Medicare Resources. A brief guide to sources of help and advice to make your Medicare experience more pleasant.

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1 Medicare Resources A brief guide to sources of help and advice to make your Medicare experience more pleasant.

2 1 What is Medicare? The Medicare program is a federal system of health and hospital insurance for persons aged 65 and older as well as those who are disabled. It provides basic health care benefits to recipients of Social Security and others who have paid into Medicare and is funded through the Medicare Trust Fund, beneficiary premiums and co-payments, and general tax revenues. Medicare went into effect in 1966 and was initially administered by the Social Security Administration. In 1977, Medicare was transferred to the newly created Health Care Financing Administration (HCFA), which later became the Centers for Medicare and Medicaid Services (CMS) in the United States (US) Department of Health and Human Services. CMS contracts with private insurance companies for the processing of Medicare claims. Health care providers must meet state and local licensing laws and standards set by CMS to qualify for Medicare payments for their services. Eligibility for Medicare does not depend on income. Almost everyone aged 65 and older is entitled to coverage as well as disabled persons under age 65 who have been collecting Social Security or railroad disability payments for at least two years. You don t have to retire at age 65 to be protected by Medicare. People who have not worked long enough under Social Security to receive retirement benefits may enroll in the plan by paying a monthly premium. Medicare is also available for people of any age with End-Stage Renal Disease (ESRD) 1. For low-income individuals Medicaid is available to help pay Medicare premiums and cost sharing. For the latest information on Medicare, visit the Medicare web site at MEDICARE S PARTS Medicare is divided into four parts: Part A: Hospital Insurance Part B: Medical Insurance Part C: Medicare Advantage Part D: Prescription Coverage 1 ESRD is permanent kidney failure requiring dialysis or a kidney transplant.

3 Medicare Part A: Hospital Insurance Medicare Part A helps pay for inpatient care in hospitals as well as skilled nursing facilities, hospice and home health care. You can find out if you have Part A by looking at your Medicare card. If you have Original Medicare, you will use this card to get your Medicare-covered services. If you join a private Medicare Advantage plan, you must also use the card from that plan to get your Medicarecovered services. Please keep in mind that there may be co-payments, coinsurance and deductibles in addition to monthly premiums. If you re in a Medicare Advantage plan or have other insurance like a Medicare Supplement Insurance ( Medigap ) policy or employer or union coverage these costs may be covered. To find out, contact the individual plans. For specific cost information and coverage details, visit or call MEDICARE ( ). TTY Medicare Part B: Medical Insurance Medicare Part B helps cover the cost of doctors and other health care providers services, outpatient care, durable medical equipment and home health care. It also covers preventive services, without out-of-pocket costs, to help maintain your health and to keep certain illnesses from getting worse. Look at your Medicare card to see if you have Medicare Part B. For full information about Medicare Part B, visit or call MEDICARE ( ). TTY Medicare Part C: Medicare Advantage Medicare Part C offers health plan options run by Medicare-approved private insurance companies. Medicare Advantage plans are an alternative way to receive the benefits and services covered under Part A and Part B. Most Medicare Advantage plans cover Medicare prescription drug coverage (Part D) and some plans may include extra benefits for an additional cost. There are several types of Medicare Part C plans including Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). Keep in mind that Part C plans cannot be used with Medigap supplemental plans. Choosing a Medicare Part C plan can

4 be very complicated and you are urged to have all the details of plans in your area before signing up for a private plan. For full information about Medicare Part C in your area, visit find-a-plan or call MEDICARE ( ). TTY For more information about health care resources, visit quality-care-finder. 3 Medicare Part D: Prescription Drugs Medicare Part D helps cover the cost of prescription drugs. Part D plans are administered by Medicare-approved private insurance companies. It is best to join a Medicare drug plan when you re first eligible for Medicare if you don t have any creditable prescription drug coverage. To find out more about Medicare drug plans visit or call MEDICARE ( ). TTY Important: If you now have employer or union coverage, call your benefits administrator before making any changes or before you sign up for any other Part D coverage. Medigap (Supplemental) Plans Medicare Supplement Insurance policies (called Medigap plans), provided by private insurance companies, help pay some of the health care costs for Medicare-covered services that Medicare doesn t cover, like co-payments, coinsurance and deductibles. You must pay premiums for a Medigap policy. In most cases, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy will pay its share. Although all Medigap policies offer the same basic benefits, some offer additional benefits. You can choose the policy that meets your needs. The cost of Medigap policies differs greatly, even for the same exact policy. So make sure you re comparing the same coverage (for example, compare Plan A from one company with Plan A from another company). Your choice is not easy and it can be complicated to compare and choose a policy that s best for you. We recommend that you seek advice.

