Medicare

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What is Medicare?

Medicare is a Health Insurance Program for:

Medicare has Two Parts:

• Part A (Hospital Insurance)

  Most people don't have to pay for Part A premium.
  

• Part B (Medical Insurance)

  Most people pay monthly for Part B premium.

You can choose different ways to get the services covered by Medicare. Depending on where you live, you may have different choices. In most cases, when you first get Medicare, you are in the Original Medicare Plan. You may want to consider a Medicare Prescription Drug Plan to add drug coverage. Or, you may want to consider a Medicare Advantage Plan (like an HMO or PPO) that provides all your Part A, Part B, and often Part D coverage. You make a choice when you are first eligible for Medicare. Each year you can review your health and prescription needs and switch to a different plan in the fall.

As long as you have both Part A and Part B, items covered by Part A and Part B are covered whether you have the Original Medicare Plan, or you belong to a Medicare Advantage Plan (like an HMO or PPO). For more information see the Your Medicare Coverage database.

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 (not custodial or long-term care), hospice care, and some home health care. Information about your coverage under Medicare Part A can be found in the Medicare coverage database.

If you aren’t sure if you have Part A, look on your red, white, and blue Medicare card. If you have Part A, “HOSPITAL (PART A)” is printed on your card.

Cost:

Most people get Part A automatically when they turn age 65. They don't 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 don’t automatically get premium-free Part A, you may be able to buy it if

• You (or your spouse) aren’t entitled to Social Security because you didn’t work or didn’t pay enough Medicare taxes while you worked and you are age 65 or older, or
• You are disabled but no longer get premium-free Part A because you returned to work.

If you have limited income and resources, your state may help you pay for Part A and/or Part B. For more information, visit www.socialsecurity.gov on the web or call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-877-772-5772.

Part B (Medical Insurance)

Helps Pay For:

Doctors' services, outpatient hospital care, and some other medical services that Part A doesn't 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. Information about your coverage under Medicare Part B can be found in the Your Medicare Coverage database.

Cost:

Most people pay the Medicare Part B premium of $96.40* per month in 2009. This amount may change January 1, 2010. In some cases this amount may be higher if you didn’t 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% as long as you have Medicare Part B.
*Your Part B premium may be higher if your income is above a certain level. For more information, see our FAQ: Medicare Part B Monthly Premiums in 2009.

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. Please call Social Security at 1-800-772-1213 or visit or call your local Social Security office 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 don’t 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 don’t get your bill by the 10th, call Social Security 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 1-877-772-5772.

For More Information About Medicare Part B Coverage:

Visit the Your Medicare Coverage database.

Who is 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 or older and a citizen or permanent resident of the United States. If you aren’t yet 65, you might also qualify for coverage if you have a disability or with End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant).

Here are some simple guidelines. You can get Part A at age 65 without having to pay premiums if:

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

• Received Social Security or Railroad Retirement Board disability benefits for 24 months.
  
• End-Stage Renal Disease and meet certain requirements.

While you don’t 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 2009 is $96.40. (Note: The Part B premium may be higher if your income is above a certain amount. For more information, see our FAQ: Medicare Part B Monthly Premiums in 2009. It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t get any of the above payments, Medicare sends you a bill for your Part B premium every 3 months.

Note: You will be eligible for Medicare when you turn 65 even if you are not eligible for Social Security retirement benefits. For more information, please visit our retirement age FAQ.

If you have questions about your eligibility for Medicare Part A or Part B, or if you want to apply for Medicare, please call Social Security at 1-800-772-1213 or visit or call your local Social Security office. TTY users should call 1-800-325-0778. You can also get information about buying Part A as well as Part B if you don’t qualify for premium-free Part A.

Enrolling in Medicare

Most people don't have to pay for Medicare Part A. Most people pay for Medicare Part B.

To find out how you enroll in Medicare Part A & B, please go to My Medicare Enrollment

If you didn’t sign up for Medicare Part B when you first became eligible, you may be able to sign up during the General Enrollment Period. This period runs from January 1 through March 31 of each year. During this time, you can sign up for Medicare Part B at your local Social Security office. If you get benefits from the Railroad Retirement Board (RRB), call your local RRB office or 1-877-772-5772. Your Medicare Part B coverage will start on July 1 of the year you sign up.

Important: The cost of Medicare Part B will go up 10% for each full 12-month period that you could have had Medicare Part B but didn’t take it, except in special cases. You will have to pay this penalty as long as you have Medicare Part B.

