What is Medicare - General Information

      Medicare Needs You !       The Health Care Financing Administration (HCFA) administers Medicare,  the nation's largest health insurance program,
which covers over 39 million Americans.

Medicare provides health insurance to people age 65 and over and those who have permanent kidney failure and certain people with disabilities.

Medicare has Two Parts:

bulletPart A (Hospital Insurance)

Most people do not have to pay for Part A.

 

bulletPart B (Medical Insurance)

Most people pay monthly for Part B.

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 care.

Cost:

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.

Cost:

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:

bulletYou are already receiving retirement benefits from Social Security or the Railroad Retirement Board.

bulletYou are eligible to receive Social Security or Railroad benefits but have not yet filed for them.

bulletYou or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A without having to pay premiums if:

bulletYou have received Social Security or Railroad Retirement Board disability benefits for 24 months.

bulletYou are a kidney dialysis or kidney transplant patient.

While 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.

If you 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

Enrollment in Medicare is handled in two ways: either you are enrolled automatically or you have to apply.  Here's how it works.

Automatic Enrollment

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 Medicare.

 

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).


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.


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