social security: 10043

8/14/2019 Social Security: 10043

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Medicare

http://www.socialsecurity.gov/



Contacting Social Security

Visit our website

Our website, www.socialsecurity.gov , is a valuableresource or inormation about all o Social Security’sprograms. At our website, you also can:

• Applyforcertainkindsofbenefits;

• GettheaddressofyourlocalSocialSecurityoffice;

• Requestimportantdocuments,suchasaSocialSecurity Statement, a replacement Medicare card

oralettertoconfirmyourbenefitamount;and• Findcopiesofourpublications.

Call our 1-800 numberIn addition to using our website, you also can call

toll-ree at 1-800-772-1213. We can answer speciicquestionsfrom7a.m.to7p.m.,MondaythroughFriday.Wecanprovideinformationbyautomatedphone service 24 hours a day. I you are dea orhard o hearing, you may call our TTY number,1-800-325-0778.

We treat all calls conidentially. We also want tomakesureyoureceiveaccurateandcourteousser-vice. That is why we have a second Social Securityrepresentative monitor some telephone calls.








What’s inside

Medicare 2

What is Medicare? 2

Who can get Medicare? 4

Help for some low-income people 7

Signing up for Medicare 8

Options for receiving health services 12

If you have other health insurance 12



2 S o c i a l S e c u r i t y

Medicare

ThisbookletprovidesbasicinformationaboutwhatMedicare is, who is covered and some o the options

youhaveforchoosingMedicarecoverage.Forthelatestinormation about Medicare, visit the website or callthe toll-ree number listed below.

Website: wwwmedicaregovToll-free number: 1-800-MEDICARE

(1-800-633-4227)TTY number: 1-877-486-2048

Medicare

What is Medicare?

Medicare is our country’s health insurance programor people age 65 or older. Certain people younger thanage65canqualifyforMedicare,too,includingthose

who have disabilities and those who have permanentkidneyfailureoramyotrophiclateralsclerosis(LouGehrig’sdisease).Theprogramhelpswiththecostofhealth care, but it does not cover all medical expensesor the cost o most long-term care.

Medicare is fnanced by a portion o the payrolltaxespaidbyworkersandtheiremployers.Italsois

fnanced in part by monthly premiums deducted romSocialSecuritychecks.

The Centers or Medicare & Medicaid Services isthe agency in charge o the Medicare program. But youapply or Medicare at Social Security, and we can giveyou general inormation about the Medicare program.

Medicare has four partsHospital insurance (Part A) that helps pay or•inpatientcareinahospitalorskillednursingfacility(ollowing a hospital stay), some home health careand hospice care.

http://www.medicare.gov/





Medical insurance (Part B) that helps pay or doctors’•services and many other medical services andsupplies that are not covered by hospital insurance.

Medicare Advantage (Part C) plans are available in•

many areas. People with Medicare Parts A and B canchoose to receive all o their health care servicesthrough one o these provider organizations underPart C.

Prescription drug coverage (Part D) that helps pay or•medications doctors prescribe or treatment.

You can get more detailed inormation about whatMedicare covers rom Medicare & You (PublicationNo. CMS-10050). To get a copy, call the Medicare toll-ree number, 1-800-MEDICARE (1-800-633-4227), orgo to www.medicare.gov . I you are dea or hard ohearing, you may call TTY 1-877-486-2048.

A word about MedicaidYoumaythinkthatMedicaidandMedicareare

the same. Actually, they are two dierent programs.Medicaid is a state-run program that provides hospitaland medical coverage or people with low incomeand little or no resources. Each state has its ownrules about who is eligible and what is covered underMedicaid.SomepeoplequalifyforbothMedicareand

Medicaid.FormoreinformationabouttheMedicaidprogram, contact your local medical assistance agency,social services or welare ofce.

3w w w . s o c i a l s e c u r i t y . g o v





Who can get Medicare?

