Who Is Eligible For Medicare
To be eligible for Original Medicare, you must be an American citizen for at least five years AND one of the following:
- Age 65 or older
- Under age 65 and receiving Social Security Disability Income for 24 months
- Diagnosed with End-Stage Renal Disease or Amyotrophic Lateral Sclerosis
To enroll in Original Medicare, you may be required to reach out to your local Social Security office in some circumstances.
Can I Enroll In Medicare Advantage And Medigap
It is illegal to enroll in both a Medicare Supplement plan and a Medicare Advantage plan. If you were to enroll in both plans, neither plan would be recognized as primary coverage which would lead to denial of services. This could leave you paying out-of-pocket for all your healthcare services, regardless of having both coverages.
To avoid this, it is illegal for an agent to enroll you in one plan if you are already enrolled in the other and do not have a valid way out of the plan.
What Services Does The Partnership Provide
- Medicare and Medicaid information and education
- Help with original Medicare eligibility, enrollment, benefits, complaints, rights and appeals
- Explain Medicare Supplemental insurance policy benefits and comparisons
- Explain Medicare Advantage and provide comparisons and help with enrollment and disenrollment
- Explain Medicare Prescription Drug coverage, help compare plans and search for other prescription help
- Information about long-term care insurance
The partnership also helps with the following programs. Benefit Counselors are specially trained to help you understand all the fine print to find and apply to a plan that works for you. They advocate for you with these programs and help you get the services you need.
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What Happens To My Medicare Plans When I Move
If you move to a new city or state, you will need to change your address with Social Security.
Because Original Medicare is a federal program, benefits are the same nationwide. So, your benefits will not change.
However, if you are enrolled in a Medicare Supplement or Medicare Advantage plan, you may be required to choose a new plan or pay a higher monthly premium. If you are in the process of moving, our Medicare agents will be able to help you easily find a new top-rated plan in your area.
Who Do I Contact To Change My Name And Address For Medicare Purposes
If you have had a recent name or address change, it will need to be reported to the Social Security Administration. Social Security will notify Medicare of the change when they change their records. Their phone number can be found in the Important Phone Numbers page of this web site. If you are in the Original Medicare Plan, you should also notify the Part B carrier of your new name or address change. The carrier processes your claims for doctor bills and other medical expenses. Check the Important Phone Numbers section of this web site for the phone number of your carrier. If you are in a Medicare managed care plan, you should contact your plan of any name or address changes.
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Does Medicare Pay For Prescription Drugs
Generally, Original Medicare does not cover prescription drugs. However, Medicare does cover some drugs in certain cases such as immunosuppressive drugs and oral anti-cancer drugs. You should call your Durable Medical Equipment Regional Carrier for more information. Check the Important Phone Numbers section of this web site for the phone number. There are some Medicare Health Plans that cover prescription drugs. You can also check into getting a Medigap or supplemental insurance policy for prescription drug coverage. Medicaid may also help pay for prescription drugs for people who are eligible.
What Diabetic Supplies Does Original Medicare Cover
Medicare covers the same supplies for both insulin and non-insulin dependent diabetics. They include: Glucose testing monitor, Blood glucose test strips, Lancets, Spring powered devices for lancets, and Glucose control solutions. Some frequency limitations may apply. Medicare does not cover insulin and syringes. Contact your Durable Medical Equipment Regional Carrier for more information. Check the Important Phone Numbers section of this web site for the phone number.
Is There Anyone I Can Talk To About My Specific Medicare Eligibility Needs
Yes. You can make an appointment with a Social Security representative at your local office by calling 1-800-772-1213. You can also call Medicare directly at 1-800-633-4227.
Finally, your State Health Insurance Assistance Program provides free counseling and education to help you choose coverage. You can go online to www.shiptalk.org to find a counselor in your area.
How Do Medicare Managed Care Plans Work
Medicare managed care plans are another way for you to receive Medicare benefits. All plans must provide all of the services that you would receive under Original Medicare with some added benefits. You usually must use the doctors, hospitals and providers in the plan’s network. You may have to pay a monthly premium to your health plan. However, you would not need a supplemental Medigap policy if you join a managed care plan.
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Does Medicare Cover Prescription Medications
Original Medicare does not cover prescription drugs. If you wish to have coverage for prescription Medications, you will need to enroll in Medicare Part D. Medicare Part D helps cover the cost of prescription medications. Additionally, some Medicare Advantage plans provide prescription drug coverage as well.
If you do not enroll in Medicare Part D, you may be subject to the Medicare part D late enrollment penalty. This penalty is assessed for those who delay Part D benefits without creditable coverage. You will be required to pay the additional premium cost for as long as you are enrolled in Medicare Part D.
Where To Get Your Medicare Questions Answered
To get general or claims specific Medicare information and important telephone numbers. If you need help in a language other than English or Spanish, say Agent to talk to a customer service representative.
- TTY 1 877 486 2048 www.medicare.gov
State Health Insurance Assistance Program To get free personalized Medicare counseling on decisions about coverage help with claims, billing, or appeals and information on programs for people with limited income and resources.
