m eligible for disability benefits from Social Security?






If my spouse doesn’t have enough work credits to qualify for Medicare or Social Security, can (s)he qualify for Social Security and Medicare on my record?

Medicare is a tax-payer sponsored health insurance plan

  that provides coverage for qualifying applicants

• People age 65 or older

   

• People under age 65 with certain disabilities


• People of all ages with End-Stage Renal Disease

      (permanent kidney failure needing dialysis or transplant)


Medicare Has Two Parts:

       Medicare Part A (Hospital Insurance)

  1.         Hospital insurance helps pay hospital bills and some

  2.         follow-up care. Most people don't pay for Part A. The

  3.         taxes you paid while you worked helped financed this

  4.         coverage, so Part A is premium free.


  5.      Medicare Part B (Medical Insurance)

  6.         Most people pay monthly premiums for Medicare Part

  7.         B if they want it.    Medicare Part B medical insurance

  8.         helps pay for doctor bills and other covered services.

   

  Anyone with Medicare can also elect to get prescription

  drug coverage. 


   

  You can choose a Medicare Advantage Plan (C), a plan

  that includes Part A, Part B, and often Part D coverage.


   

Most people qualify for Medicare when they turn 65. You qualify for it if you're eligible for Social Security or Railroad Retirement benefits. Or you may qualify on a spouse's (including divorced spouse's) record.  Others qualify because they are government employees not covered by Social Security who paid the Medicare part of the Social Security tax.

  1. If you've been getting Social Security disability benefits for 24 months or get Social Security disability benefits and have amyotrophic lateral sclerosis (Lou Gehrig's disease), you will qualify for Medicare.

  2. You may also qualify if you have permanent kidney failure and you receive maintenance dialysis or a kidney transplant.

  3. If you are already getting Social Security benefits, you'll automatically be enrolled in Medicare Parts A and B. However, because you must pay a premium for Part B coverage, you have the option of turning it down. 


You should receive Medicare information by mail a few months before you become eligible and given all the information you need to apply for Medicare benefits.

If you are not already getting benefits when you turn 65, you should call 1-800-772-1213 three months prior to your birthday to get help deciding if you should sign up for Medicare. You should do this even if you plan to continue working or do not think you have enough work credit under Social Security, because Medicare enrollment period rules are very strict. 

If you would like to file for Medicare only, apply by calling 1-800-772-1213. If you are not already getting benefits when you turn 65, call 1-800-772-1213 three months prior to your birthday to get help deciding if you should sign up for Medicare. You should do this even if you plan to continue working or do not think you have enough work credit under Social Security, because Medicare enrollment period rules are very strict. 

If you would like to file for Medicare only, you can apply by calling the same number, 1-800-772-1213.



   You can select a coverage plan as soon as you become

   eligible for Medicare.  You should review your health and

   prescription drug coverage needs every year. 



   You are able to switch to different Medicare plan every

   year during Medicare’s Special Enrollment Period (SEP). 

   The special enrollment period may occur during any month

   you are covered under a group health plan based on your

   current employment, or during the 8-month period starting

   the first full month after employment or when group plan

   coverage ends, whichever comes first.   


   Use Medicare’s website or call 1-800-633-4227 to check

   your current Medicare coverage and compare options if you

   are interested in making any kind of change.


  Your premium increases if you do not apply at age 65.

Enrollment rules are very strict.

Initially, you have seven months to sign up for medical insurance (Medicare Part B). This seven-month period begins three months before your 65th birthday, includes the month you turn 65 and ends three months after that birthday.

If you enroll during the first three months of your enrollment period, your medical insurance protection will start with the month you are eligible. If you enroll during the last four months, your protection will start one to three months after you enroll.

If you do not enroll during this initial enrollment period, each year you are given another chance to sign up during a general enrollment period from January 1 through March 31. Your coverage begins the following July.

Your monthly premium increases 10 percent for each 12-month period you were eligible but didn't enroll.

There is an exception. If you are covered by an employer or union group health plan through your or your spouse's current or active employer, you may qualify for a special enrollment period (SEP). The special enrollment period is a period of time, during which you may enroll.  If you did not enroll during your initial enrollment period because you are covered under a group health plan based on your own current employment or the current employment of any family member, you may still be exempt from the premium increase.  Check with Medicare to be sure. Go to www.medicare.gov or call toll-free at 1-800-633-4227.


   Medicare offers help to people with limited income and

   and resources. They may be eligible for Extra Help to pay

   for costs (examples: monthly premiums, annual deductibles

   and prescription co-payments) related to a prescription drug

   plan.  Extra Help could be worth up to an average of $3900

   per year.


   Many people who qualify for the assistance aren’t aware of

   they are.  To establish eligibility, Social Security - Medicare

   needs your income information, along with the value of any

   savings, investments and real estate holdings  -  except for

   your residence.



  To qualify for Extra Help, your annual income must be less

  than $16,245 for an individual or $21,855 if you are married

  and living together.


  If your annual income is higher than the above limits, it may

  still be possible to qualify for Extra Help.  Your income can

  be higher if you support other family members who live with

  you, or if you live in Hawaii or Alaska.



  Apply for Extra Help online at www.socialsecurity.gov. Go

  to the Extra Help link in the center of the page and click it.