If you already have Medicare Part A and need Part B you can sign up for Part B at your local Social Security office or by calling 1-800-772-1213 (TTY users should call 1-800-325-0778).

For more information on how delaying enrollment in Medicare Part B could result in paying higher Part B premiums, see our FAQ: What if I'm over 65 and didn't enroll in Part B during my Initial Enrollment Period?

For more information on delaying enrollment in Medicare Part B if you or your spouse is still working, see our FAQ: Can I delay my Medicare Part B enrollment without paying higher premiums? If you can delay your enrollment because you or your spouse are still working, the General Enrollment Period will not affect you until after you (or your spouse) stop working.

If you are a military retiree or the spouse or dependent child of either a military retiree or an active duty sponsor, see our FAQ: How does the Medicare Prescription Drug Improvement and Modernization Act impact enrollment in Medicare Part B for military retirees or the spouse or dependent child of either a military retiree or an active duty sponsor?

If your income is above a certain amount, then you may have to pay a higher Part B premium. For more information, see our FAQ: Medicare Part B Monthly Premiums in 2009.

Note: If you are a military retiree or the spouse or dependent child of either a military retiree or an active duty sponsor, please visit our military retiree FAQ.

Special Enrollment Period

When a Special Enrollment Period Can Occur

If you didn’t take Medicare Part B when you were first eligible because you or your spouse were working and had group health plan coverage through your or your spouse’s employer or union, you can sign up for Medicare Part B during a Special Enrollment Period. You can sign up:

If you are disabled and working (or you have coverage from a working family member), the Special Enrollment Period rules also apply.

When Coverage is Effective if you sign up during a Special Enrollment Period

• If you enroll in Medicare Part B while covered by the group health plan or during the first full month after coverage ends, your Medicare Part B coverage starts on the first day of the month you enroll. You also can delay the start date for Medicare Part B coverage until the first day of any of the following 3 months.

• If you enroll during any of the 7 remaining months of the Special Enrollment Period, your Medicare Part B coverage begins the month after you enroll.

Are You Eligible for a Special Enrollment Period?

To find out if you are eligible for a Special Enrollment Period, please contact the Social Security Administration at 1-800-772-1213. You may also contact your local Social Security office

Remember: If you don't enroll in Medicare Part B during your Special Enrollment Period, you'll have to wait until the next General Enrollment Period, which is January 1 through March 31 of each year. You may then have to pay a higher Medicare Part B premium because you could have had Medicare Part B and didn't take it. Please call Social Security at 1-800-772-1213 for more information or to enroll in Medicare.

Medicare Premium Amounts for 2009

Part A: (Hospital Insurance) Premium

Part B: (Medical Insurance) Premium

• $96.40 per month.

The Medicare Part B premium shown is the standard monthly Part B premium that most people will pay. Some people will pay a higher premium based on their modified adjusted gross income. Learn More

Original Medicare Plan Deductible and Coinsurance Amounts for 2009

Part A: (Hospital Insurance)

Deductible

• $1,068.00 (Per Benefit Period)

Coinsurance

• $267.00 a day for the 61st - 90th day each benefit period.

• $534.00 a day for the 91st - 150th day for each lifetime reserve day (total of 60 lifetime reserve days - non-renewable).

• All costs for each day beyond 150 days.

Skilled Nursing Facility Coinsurance

• Up to $133.50 a day for the 21st - 100th day each benefit period.

Part B: (Medical Insurance)

Deductible

• $135.00 per year. (Note: You pay 20% of the Medicare approved amount for services after you meet the $135.00 deductible.)

See Medicare & You for additional information about Original Medicare Plan coinsurance and copayment amounts.

Help to pay Your Health Care Costs

Most of your health care costs are covered if you have Medicare and you qualify for Medicaid. Medicaid is a joint Federal and state program that helps pay medical costs for some people with limited incomes and resources. Medicaid programs vary from state to state. People who have Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on cms.hhs.gov.

States also have programs that pay some or all of Medicare's premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have:

For more information on Medicare savings programs, look at the Medicare Savings Programs publication.

You can also get information on a wide range of programs that may assist you with your prescription drug and other health care costs in our Medicare Prescription Drug Plan Finder tool.

Page Last Updated: September 17, 2008 Info from the www.medicare.gov website. For more Infomation go the there website.

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Below are some guide lines to see if you qualify for extra help to pay for your Medicare cost.