- Call 1 800 MEDICARE to get the telephone numbers of SHIPs in other states.
Social SecurityTo get a replacement Medicare card change your address or name get information about Part A and/or Part B eligibility, entitlement, and enrollment apply for Extra Help with Medicare prescription drug costs ask questions about premiums and report a death.
Coordination of Benefits ContractorTo get information on whether Medicare or your other insurance pays first and to report changes in your insurance information.
- TTY 1 800 318 8782
Department of DefenseTo get information about TRICARE for Life and the TRICARE Pharmacy Program.
- TTY 1 866 773 0405
- TTY 1 877 540 6261
Department of Health and Human ServicesOffice of Inspector GeneralIf you suspect Medicare fraud.
To get information about the Federal Employee Health Benefits Program for current and retired Federal employees.
- Local RRB office or
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State Health Insurance Assistance Program
Jose Luis Pelaez Inc / DigitalVision / Getty Images
Each state has a State Health Insurance Assistance Program, or SHIP, that offers one-on-one counseling and assistance to state residents. Your SHIP can help you with questions about Medicare benefits, premiums, and cost-sharing. It can also help you deal with problems signing up for a Medicare plan, complaints, and appealing a coverage or payment decision.
SHIPs are staffed primarily by volunteers who have undergone an extensive training program. If your SHIP volunteer doesnt have an answer to your Medicare questions or cant resolve your Medicare problems, they will know where to turn to get the answer or resolution.
SHIP names can vary from state to state. For example, the SHIPs in Massachusetts and Florida are called SHINE, short for Serving Health Information Needs of Seniors. Californias SHIP goes by the acronym HICAP, short for California Health Insurance Counseling & Advocacy Program. You can get contact information for your states SHIP here.
State Health Insurance Assistance Programs
State Health Insurance Assistance Programs are available in every state plus the District of Columbia, Guam, Puerto Rico and the U.S. Virgin Islands. These programs are a public service that provide personal help from trained counselors on all Medicare issues.
More than 12,500 SHIP counselors provide free one-on-one counseling, seminars and outreach programs, especially during the Oct. 15 to Dec. 7 annual open enrollment period. They can answer questions over the phone, in person or online
Search online for a SHIP in your area or call 877-839-2675.
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I Enrolled In Medicare Advantage And Want A Medigap Plan How Can I Switch Plans
If you have a Medicare Advantage plan and wish to switch to a Medicare Supplement plan you may have to wait until the Annual Enrollment Period to do so.
Unlike Medicare Supplement plans, Medicare Advantage plans require you to enroll for one year unless you have a life changing event that would allow you to leave the plan early. This means that you cannot change plans whenever you wish throughout the year. With an exception of your first year on Medicare, Medicare Advantage plans are a 12 month term lasting from January to December.
To change your plan for the upcoming year, you will need to enroll during the Annual Enrollment Period. By doing so, you must to answer underwriting health questions to enroll in a Medicare Supplement plan. This means that your application for coverage may be denied depending on your answers to the health questions.
Will Medicare Cover Hearing
Original Medicare does not offer coverage for hearing-aids.
However, some Medicare Advantage plans may provide this benefit. CMS does not deem hearing-aids medically necessary, so they are not covered by the federal healthcare program.
If you need hearing coverage but do not want to enroll in a Medicare Advantage plan, there are several options. You can enroll in a stand-alone benefits plan that has the option for hearing coverage to work alongside your Medicare plan.
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I Didn’t Enroll In Medicare Part B When I Turned 65 Because I Was Still Working Can I Enroll Now
You qualify to enroll in Medicare during a Special Enrollment Period if you delayed enrolling in Part B because you were working and had group health insurance through your employer or your spouse’s employer. If you sign up during the Special Enrollment Period, you do not have to pay the Part B premium surcharge. Signing up for Medicare Part B will begin your 6 month open enrollment period for buying a Medigap policy. You can enroll in Part B:
- Any month in which you are still covered under your current enrollment or
- The 8-month period beginning with either the date your employment ends or the date your group health plan ends, whichever comes first.
You should contact the Social Security Administration to file an application. The phone number for the Social Security office in your area can be found in the Important Phone Numbers section of this site.
New York State Partnerships For Long
The New York State Partnership for Long-Term Care combines private long-term care insurance with Medicaid to help people prepare financially for possible nursing home care, home care or other long-term care services as specified under the policy. It allows New Yorkers to protect assets while remaining eligible for Medicaid extended coverage if their long-term care needs exceed the period covered by their private partnership insurance policy. For an application, contact your local office for the aging.
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Aarp Medicare Resource Center
AARPs Medicare Resource Center has stories that can give you an overview about the way Medicare works, news on the latest changes and developments, answers to questions that go more in depth and a link to the Medicare Enrollment Guide, which can introduce you and your friends to the health care benefit that covers nearly 1 in 5 Americans.