  To get Extra Help with Medicare prescription drug plan costs

  your total resources must be limited to $12,510 ( $25,010 if

  you are married and living with your spouse.) 


  Resources include the value of the things you own: your bank

  accounts including checking, savings and CDs; stocks, bonds

  including U.S. Savings Bonds; mutual funds; IRAs and cash. 

  Your primary residence is excluded from real estate holdings.


 

  If you have limited income and resources, your state may

  be able to help with Medicare Part B premiums, deductibles

  and coinsurance. 


  Contact your state of local medical assistance, social services

  or welfare office.  Also, try calling the Medicare toll-free hotline

  (1-800-633-4227).


  You might also be eligible for help paying for prescription drug

  coverage under Medicare Part D.  You should also call Social

  Security at 1-800-722-1213 (TTY 1-800-325-0778) or visit any

  Social Security office in your area.   Ask for Extra Help paying

  for Medicare Prescription Drug Coverage.

 


  You are automatically enrolled in Medicare if you qualify

  for and get disability benefits for two years. The Medicare

  benefits begin 24 months from the month when you received

  your first disability check.


  People with Lou Gehrig’s disease get Medicare beginning with

  the month they become entitled to disability benefits.


 

  Even if your spouse has not worked under Social Security,

  at full retirement age your spouse can receive a benefit equal

  to one-half of your full retirement account.


  If your spouse will receive a pension for work not covered by

  Social Security, the amount of his/her Social Security benefits

  on your record may be reduced.


  Your spouse who cares for your child who is also receiving

  benefits is eligible to receive the full one-half benefit amount

  no matter what his or her age is. 


  Your spouse can receive the benefits until your child reaches

  age 16.  At 16, your child’s benefits continue but your spouse’s

  benefits stop unless he/she is old enough to receive retirement

  benefits (age 62 or older) or survivor benefits as a widow or a

  widower (age 60).


  If your spouse is eligible for retirement benefits on his or her

  own record, Social Security will always pay that amount first.

  However, if the spouse benefit on your record is higher, he or

  she will get a combination of benefits that equals that higher

  amount. 


  It doesn’t matter if your spouse starts getting benefits before,

  after or at the same time you do - Social Security will check

  both of your records to make sure that your spouse gets the

  higher amount whenever he/she becomes entitled to it. 

 

You can find out about your current coverage online at http://www.medicare.gov/Coverage/Home.asphttp://www.medicare.gov/Coverage/Home.asphttp://www.medicare.gov/Coverage/Home.asphttp://www.medicare.gov/Coverage/Home.asphttp://www.medicare.gov/shapeimage_1_link_0shapeimage_1_link_1shapeimage_1_link_2
Compare your Medicare Health Plan choices at Medicare Options Comparehttp://www.medicare.gov/MPPF/home.asphttp://www.medicare.gov/MPPF/home.asphttp://www.medicare.gov/Choices/Advantage.aspshapeimage_2_link_0shapeimage_2_link_1
Compare Prescription Plans at Medicare Prescription Drug Plan Finderhttp://www.medicare.gov/MPDPF/home.asphttp://www.medicare.gov/MPDPF/home.asphttp://www.medicare.gov/MPDPF/home.asphttp://livepage.apple.com/shapeimage_3_link_0shapeimage_3_link_1shapeimage_3_link_2
To get more information about the Medicare Advantage Plans
Click herehttp://www.medicare.gov/Choices/Advantage.asphttps://www.medicare.gov/find-a-plan/questions/home.aspxshapeimage_4_link_0
Visit Medicare’s website  www.Medicare.gov or call 1-800-772-1213 at least 3 months before you turn 65 to make sure you comply with Medicare’s enrollment rules.http://www.Medicare.govhttps://www.medicare.gov/find-a-plan/questions/home.aspxshapeimage_5_link_0
To make changes to coverage during Medicare’s annual SEP (Special Enrollment Period) you can go to www.medicare.gov or call Medicare toll-free 1-800-663-4227.http://www.medicare.govhttp://www.medicare.gov/Coverage/Home.aspshapeimage_6_link_0
Find out about your current Medicare coverage costs online at http://www.medicare.gov/Coverage/Home.asp or 1-800-633-4227http://www.medicare.gov/Coverage/Home.asphttp://www.medicare.gov/Coverage/Home.asphttp://www.medicare.gov/Coverage/Home.asphttp://www.medicare.gov/shapeimage_7_link_0shapeimage_7_link_1shapeimage_7_link_2
Find information on how to qualify for a special enrollment period (SEP), read Medicare.  To access it, Click herehttp://www.socialsecurity.gov/pubs/10043.htmlhttp://www.medicare.gov/Coverage/Home.aspshapeimage_8_link_0
Get Extra Help for Medicare costs at www.socialsecurity.gov Click on the Extra Help link in the center of the page.http://www.socialsecurity.govhttp://www.socialsecurity.gov/pubs/10043.htmlshapeimage_9_link_0

Call the Medicare help line (1-800-633-4227) to find out about state and local help.

Contact Social Security

 www.SocialSecurity.gov
    1-800-722-1213 
    1-800-325-0778 (TTY) http://www.socialsecurity.govhttp://www.socialsecurity.gov/shapeimage_10_link_0
www.Medicare.gov
   1-800-633-4227http://www.Medicare.govhttp://www.socialsecurity.gov/shapeimage_11_link_0

Contact Medicare

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