5 4 To get additional background and details about understanding and choosing a Medigap policy, visit and view the booklet Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare. You can also call MEDICARE ( ) to find out if a copy can be mailed to you. TTY Medicare Open Enrollment If you are receiving Social Security benefits, you will be automatically enrolled in Medicare Parts A and B when you become 65. Otherwise, you must sign up for benefits during a sevenmonth Initial Enrollment Period, which includes the three months before your birthday, the month of your birthday and the following three months after your birthday. If you miss this enrollment period and don t sign up when you first became eligible, you can sign up from January 1 to March 31 each year during General Enrollment Periods. Your coverage will begin on July 1. You may use Open Enrollment Periods to make changes to your Part C and Part D coverage including switching to and from Original Medicare. Typically, these open enrollment dates are during the autumn of each year. For example, Part C and Part D open enrollment dates for 2012 were October 15 to December 7 for coverage that went into effect on January 1, For more information, visit click on Sign Up/Change Plans then When can I join a health or drug plan? Or call MEDICARE ( ). TTY Medigap Open Enrollment Medicare Supplement Insurance policies ( Medigap ) sold by private insurance companies, have a six-month Open Enrollment Period which starts the first month you re 65 and enrolled in Part B. During this period, you are guaranteed the right to buy any Medigap policy sold in your state regardless of your health status. To learn more details about subsequent enrollment periods, visit publications and view the booklet Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare. The Medigap open enrollment information is on pages

6 5 Medicaid Medicaid provides health care coverage for many low income citizens of all ages who cannot afford health care or Medicare. To qualify for Medicaid, you must meet specific eligibility requirements that vary by state: You must be considered categorically needy due to blindness, disability and/or age, or You must be financially needy. This means that your income and your assets must fall under a certain limit set by the state in which you live. Medicaid doesn t provide medical assistance for everyone with limited incomes and resources. You must qualify for Medicaid and low income is only one of the tests for Medicaid eligibility. There are other established thresholds that vary by state in order to be eligible for benefits. Since Medicaid is administered at the state level, you should contact your state Medicaid administrator for details. To find your state s Medicaid administrator, visit click on Medicaid then By State. Home Health Care Resources You can find Medicare-certified local providers of home health care, including nursing care, physical therapy, occupational therapy, speechlanguage services, home health aides and medical social services. To find services in your area, visit Eligible for VA Benefits? Did you serve in the US Military? You may be eligible for the vast array of Veterans benefits. To find out about your personal situation, visit or call TTY

7 Past or Present Government Employees Get information about the Federal Employee Health Benefits Program for current and retired Federal employees from the Office of Personnel Management (OPM). Visit or call TTY Past or Present Railroad Employees The Railroad Retirement Board (RRB) provides benefits for certain railroad employees and their families. If you have benefits from the RRB, call them to change your address or name, check eligibility, enroll in Medicare, replace your Medicare card or report a death. Visit or call the RRB office at TTY Help from Social Security 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 or get an estimate of your retirement benefits. Visit or call TTY Medicare and You Handbook Perhaps the best and most comprehensive source of information about Medicare and everything you need to know is Medicare and You, a handbook published each year by the government. To access and download the current issue visit To sign up for your next free copy electronically, visit mymedicare.gov. Medicare suggests that a PDF version is best because it reduces clutter, saves tax dollars and forests. But if you need a paper handbook (148 pages) in the future call MEDICARE ( ). TTY Also consult the National Committee s booklet entitled Medicare Part D: from A Z at

8 How to Report Medicare Fraud and Abuse One of the greatest threats to Medicare is fraud and abuse. To report suspected fraud or abuse or to learn more about identifying it, visit or call HHS-TIPS ( ). TTY Transportation, Home Care, Homemakers and Day Care Services Depending on where you live, there are numerous services to help you remain independent in your homes and communities through: Transportation Services rides to doctor s offices, grocery stores, pharmacies, senior centers, meal sites and other critical daily activities. Personal Care, Homemaker and Chore Services assistance to seniors unable to perform daily activities (such as eating, dressing or bathing) instrumental activities of daily living (such as shopping or light housework). Adult Day Care/Day Health Services care for dependent adults in a supervised, protective group setting during some portion of a 24-hour day. Case Management Services assistance in assessing needs, developing care plans and arranging services for older persons or their caregivers. To find out more about these services in your area, visit the Eldercare Website or call Important Tip: If you do nothing else, please write down the name, address, telephone number and your policy number of any insurance plans, Medigap plans or employer or union plans you may have. It s also a good idea to photocopy both sides of all your cards (drivers license, Medicare card, Social Security card, Medigap insurance card, prescription insurance card) and keep in a safe place inside your home. Hint: You can photocopy them all at once; once on their fronts and once on their backs on a standard size photocopier. This information has been checked carefully and believed to be accurate as of January 9, The National Committee to Preserve Social Security and Medicare is not responsible for inaccuracies caused by future changes beyond its knowledge or control. 10 G Street, NE, Suite 600 Washington, DC

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