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Medicare
Frequently
Asked Questions
- What Are the
Different Parts of Medicare?
- Am I Eligible
for Medicare and When Can I Enroll?
- How Do I Apply
for Medicare?
- Are There Special
Enrollment Situations?
- What Are
the Enrollment Guidelines for Part B (Medical Insurance)?
- What Do I
Do If I Have Other Health Insurance?
- What Does My Medicare
Cover?
- What Are Medicare
Prescription Drug (Part D) Plans?
- How Do I Find a
Medicare Prescription Drug Plan?
- Do I Need To
Sign Up for a Prescription Drug Plan?
- Who Can Assist
Me with Signing Up for a Medicare Part D Plan?
What
Are the Different Parts of Medicare?
- Hospital Insurance (Part A) helps pay
for inpatient care in a hospital or skilled nursing facility
(following a hospital stay), some home health care and hospice
care.
- Medical Insurance (Part B)
helps pay for doctors’ services and many other medical
services and supplies that are not covered by hospital insurance.
- Medicare Advantage (Part C)
formerly known as Medicare + Choice plans are available
in many areas. People with Medicare Parts A and B can choose
to receive all of their health care services through one
provider organization under Part C.
- Prescription drug coverage (Part
D) helps pay for medications doctors prescribe
for treatment.
Additional Information Regarding the Parts
of Medicare
Am I Eligible for
Medicare and When Can I Enroll?
For information about your Medicare eligibility and enrollment
please refer to the Medicare
Eligibility Tool
How
Do I Apply for Medicare?
Most people qualify for Medicare when they turn 65. You qualify
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. In addition, 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'll qualify for
Medicare. You may also qualify if you have permanent kidney
failure and you receive maintenance dialysis or a kidney transplant.
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 will be contacted by mail
a few months before you become eligible and given all the
information you need.
If you are not already getting benefits when you turn 65,
you should contact
your local Social Security office 3 months prior
to your birthday so they can help you decide 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 1-800-772-1213. Social Security
has a publication with additional information regarding signing
up for Medicare.
Are
There Special Enrollment Situations?
You should contact
Social Security about applying for Medicare if:
- You are a disabled widow or widower between age 50 and
age 65, but have not applied for disability benefits because
you are already getting another kind of Social Security
benefit;
- You are a government employee and became disabled before
age 65;
- You, your spouse or your dependent child has permanent
kidney failure;
- You had Medicare medical insurance in the past but dropped
the coverage; or
- You turned down Medicare medical insurance when you became
entitled to hospital insurance (Part A)
What
Are the Enrollment Guidelines for Part B (Medical Insurance)?
Initial enrollment period for Part B
When you first become eligible for hospital insurance (Part
A), you have a seven-month period (your initial enrollment
period) in which to sign up for medical insurance (Part B).
A delay on your part will cause a delay in coverage and result
in higher premiums. If you are eligible at age 65, your initial
enrollment period begins three months before your 65th birthday,
includes the month you turn age 65 and ends three months after
that birthday. If you are eligible for Medicare based on disability
or permanent kidney failure, your initial enrollment period
depends on the date your disability or treatment began.
General enrollment period for Part B
If you do not enroll in Medicare Part B during your initial
enrollment period, you have another chance each year from
January 1st through March 31st. Your coverage begins the following
July. However, your monthly premium increases 10 percent for
each 12-month period you were eligible for, but did not enroll
in, Medicare Part B.
Special enrollment period for people covered under
an employer group health plan
If you are 65 or older and are covered under a group health
plan, either from your own or your spouse’s current
employment, you have a “special enrollment period”
in which to sign up for Medicare Part B. This means that you
may delay enrolling in Medicare Part B without having to wait
for a general enrollment period and paying the 10 percent
premium surcharge for late enrollment. The rules allow you
to:
- Enroll in Medicare Part B any time while you are covered
under the group health plan based on current employment;
or
- Enroll in Medicare Part B during the eight-month period
that begins with the month your group health coverage ends,
or the month employment ends—whichever comes first.
Special enrollment period rules do not apply if employment
or employer-provided group health plan coverage ends during
your initial enrollment period.
