Part A (Hospital Insurance)
Helps Pay For:
Care in hospitals as an inpatient, critical
access hospitals (small facilities that give limited outpatient and inpatient services to
people in rural areas), skilled nursing facilities, hospice care, and some home health
Most people get Part A automatically when
they turn age 65. They do not have to pay a monthly payment called a premium for Part A
because they or a spouse paid Medicare taxes while they were working.
If you (or your spouse) did not pay Medicare
taxes while you worked and you are age 65 or older, you still may be able to buy Part A.
If you are not sure you have Part A, look on your red, white, and blue Medicare card. It
will show "Hospital Part A" on the lower left corner of the card. You can also
call the Social Security Administration toll free at 1-800-772-1213 or call your local
Social Security office for more information about buying Part A. If you get benefits from
the Railroad Retirement Board, call your local RRB office or 1-800-808-0772.
Part B (Medical Insurance)
Helps Pay For:
Doctors, services, outpatient hospital care,
and some other medical services that Part A does not cover, such as 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.
You pay the Medicare Part B premium of
$50.00 per month. In some cases this amount may be higher if you did not choose Part B
when you first became eligible at age 65. The cost of Part B may go up 10% for each
12-month period that you could have had Part B but did not sign up for it, except in
special cases. You will have to pay this extra 10% for the rest of your life.
Enrolling in part B is your choice. You can
sign up for Part B anytime during a 7 month period that begins 3 months before you turn
65. Visit your local Social Security office, or call the Social Security Administration at
1-800-772-1213 to sign up. If you choose to have Part B, the premium is usually taken out
of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment.
If you do not get any of the above payments, Medicare sends you a bill for your part B
premium every 3 months. You should get your Medicare premium bill by the 10th of the
month. If you do not get your bill by the 10th, call the Social Security Administration at
1-800-772-1213, or your local Social Security office. If you get benefits from the
Railroad Retirement Board, call your local RRB office or 1-800-808-0772.
Who's Eligible for Medicare?
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.
You might also qualify for coverage if you are a younger person with a disability or with
chronic kidney disease.
Here are some simple
guidelines. You can get Part A at age 65 without having to pay premiums if:
you do not 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. The Part B monthly premium in 2001 is $50.00.
It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement
check. If you do not get any of the above payments, Medicare sends you a bill for
your Part B premium every 3 months.
have questions about your eligibility for Medicare Part A or Part B, or if you want to
apply for Medicare, call the Social Security Administration. The toll-free telephone
number is: 1-800-772-1213. The TTY-TDD number for the hearing and speech impaired
is 1-800-325-0778. You can also get information about buying Part A as well as part
B if you do not qualify for premium-free part A.
Enrollment in Medicare is handled in two
ways: either you are enrolled automatically or you have to apply. Here's how it
If you are not yet 65 and already getting
Social Security or Railroad Retirement benefits, you do not have to apply for Medicare.
You are enrolled automatically in both Part A and Part B and your Medicare card is mailed
to you about 3 months before your 65th birthday. If you do not want Part B, follow the
instructions that come with the card.
If you are disabled, you will be
automatically enrolled in both Part A and Part B of Medicare beginning in your 25th month
of disability. Your card will be mailed to you about 3 months before you are entitled to
Applying for Medicare
You need to apply for Medicare if you are
not receiving Social Security or Railroad Retirement Benefits three months before you turn
65, or if you require regular dialysis or kidney transplant. That's the beginning of your
7-month initial enrollment period. By applying early, you'll avoid a possible delay in the
start of your Part B coverage. You apply by contacting any Social Security Administration
office or, if you or your spouse worked for the railroad, the Railroad Retirement Board.
If you do not enroll during this
7-month period, you'll have to wait to enroll until the next general enrollment
period. General enrollment periods are held January 1 to March 31 of each year, and Part B
coverage starts the following July.
Don't put off enrolling. If you wait
12 or more months to sign up, your premiums generally will be higher. Part B premiums go
up 10 percent for each 12 months that you could have enrolled but did not. The
increase in the Part A premium (if you have to pay a premium) is 10 percent no matter how
late you enroll for coverage.
Under certain circumstances,
however, you can delay your Part B enrollment without having to pay higher premiums. If
you are age 65 or over and have group health insurance based on your own or your spouse's
current employment, or if you are disabled and have group health insurance based on your
current employment or the current employment of any family member, you have a choice:
· You may enroll in Part B at any time
while you are covered by the group health plan; or,
· You can enroll in Part B during the
8-month enrollment period that begins the month employment ends or the month you are no
longer covered under the employer plan, whichever comes first.
If you enroll in Part B while covered by
an employer plan or during the first full month when not covered by that plan, your
coverage begins the first day of the month you enroll. You also have the option of
delaying coverage until the first day of the following 3 months. If you enroll during any
of the 7 remaining months of the special enrollment period, your coverage begins the month
after you enroll.
If you do not enroll by the end of the
8-month period, you'll have to wait until the next general enrollment period, which
begins January 1 of the next year.
Even if you continue to work after
you turn 65, you should sign up for Part A of Medicare. Part A may help pay some of
the costs not covered by the employer plan. It may not, however, be advisable to sign up
for Part B if you have health insurance through your employer. You would have to pay the
monthly Part B premium, and the Part B benefits may be of limited value to you as long as
the employer plan was the primary payer of your medical bills. Moreover, you would trigger
your 6-month Medigap open enrollment period (see Medigap Insurance).
Though Medicare covers many health care
costs, you will still have to pay Medicare's coinsurance and deductibles. There are also
many medical services that Medicare does not cover.
You may want to buy a Medicare
supplemental insurance (Medigap) policy. Medigap is private insurance that is
designed to help pay your Medicare cost-sharing amounts. There are 10 standard Medigap
policies, and each offers a different combination of benefits.
The best time to buy a policy is during
your Medigap open enrollment period. For a period of 6 months from the date you are
first enrolled in Medicare Part B and are age 65 or older, you have a right to buy the
Medigap policy of your choice. That is your open enrollment period.
You cannot be turned down or
charged higher premiums because of poor health if you buy a policy during this period.
Once your Medigap open enrollment period ends, you may not be able to buy the policy of
your choice. You may have to accept whatever Medigap policy an insurance company is
willing to sell you.
If you have Medicare Part B but are not yet
65, your 6-month Medigap open enrollment period begins when you turn 65. However,
several states (Connecticut, Maine, Massachusetts, Minnesota, New Jersey, New York,
Oklahoma, Oregon, Pennsylvania, Virginia, Washington, and Wisconsin) require at least a
limited Medigap open enrollment period for Medicare beneficiaries under 65.
Your state health insurance assistance
program can answer questions about Medicare and other health insurance. The services are
free. You can get help in deciding whether you need more insurance and, if so, what kind
and how much to buy. A state-by-state listing of assistance program telephone numbers is
located in the Important Contacts section of this site. Free copies of the Guide to Health
Insurance for People with Medicare are also available from the assistance office.
Your state assistance program can also
provide you with information about Medicare SELECT, another type of Medicare supplemental
health insurance sold by insurance companies and HMOs throughout most of the country.
Medicare SELECT is the same as standard Medigap insurance in nearly all respects. The only
difference between Medicare SELECT and standard Medigap insurance is that each
insurer has specific hospitals, and specific doctors, that you must use, except
in an emergency, in order to be eligible for full benefits. Medicare SELECT
policies generally have lower premiums than other Medigap policies because of this
requirement. Medicare SELECT is explained in more detail in the Guide to Health Insurance
for People With Medicare.