Hospital insurance (Part A)

Most people age 65 or older who are citizens orpermanent residents o the United States are eligibleor ree Medicare hospital insurance (Part A). You areeligible at age 65 i:

You receive or are eligible to receive Social Security•benets;or

You receive or are eligible to receive railroad•

retirementbenets;orYou or your spouse (living or deceased, including•divorcedspouses)workedlongenoughinagovernmentjobwhereMedicaretaxeswerepaid;or

You are the dependent parent o someone who•workedlongenoughinagovernmentjobwhereMedicare taxes were paid.

Ifyoudonotmeettheserequirements,youmay be able to get Medicare hospital insurance by payinga monthly premium. Usually, you can sign up orthis hospital insurance only during designatedenrollment periods.

NOTE: Even though the ull retirement age is no

longer 65, you should sign up or Medicare three monthsbeore your 65th birthday.

Beore age 65, you are eligible or ree Medicarehospital insurance i:

You have been entitled to Social Security disability•benetsfor24months;or

You receive a disability pension rom the railroad•retirementboardandmeetcertainconditions;orYouhaveLouGehrig’sdisease(amyotrophic •lateralsclerosis);or




Youworkedlongenoughinagovernmentjobwhere•Medicaretaxeswerepaidandyoumeettherequire-mentsoftheSocialSecuritydisabilityprogram;or

You are the child or widow(er) age 50 or older,•

including a divorced widow(er), o someone whohasworkedlongenoughinagovernmentjobwhereMedicaretaxeswerepaidandyoumeettherequire-ments o the Social Security disability program.

Youhavepermanentkidneyfailureandyoureceive•maintenancedialysisorakidneytransplantand:

You are eligible or or receive monthly benefts—under Social Security or the railroad retirementsystem;or

YouhaveworkedlongenoughinaMedicare-—coveredgovernmentjob;or

You are the child or spouse (including a divorced—spouse)ofaworker(livingordeceased)whohasworkedlongenoughunderSocialSecurityorin a Medicare-covered government job.

Medical insurance (Part B)Anyone who is eligible or ree Medicare hospital

insurance (Part A) can enroll in Medicare medicalinsurance (Part B) by paying a monthly premium.Some benefciaries with higher incomes will pay ahighermonthlyPartBpremium.Formoreinforma-tion,askforMedicare Part B Premiums: New RulesFor Benefciaries With Higher Incomes (PublicationNo. 05-10161) or visit www.socialsecurity.gov/ mediinfo.htm.

I you are not eligible or ree hospital insurance,you can buy medical insurance, without having tobuy hospital insurance, i you are age 65 or older andyou are—

AU.S.citizen;or•


http://www.socialsecurity.gov/pubs/10161.html




http://www.socialsecurity.gov/mediinfo.htm








A lawully admitted noncitizen who has lived in•the United States or at least fve years.

Medicare Advantage plans (Part C)

I you have Medicare Parts A and B, you can joina Medicare Advantage plan. With one o these plans,you do not need a Medigap policy, because MedicareAdvantage plans generally cover many o the samebenefts that a Medigap policy would cover, such asextra days in the hospital ater you have used thenumber o days that Medicare covers.

Medicare Advantage plans include:Medicaremanagedcareplans;•

Medicarepreferredproviderorganization(PPO)plans;•

Medicareprivatefee-for-serviceplans;and•

Medicare specialty plans.•

I you decide to join a Medicare Advantage plan, youuse the health card that you get rom your MedicareAdvantage plan provider or your health care. Also,you might have to pay a monthly premium or yourMedicare Advantage plan because o the extra beneftsit oers.

People who become newly entitled to Medicareshould enroll during their initial enrollment period(as explained under Signing up or Medicare onpages 8 – 9) or during the annual coordinated electionperiod rom November 15 – December 31 each year.There also will be special enrollment periods orsome situations.

Medicare prescription drug plans (Part D)Anyone who has Medicare hospital insurance

(Part A), medical insurance (Part B) or a MedicareAdvantage plan (Part C) is eligible or prescriptiondrug coverage (Part D). Joining a Medicare prescriptiondrug plan is voluntary, and you pay an additionalmonthly premium or the coverage. You can wait to




paying Medicare costs, there are programs that can help you save money (Publication No. CMS-10126).

