Questions and Answers About Medicare
Q. After I enroll in Medicare, how do I get my benefits?
A. You can choose Original Medicare, often referred to as Part A and Part B, or enroll in a Medicare health plan such as a Medicare Advantage Plan. If you do not make a choice when you are first eligible for Medicare, you will be automatically enrolled in Original Medicare.
Q. What is the difference between Medicare Part A and Part B?
A. Part A provides hospital insurance and Part B covers medical expenses. You are eligible for Part A if you are age 65 or older, and you or your spouse worked and paid Medicare taxes for at least 10 years. You can be covered by Part A at age 65 without having to pay premiums if you are receiving retirement benefits from Social Security or the Railroad Retirement Board. If you want Part B coverage, you must pay for it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check
Q. If I am still working, should I sign up for Medicare Part A or B?
A. Even if you keep working after age 65, you should sign up for Medicare Part A. Part A benefits may help pay some of the costs not covered by your group health plan. Because you have to pay the monthly Part B premium, you may want to wait to sign up for Medicare Part B if you or your spouse are working and have group health coverage through your work.
Q. What if I'm over 65 and didn't enroll in Part B during my Initial Enrollment Period?
A. Automatic enrollment in Part B if you are receiving Social Security or Railroad Retirement benefits when you turn 65 – unless you say you don’t want medical insurance. Your Initial Enrollment Period starts 3 months before you turn age 65 and lasts for 7 months. Except in certain cases, if you do not enroll in Medicare Part B during your Initial Enrollment Period, you will have wait until the next General Enrollment Period to enroll. General Enrollment Periods are between January 1 and March 31 each year. When March 31 falls on a non-business day, the General Enrollment Period is extended to the next business day. If you sign up for Medicare Part B during a General Enrollment Period, your coverage starts on July 1 of that year. Your Medicare Part B premium may go up 10 percent for each 12 month period that you could have had Medicare Part B, but did not take it.
Q. Does Medicare Cover Prescription Drugs?
A. Medicare Part D prescription drug coverage is available to anyone covered by Original Medicare. Part D coverage is provided through a private insurance company that is contracted with Medicare to offer these plans. Insurers offer various types of plans, so your premium and your out-of-pocket expenses (copayments, coinsurance and deductible) will vary.
Q. What is a Medicare Advantage plan?
A. Similar to an HMO or PPO, Medicare Advantage Plans provide all of your Part A (hospital insurance) and Part B (medical insurance) coverage. Medicare Advantage Plans may also offer cover vision, hearing, dental, and wellness programs. Most include Medicare prescription drug coverage (Part D).
Q. What is a Medicare deductible?
A. A deductible is the amount you must pay each year before Medicare begins covering its portion of your medical bill. There are deductibles for both Part A and Part B. Medicare will not start paying on your claims until you have met your annual deductible.
Q. What is the difference between Medicare and Medicaid?
A. Medicare is a federal health program provided with Social Security. It covers people 65 years of age or older and those with certain disabilities, and is available regardless of income. Medicaid is a joint federal and state program that helps low-income individuals and families pay for medical care. Unlike Medicare, which is available to everyone, Medicaid has strict eligibility requirements and income restrictions. People who qualify for both Medicaid and Medicare (called 'dual eligible') may use Medicaid to help pay for Medicare premiums.
Q. What is a Medigap policy?
A. Medigap is a health insurance policy sold by private companies to fill gaps in the Original Medicare Plan coverage. Medigap policies must follow federal and state laws and must clearly identify themselves as "Medicare Supplemental Insurance." You must have both Medicare Parts A & B to buy a Medigap Policy.
Q. If a person with Medicare is covered by another health insurance plan, who pays?
A. It depends. In some cases, the other health insurance pays the person's health care bills first, and the patient’s Original Medicare plan or Medicare Advantage plan pays second. There are rules about whether Medicare or the other insurer pays health care bills first, in a process called "coordination of benefits." If you have other insurance, it is important to tell your doctor, hospital, and pharmacy so that your bills get paid correctly.
Q. What if I disagree with a decision Medicare makes about coverage or payment for a service?
A. If you have Medicare, you have the right to appeal any decision about your Medicare coverage. You can find instructions on how to file an appeal on your Medicare Summary Notice (MSN), or in your health plan or drug plan materials.
Q. How do I assure that Good Samaritan Hospital is my hospital of choice?
A. People with Original Medicare can visit any hospital they choose, as long as the hospital is a Medicare-certified hospital. And Good Sam has been Medicare-certified for years, so you have access to our full range of high-quality services. Those with a Medicare Advantage Plan should check with their insurer to see if Good Sam is listed among their plan’s contracted hospitals. You can find an up-to-date list of plans accepted at Good Sam at http://goodsam.org/healthplans/index.php, or feel free to call Alma and she will tell you if we are in your plan’s network. If not, be sure to select a plan that includes Good Sam during your next open enrollment.
If you have other questions that are not answered here, don’t hesitate to call Alma at 1 855-ASK ALMA (1-855-275-2562).
If you would prefer to contact Medicare directly, call 1-800-MEDICARE (1-800-633-4227).
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