Medicare Answers to Common Questions

Medicare is a topic that every person nearing or in retirement should understand. After all, health care costs may make up a big share of your expenses during retirement. Use this guide to learn more about Medicare to help you make better decisions about this important benefit.

      1.  Who is eligible for Medicare?

Most individuals age 65 and older, as well as certain individuals under age 65 who qualify for Social Security disability benefits. Individuals with amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease) or end- stage renal disease (permanent kidney failure).

2.  What is the difference between Medicare Part A and Part B?

Medicare Part A is hospital insurance and helps cover the cost of inpatient care. Medicare Part B is medical insurance to cover medically necessary services like visits to the doctor and outpatient care.

PART A Hospital Insurance		PART B Medical Insurance
• Hospital Stays • Skilled Nursing Care • Home Health Care • Hospice Care		• Doctors’ Services • Outpatient Medical/ Surgical Services • Diagnostic Tests • Outpatient Therapy

3.  How do I enroll for Medicare Part B

and how much does it cost?

Generally, you enroll in Medicare Part B when you enroll in Medicare Part A, unless you are still covered by your or your spouse’s group medical plan.

There are two options for enrolling for Medicare Part B

benefits if you don’t sign up when you are first eligible:

•  General Enrollment Period – January 1 through March 31 each year.

•  Special Enrollment Period – Extending up to eight months after your group coverage ends.

Premiums vary depending on your household income. See the chart below.

MED ICARE PART B

If your annual household income is…

File Individual Tax Return	File Joint Tax Return	You Pay
$85,000 or less	$170,000 or less	$99.90
$85,001 – $107,000	$170,001  – $214,000	$139.90
$107,001  – $160,000	$214,001  – $320,000	$199.80
$160,001  – $214,000	$320,001  – $428,000	$259.70
Above $214,000	Above $428,000	$319.70

Important note: If you don’t enroll when you’re

first eligible, premiums will increase 10% for each full

12 months until you do enroll.

4.  How is Medicare Part C different and why can’t I find how much it costs?

Medicare Part C, sometimes called Medicare Advantage, is medical and hospital insurance provided by private companies. Part C:

•  Covers everything in Medicare Parts A and B.

•  May also cover other medical expenses

(e.g. vision, dental).

•  May also provide cost-sharing such as co-insurance or copay, but may add additional expense.

•  Has premiums that will vary on an individual basis.

Most Medicare Advantage Plans are managed care plans, usually a health maintenance organization (HMO) or a preferred provider organization (PPO). These plans may require that you choose a primary care physician (PCP),get a referral from your PCP to see a specialist, and use only doctors, hospitals, and other medical facilities and services that are part of that health plan’s provider network.

5.   What is Medicare Part D and how much does it cost?

Medicare  Part D is prescription  drug  coverage.  Part D

benefits can be purchased in two different ways:

•    Through  a Medicare  Advantage  program  (Part C).

•    Through  a stand-alone prescription  drug  plan offered by an outside provider.

Other important information about Part D :

•    Costs will vary based  on which  plan you choose.

•    There may be an additional  charge  depending  on your income (see below).

•    You can change  your plan during  the Annual Election Period (October  15 – December  7 each year).

MEDICARE PART D

If your annual income is…

File Individual Tax  Return	File Joint Tax Return	Add thg e followinamount  to your Part D premium:
$85,000 or below	$170,000 or below	$0.00
$85,001  – $107,00	$107,001   – $214,000	$11.60
$107,001   – $160,000	$214,000   – $320,000	$29.90
$160,001   – $214,000	$320,001   – $428,000	$48.10
Above $214,000	Above $428,000	$66.40

6.   What is the coverage gap for Medicare Part D ?

Most  Part D programs   have what  is called a “donut  hole,”  or coverage  gap.  This means  that  after total retail costs for your prescriptions  reach  $2,930  (for 2012),  you will have to pay the full amount   until you have paid a total of $4,700  (for 2012).

At that point, catastrophic  coverage will pick up most of the additional  prescription  drug  costs. In 2012,  there  is assistance for individuals  who reach  the “donut  hole.”  You’ll get  a 50% discount  on brand-name  drugs  and a 14%  discount  on generic drugs. You still receive credit for the full cost in meeting  the

“donut   hole”  exclusion  amount.

7.   What is Medigap insurance?

Medigap insurance is Medicare supplemental insurance provided by private insurance companies to help cover some of the costs not covered by Medicare (such

as the 20% co-insurance).

You have a six-month open enrollment period to buy a Medigap  policy.  The period  starts the  month  you’re  65 and enrolled in Part B. You have a guaranteed right to buy

any Medigap policy sold in your state regardless of your health status during that time.

If purchased after the initial enrollment period, however,

the insurance company can require underwriting, set waiting periods for pre-existing conditions, set different terms or premiums, or may not accept your application at all.

   8.   What if I’m still working?

If you or your spouse is still working and has insurance through your employer, contact your benefits administrator to find out how your insurance works with Medicare.

   9.   C an I change my coverage?

There  are certain  times of year when  you can make changes to the coverage you already have:

1]   During certain  open  enrollment  periods  that happen every year from October  15 – December  7.

2]  Under certain circumstances  that qualify you for a

Special Enrollment  Period (SEP), such as the following:

•    You move.

•    You’re eligible for Medicaid.

•    You qualify for extra  help with  Medicare prescription drug costs.

•    You’re getting  care in an institution,  such as a skilled nursing facility or long-term care hospital.

  10. How do I enroll in Medicare?

The Social Security Administration  handles  Medicare eligibility and enrollment. You can contact the Social Security Administration  at  800-772-1213 to enroll in Medicare  or to ask questions about whether you are eligible. You can also enroll online at  socialsecurity.gov.

You are eligible when you turn 65. Sign up 3 months prior to your birthday to avoid delaying your coverage. You are still eligible to sign up 4 months  after your birthday,  but your coverage will be delayed.