25 Questions About Medicare

    25
  • What exactly is Medicare? It is health insurance that is available for those who are 65. It's also for people under age 65 who have certain disabilities and chronic conditions.
  • What is Medicare.gov? This is the official U.S. Government site for Medicare information. It was created in 1998 and it's designed to give you up-to-date health and insurance information.
  • When can I call 1-800-MEDICARE? You may speak to someone in English or Spanish 24 hours a day, 7 days a week.
  • What is Part A? It's hospital insurance. It pays for some of the cost of inpatient care in hospitals. It also helps with the cost of skilled nursing facilities, hospices, and home health care. If you paid Medicare taxes while you were working, Part A is free.
  • What is Part B? It's insurance for "medically-necessary services." It helps with the cost of doctors' services, outpatient care, home health services, and other medical services. It also covers some preventive services. You pay a nominal Part B premium every month. The amount depends on your income. You have to pay a late fee if you don't sign up when you become eligible.
  • What is Part C? This refers to a Medicare Advantage Plan such as an HMO or PPO. Private companies approved and subsidized by Medicare offer them. If you join one, your plan will provide all of your hospital insurance (Part A) and your medical insurance (Part B). Some plans also cover such services as vision care, hearing care, dental care, and health and wellness programs. Most also include Part D, prescription drug coverage. (See next question.) Costs vary from plan to plan.
  • What is Part D? This is prescription drug coverage. You pay a late fee if you don't get Part D when you're first eligible. You have to join a plan run by an insurance company or other private company approved by Medicare. (See question 6.)
  • How Can I Apply For Medicare You can file online when you file for retirement or disability or when you reach eligible age for Medicare even if you don't plan to retire at that point. You can also make an appointment by calling 1-800-772-1213.
  • When Can I Enroll? If you already get benefits from the Social Security Administration or the Railroad Retirement Board, your Medicare card will be mailed to you about 3 months before your 65th birthday. Otherwise, apply three months before your 65th birthday and no later than three months after your 65th birthday. Do this even if you plan to wait to "go out" of Social Security until your full retirement age of 66 or 67, or until you are 70. With a few exceptions, if you miss your initial enrollment period you'll have to wait until the following year.
  • I have employer group health insurance. Can I drop Part B and add it later? If you are covered by your employer group health insurance as the primary payer, Part B benefits are probably not very helpful for you. However, if you are working for a company with fewer than 20 employees, talk to your health benefits administrator before deciding not to take Part B.
  • Can I delay Medicare Part B enrollment without paying higher premiums? In some cases, yes. If you opted not to take Part B because you had an employer's plan, you'll have a Special Enrollment Period when you can sign up without a penalty.
  • What is the difference between Medicare and Medicaid? Medicaid is a state program and Medicare is a federal program. Medicaid is for various low-income people such as those who are blind, disabled, pregnant, or need home care.
  • If I take my Social Security benefits when I'm 62, can I get Medicare then? No. Medicare benefits can't begin until you're 65. You can buy insurance from a private company until you turn 65.
  • Why does Social Security take money for Part B even though I joined a Medicare Advantage Plan? Medicare Advantage Plans are under contract to Medicare. You have to pay the monthly Medicare Part B premium when you join a Medicare Advantage Plan. You may also have to pay an additional monthly premium to the plan.
  • 15. Does Medicare cover me when I'm traveling? There are rare exceptions, but generally the answer is that you're not covered when you're outside the United States. Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands are considered part of the United States.
  • Which Preventive Services does Medicare cover? According Medicare.gov, the following are covered: "Welcome to Medicare" Physical Exam Physical Exam: Yearly "Wellness" Exam Abdominal Aortic Aneurysm Screening Bone Mass Measurements Cardiovascular Screening Colorectal Cancer Screening (includes Fecal Occult Blood, Sigmoidoscopy, Colonoscopy, and Barium Enema) Diabetes Screening, Supplies and Self-Management Training Flu Shots Glaucoma Tests Hepatitis B Vaccine HIV Screening Mammograms (Breast Cancer Screening) Medical Nutrition Therapy Services Pap Test and Pelvic Exam (Cervical and Vaginal Cancer Screening) Pneumococcal Vaccine (PPV) Prostrate Cancer Screening (PSA) Smoking Cessation Screening
  • Where can I find out which physicians participate in Medicare? Go to "Find a Doctor of Other Healthcare Professional" on the Medicare web site or find the phone number of someone who can assist you under "Helpful Contacts" on the site.
  • I am retired and on Medicare. If I go back to work, will my earnings affect my Medicare eligibility? Is there a ceiling on h Medicare eligibility is not based on income or resource levels. Your Medicare eligibility will not be affected by how much income you earn after retirement.
  • How can I protect myself from Medicare fraud? Don't give your personal information to anyone selling products related to Medicare. Representatives of approved plans can't sell door-to-door or make unsolicited phone calls. They can give you information about a plan but they can't ask for information or enroll you.
  • What is a formulary? It's a list of medications that a Medicare drug plan will cover. Plans can limit which specific drugs of each required type of drug they will cover. Costs may differ as well.
  • Will my Medicare Part B premium increase in 2011? Most people will still pay $96.40 or $110.50 for Part B. Those with incomes higher than $85,000 or $170,000 for a couple may have to pay $115.40 per month.
  • Will Medicare pay for my vision care, contact lenses and prescription eyeglasses? If you have cataract surgery, yes. Otherwise, no. However, services by a state licensed optometrist may be covered. Also, some Medicare Advantage Plans will pay for lenses and glasses even if you didn't have cataract surgery, but only standard frames are covered. These are dubbed the "insurance glasses." If you want designer frames, you'll have to pay out of pocket for them
  • Will Medicare pay for my dental care? In almost all cases, no. However, some Medicare Advantage Plans do cover dental care.
  • Are my spouse and dependent children eligible to get Medicare coverage? No. This is not a family plan. Each person who is eligible has to qualify as an individual.