If you do not enroll by the end of the eight-month period,
you will have to wait until the next general enrollment period,
which begins January 1 of the next year. You also may have
to pay a higher premium, as described on this page.
People who receive Social Security disability benefits and
are covered under a group health plan from either their own
or a family member’s current employment also have a
special enrollment period. The Social Security Administration
has a publication with more details about Guidelines
for enrollment in Medicare Part B.
What
Do I Do If I Have Other Health Insurance?
Medicare hospital insurance is free for almost everyone,
but you do pay a monthly premium for medical insurance. If
you already have other health insurance when you become eligible
for Medicare, is it worth the monthly premium cost to sign
up for Medicare medical insurance?
The answer varies with each person and the kind of other health
insurance you may have. Although we cannot give you “yes”
or “no” answers, we can offer a few tips that
may be helpful when you make your decision.
If you have a private insurance plan
Contact your insurance provider to see how your private plan
fits with Medicare medical insurance. This is especially important
if you have family members who are covered under the same
policy. And remember, just as Medicare does not cover all
health services, most private plans do not either. In planning
your health insurance coverage, keep in mind that most nursing
home care is not covered by Medicare or private health insurance
policies. One important word of caution: for your own protection,
do not cancel any health insurance you now have until your
Medicare coverage actually begins.
If you have insurance from an employer-provided
group health plan
Group health plans of employers with 20 or more employees
are required by law to offer workers and their spouses who
are age 65 (or older) the same health benefits that are provided
to younger employees.
If you are currently covered under an employer- provided group
health plan, you should talk to your personnel office before
you sign up for Medicare medical insurance.
If you have health care protection from other
plans
If you have coverage under a program from the Department of
Defense, your health benefits may change or end when you become
eligible for Medicare. You should contact the Department
of Defense or a military health benefits advisor
for information before you decide whether to enroll in Medicare
medical insurance.
If you have health care protection from the
Indian Health Service, Department
of Veterans Affairs or a state medical assistance
program, contact the people in those offices to help you decide
whether it is to your advantage to have Medicare medical insurance.
For more information on how other health insurance plans work
with Medicare, call the Medicare toll-free number
1-800-MEDICARE (1-800-633-4227) and ask for Medicare
And Other Health Benefits: Your Guide To Who Pays First
(Publication No. CMS-02179) or visit www.medicare.gov
. If you are deaf or hard or hearing, you may call TTY
1-877-486-2048.
What
Does My Medicare Cover?
By searching the Medicare
Coverage section of the Medicare website you
can find information in regard to what your Medicare insurance
covers.
What
Are Medicare Prescription Drug (Part D) Plans?
Beginning January 1, 2006, Medicare will offer prescription
drug coverage to people with Medicare. For the first time,
you can choose coverage for this important health need, and
Medicare will help pay for it. Medicare will provide coverage
to help you pay for both brand-name and generic drugs you
need. To get Medicare prescription drug coverage, you must
choose and join a Medicare drug plan.
Medicare drug plans will be offered by insurance companies
and other private companies approved by Medicare. There are
two types of Medicare plans:
- There will be individual Medicare Prescription Drug Plans
that will cover outpatient prescription drug costs.
- There will also be prescription drug coverage that is
a part of Medicare Advantage Plans (like a HMO, PPO, or
a PFFS Plan) and other Medicare Health Plans. You would
get all of your health care, including prescription drug
coverage, through these plans.
If you have limited income and resources, you may get extra
help to pay for your Medicare drug plan costs.
How Do
I Find a Medicare Prescription Drug Plan?
The best way to sort through the plans offered in Connecticut
is to use the Prescription
Drug Plan Finder. The Plan Finder will generate
a list of plans specific to your situation, which will allow
you to view the best plans available to you. All you will
need is your zip code and a list of your prescriptions (including
your daily quantity and dosage).
Do
I Need To Sign Up for a Prescription Drug Plan?
Your decision about signing up for Medicare prescription
drug coverage depends on the kind of health care coverage
you have now. The initial enrollment period runs until May
15, 2006.