Onlyyourstatecandecideifyouqualifyforhelpunder these programs. To fnd out, contact your state

or local medical assistance (Medicaid) agency, socialservices or welare ofce.

You also may be able to get extra help paying orthe annual deductibles, monthly premiums andprescription co-payments related to the Medicareprescriptiondrugprogram(PartD).Youmayqualifyor extra help i you have limited income (tied to the

ederal poverty level) and limited resources. Theseincome and resource limits change each year, and youcan contact us or the current numbers.

I you have both Medicaid with prescription drugcoverage and Medicare, Medicare and SupplementalSecurity Income, or i your state pays or yourMedicare premiums, you automatically will get this

extra help and you don’t need to apply.Formoreinformationaboutgettinghelpwithyour

prescription drug costs, call Social Security’s toll-reenumber or visit our website. You also can apply onlineat Social Security’s website.

Signing up for Medicare

When should I apply?I you are already getting Social Security retirement

ordisabilitybenetsorrailroadretirementchecks,you will be contacted a ew months beore youbecome eligible or Medicare and given the inorma-tion you need. You will be enrolled in Medicare Parts

A and B automatically. However, because you mustpay a premium or Part B coverage, you have theoption o turning it down.

I you are not already getting retirement beneits,you should contact us about three months beore your



65th birthday to sign up or Medicare. You can sign upor Medicare even i you do not plan to retire at age 65.

Once you are enrolled in Medicare, you will receivea red, white and blue Medicare card showing whether

you have Part A, Part B or both. Keep your card in asae place so you will have it when you need it. I yourcard is ever lost or stolen, you can apply or a replace-ment card on the Internet at www.socialsecurity.gov or call Social Security’s toll-ree number. You will alsoreceive a Medicare & You (Publication No. CMS-10050)handbookthatdescribesyourMedicarebenefitsand

Medicare plan choices.

Special enrollment situationsYou also should contact Social Security about

applying or Medicare i:

You are a disabled widow or widower between age•50 and age 65, but have not applied or disability

benefts because you are already getting anotherkindofSocialSecuritybenet;

You are a government employee and became•disabledbeforeage65;

You, your spouse or your dependent child has•permanentkidneyfailure;

You had Medicare medical insurance in the past•

butdroppedthecoverage;orYou turned down Medicare medical insurance when•you became entitled to hospital insurance (Part A).

Initial enrollment period for Part BWhen you frst become eligible or hospital

insurance (Part A), you have a seven-month period

(your initial enrollment period) in which to sign upor medical insurance (Part B). A delay on your partwill cause a delay in coverage and result in higherpremiums. I you are eligible at age 65, your initialenrollment period begins three months beore your







65th birthday, includes the month you turn age 65and ends three months ater that birthday. I you areeligible or Medicare based on disability or permanentkidneyfailure,yourinitialenrollmentperioddepends

on the date your disability or treatment began.

When does my enrollment in Part Bbecome effective?

I you accept the automatic enrollment in MedicarePart B, or i you enroll in Medicare Part B during thefrst three months o your initial enrollment period,

your medical insurance protection will start with themonth you are frst eligible. I you enroll during thelast our months, your protection will start rom oneto three months ater you enroll.

The ollowing chart shows when your Medicare PartB becomes eective:

If you enroll in this month ofyour initial enrollment period: Then your Part B Medicarecoverage starts:

1The month you becomeeligible or Medicare



4 One month ater enrollment

5 Two months ater enrollment

6 Three months ater enrollment

7 Three months ater enrollment

General enrollment period for Part BI you do not enroll in Medicare Part B during your

initial enrollment period, you have another chanceeach year to sign up during a “general enrollment



period” rom January 1 through March 31. Your cover-age begins the ollowing July. However, your monthlypremium increases 10 percent for each 12-monthperiod you were eligible for, but did not enroll in,

Medicare Part B

Special enrollment period for people coveredunder an employer group health plan

I you are 65 or older and are covered under a grouphealth plan, either rom your own or your spouse’scurrent employment, you have a “special enrollment

period” in which to sign up or Medicare Part B. Thismeans that you may delay enrolling in Medicare PartB without having to wait or a general enrollmentperiod and paying the 10 percent premium surchargeor late enrollment. The rules allow you to:

Enroll in Medicare Part B any time while you•are covered under the group health plan based on

currentemployment;orEnroll in Medicare Part B during the eight-month•period that begins with the month your grouphealth coverage ends, or the month employmentends—whichever comes frst.