Among the other resources youll find:
- Step-by-step tutorials on how to use Medicares Plan Finder, to learn about Medicare Advantage, Medigap and Part D prescription drug plans in your area
- On-demand webinars that teach you about key times and potential problems as you approach Medicare age and deal with this program for the rest of your life
- Videos that give a quick overview on issues, demystifying the complex topic of Medicare. They accompany the relevant articles.
Have additional Medicare questions? AARP can help. Call 877-634-8213 toll free, from 8 a.m. to 8 p.m. eastern time on weekdays, to speak to an AARP Help Center representative. If you prefer to look online, the chat feature in our digital AARP Help Center can help you with questions you type in.
Also, AARP Senior Editor Dena Bunis answers a limited number of questions in each AARP Bulletin. Write to her at .
Courtesy National Association of Insurance Commissioners
Keep in mind
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Do I Need Medicare If I Have Va Benefits
It is not required for you to enroll in Medicare if you have VA benefits. However, if you ever receive coverage outside of the VA system, you will need medical coverage to cover these costs.
Keep in mind. If you have VA coverage and delay Medicare Part B enrollment, you will have to pay the Medicare Part B penalty if you decide to enroll in Medicare coverage later in life. Once you enroll in Medicare, it pays primary, and the VA pays secondary.
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Where To Get Help With Medicare Questions
|Want to: Enroll in Medicare Part A (Hos …||Social Security 1-800-772-1213 TTY: 1-80 …|
|Have a Medicare Prescription Drug Plan, …||Your plan or policy The phone number and …|
|Have railroad retirement benefits and wa …||The Railroad Retirement Board Your local …|
|Want to report changes to insurance that …||Benefits Coordination & Recovery Center …|
Medicare Questions We Have Answers
It is important to sign up for a Medicare Part D Drug plan when you are first eligible. If you do not sign up when first eligible you will most likely have to pay a late penalty. If you have creditable drug coverage you will not have a late penalty.
There are 2 ways to receive a Medicare Prescription Drug Plan or a Part D plan:
You can add drug coverage to Original Medicare
You can get a Medicare Advantage Plan with drug Coverage. Advantage Plans are HMOs or PPOs you get your Part A and B and Drug Coverage through Advantage Plans
For more information or to enroll contact your State Health Insurance Assistance Program for Missouri the number is 1-800-390-3330.
2. What do I do if I am enrolled in a non-benchmark Medicare Plan, but found out that I am eligible to enroll into a Benchmark plan.
There are 4 benchmark plans in 2016 that a beneficiary receiving extra help can enroll. The premium for the benchmark plan will be zero and there is no deductible. If a beneficiary, who receives full extra help, enrolls in a non-benchmark plan then the premium will be reduced and the beneficiary will be required to pay that monthly premium.
3. What do I do if I am already enrolled in Medicare, but also have employer-sponsored or other third-party insurance plan?
4. What do I do if I enroll in a Medicare plan and later have to make an adjustment because of a major life event?
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What Is Medicare Coinsurance
Medicare coinsurance is the percentage that you pay out of pocket for the cost of your Medicare-approved services.
Medicare Part A charges a higher coinsurance the longer you remain hospitalized. In 2021, Part A coinsurance is $371 for hospital days 60 to 90 and $742 for days 91 and up.
Medicare Part B charges a set coinsurance amount of 20 percent.
Medicare Part D plans charge coinsurance amounts the same way as copayments, usually for higher tier, brand name medications and will only ever charge you either a copay or coinsurance but not both.
What Medical Supplies And Equipment Does Medicare Part B Cover
Medicare Part B helps pay for durable medical equipment such as oxygen equipment, wheelchairs, and other medically necessary equipment that your doctor prescribes to use in your home. Other items covered by Medicare include:
- Arm, leg, back and neck braces
- Medical supplies such as ostomy pouches, surgical dressings, splints and casts
- Breast prostheses following a mastectomy
- One pair of eyeglasses with an intraocular lens after cataract surgery
Medicare pays for different kinds of durable medical equipment in different ways. Some equipment must be rented, other equipment must be purchased. Your Durable Medical Equipment Regional Carrier can provide more specific information. Check the Important Phone Numbers section of this web site for the phone number for your Durable Medical Equipment Regional Carrier.
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Elderly Pharmaceutical Insurance Coverage
EPIC, administered by the New York State Department of Health, helps many older New Yorkers pay for prescription drugs. It covers those who do not have adequate insurance coverage for prescription drugs and who are not eligible for Medicaid. EPIC is coordinated with Medicare Part D prescription coverage to provide services with additional coverage for prescription medication.
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Can I Use Medicare When Im Outside My State
Original Medicare offers nationwide coverage to all beneficiaries. This means youre covered for out-of-state medical care.
Medicare Advantage plans, on the other hand, offer coverage only for the state you live in, though some may also offer in-network services out out-of-state.
Whether you have original Medicare or Medicare Advantage, you should always make sure that the provider youre visiting accepts Medicare assignment.
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