Like other insurance, if you join you will pay a monthly
premium (in Connecticut there are 17 plans and the range of
monthly premiums is from $7.32 to $65.58), and a yearly deductible
(no more than $250; some plans do not have deductibles). You
will also pay a part of the cost of your prescriptions. Costs
will vary depending on which drug plan you choose. Some plans
may offer more coverage and additional drugs for a higher
monthly premium.
If you currently have an Employer, Union or Retiree
Plan: You should have received
a letter from your former employer or insurance provider stating
whether the coverage they currently have is “as good
as or equal to” a Medicare Part D plan (otherwise known
as “creditable coverage”). If your coverage is
creditable, then you can choose to stay with the plan you
have, or enroll
in a Medicare plan if you feel it would offer
superior coverage. If you stay in your retiree plan and ever
want to switch to part D, or if the plan ever drops your prescription
coverage, you can enroll in a Medicare prescription drug plan
without penalty. If your coverage is not considered creditable,
you should look into signing
up for a Medicare plan.
Medicare has published a Quick
Facts Sheet for people who have coverage through
an Employer or a Union Plan.
If you do not currently have prescription coverage:
Those currently paying out of pocket for their prescriptions
should look into selecting
a Medicare Part D plan by May 15, 2006. If you
do not choose a plan before the May 15, 2006 deadline you
may incur a higher monthly premium if you sign up later. Picking
a prescription drug plan does not have to be complicated.
You can contact a Medicare representative at 1-800-633-4227.
You can also contact
CHOICES which is a federally-sponsored program
that can help seniors choose and enroll in a Medicare Prescription
Drug Plan. Call 1-800-994-9422 for assistance.
If you are considered Dual Eligible (Medicare
& Medicaid – Title 19): Under Part
D, you will be enrolled in coverage through Medicare. Dual
Eligible’s should have received an auto-enrollment letter
from Medicare (most letters were yellow) assigning you to
a plan. Dual Eligible’s do not have to pay a monthly
premium, do not have a deductible, and will have coverage
throughout the coverage gap (“doughnut hole”).
Extra Help: Dual Eligible’s
were automatically enrolled to receive extra help in paying
for their prescription drug plan premiums, co-payments, and
deductibles. If you are not receiving Title 19 (Medicaid)
but may be considered low income you can apply
for extra help.
Medicare has published a Quick
Facts Sheet regarding Additional Assistance for
Medicare Part D Plans.
ConnPACE
(Connecticut Pharmaceutical Assistance Contract to the Elderly
and Disabled) is a state-funded health insurance program for
most prescription medicines and insulin supplies for lower
income seniors. Under the Medicare Part D plan, ConnPACE members
will be receiving information providing them with a small
list of Medicare prescription drug plans to choose from. If
a ConnPACE recipient does not choose a plan on their own,
they will be automatically enrolled in an appropriate plan.
ConnPACE recipients will continue to pay the annual $30 renewal
fee, as well as a maximum of $16.25 per prescription (in some
cases the co-payments may be as low as $2 generic; $5 brand
name). ConnPACE recipients will not have to pay a monthly
premium, do not have a deductible, and will have coverage
throughout the coverage gap (“doughnut hole”).
Veterans: Veterans who have prescription
coverage through the VA do not have to enroll in a Medicare
prescription drug plan, but do have the option to enroll in
a Medicare plan if they want coverage of prescriptions not
on the VA formulary. The VA prescription co-pay is currently
$8 per prescription.
Who
Can Assist Me with Signing Up for a Medicare Part D Plan?
Here are some helpful contacts to help select a prescription
drug plan:
If you, a friend or family member have access to the Internet,
the Medicare
Plan Finder Tool can help you find a plan best-suited
to your needs. You can also call a Medicare representative
at 1-800-633-4227.
CHOICES is a federally-sponsored program, administered by
the Connecticut Agencies on Aging, which can help seniors
choose and enroll in a Medicare Prescription Drug Plan. Call
1-800-994-9422 for assistance.
If a topic is not listed here, or you cannot find the information
you are looking for, please feel free to contact
my office.
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