Special enrollment period rules do not apply iemployment or employer-provided group health plan

coverage ends during your initial enrollment period.I you do not enroll by the end o the eight-month

period, you will have to wait until the next generalenrollment period, which begins January 1 o the nextyear. You also may have to pay a higher premium, asdescribed on this page.

People who receive Social Security disability bene-

fts and are covered under a group health plan romeither their own or a amily member’s currentemployment also have a special enrollment period andpremiumrightsthataresimilartothoseforworkersage 65 or older.





Options for receiving health services

Medicare benefciaries may have choices orreceiving health care services.

You can get more inormation about your healthcare options rom the ollowing publications:

Medicare• & You (Publication No. CMS-10050)—This general guide is mailed to people ater theyenroll in Medicare and an updated version is mailedeach year ater that.

Choosing a Medigap Policy • : A Guide To Health

Insurance For People With Medicare (PublicationNo. CMS-02110)—This guide describes how otherhealth insurance plans supplement Medicare andofferssomeshoppinghintsforpeoplelookingatthose plans.

To get a copy o these publications, call theMedicare toll-ree number, 1-800-MEDICARE

(1-800-633-4227), or go to www.medicare.gov . Iyou are dea or hard o hearing, you may call TTY1-877-486-2048.

If you have other health insurance

Medicare hospital insurance is ree or almost

everyone, but you do pay a monthly premium ormedical insurance. I you already have other healthinsurance when you become eligible or Medicare,is it worth the monthly premium cost to sign up orMedicare medical insurance?

Theanswervarieswitheachpersonandthekind o other health insurance you may have. Although

we cannot give you “yes” or “no” answers, we canofferafewtipsthatmaybehelpfulwhenyoumakeyour decision.










If you have a private insurance planGetintouchwithyourinsuranceagenttoseehow

your private plan fts with Medicare medical insur-ance. This is especially important i you have amilymembers who are covered under the same policy. Andremember, just as Medicare does not cover all healthservices, most private plans do not either. In planningyourhealthinsurancecoverage,keepinmindthatmost nursing home care is not covered by Medicare orprivate health insurance policies. One important wordo caution: or your own protection, do not cancel any

health insurance you now have until your Medicarecoverage actually begins

If you have insurance from anemployer-provided group health plan

Grouphealthplansofemployerswith20ormoreemployeesarerequiredbylawtoofferworkersand

their spouses who are age 65 (or older) the same healthbenefts that are provided to younger employees.

I you are currently covered under an employer-providedgrouphealthplan,youshouldtalktoyourpersonnel ofce beore you sign up or Medicaremedical insurance.

If you have health care protectionfrom other plansI you have coverage under a program rom the

Department o Deense, your health benefts maychange or end when you become eligible or Medicare.You should contact the Department o Deense ora military health benefts advisor or inormation

beore you decide whether to enroll in Medicaremedical insurance.

I you have health care protection rom the IndianHealth Service, Department o Veterans Aairs or astate medical assistance program, contact the people





in those oices to help you decide whether it is toyour advantage to have Medicare medical insurance.

FormoreinformationonhowotherhealthinsuranceplansworkwithMedicarecalltheMedicare

toll-ree number 1-800-MEDICARE (1-800-633-4227)andaskforMedicare And Other Health Beneits:Your Guide T o Who Pays First (Publication No. CMS-02179) or visit www.medicare.gov . I you are dea orhard o hearing, you may call TTY 1-877-486-2048.









Notes




Social Security AdministrationSSA Publication No. 05-10043ICN 460000Unit o Issue - HD (one hundred)September 2007 (Destroy prior editions)


social security: 10043

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