What is Medicare?
Medicare is a Federal health insurance program for people 65 years or older, certain people with disabilities and people with end stage renal disease. Medicare has four main parts:
- Part A which is hospital insurance.
- Part B which is medical insurance.
- Part C which is a managed Health Plan (sometimes called Medicare Advantage Plan).
- Part D which is prescription insurance (new since December 2003).
Medicare Part A pays for the following:
- Hospitalizations, hospital services and supplies. There is a deductible per hospital visit.
- Skilled nursing facility care up to 100 days if you arrive at the nursing home after being hospitalized. After 20 days, you pay a daily deductible.
- Home health. Medicare only pays for part-time skilled care.
- Hospice. Medicare pays for pain relief, sympton management and support services for the terminally ill.
- Blood after you pay for the first 3 pints.
Medicare Part B pays for the following:
- Medical Expenses such as doctor visits, outpatient costs, physical and speech therapy, ambulance. Medicare pays 80% after your yearly deductible has been paid.
- Clinical Laboratory services such as blood tests, biopsies and urinalyses.
- Home health. Medicare only pays for part-time skilled care and 80% of durable medical equipment (wheelchair, scooters, walkers and more).
Medicare Part C is a health plan. The plan provides all of your Part A and Part B services. It is sometimes referred to as Medicare Advantage Plan. It operates as a HMO (health maintenance organization) or a PPO (preferred provider organization) or a PFFS (Private fee-for-service). The Plans can be cheaper than than original Medicare, but if you choose a HMO, then you can only go to doctors or hospitals on the plan's list. If you choose a PPO, then you pay less if you use doctors or hospitals that belong to the network. With a PFFS, the plan --rather than Medicare-- decides how much the plan will pay for medical services.
Who answers questions about Medicare billings?
If you have questions about your bills you should call Medicare at 1-800-633-4227.
What is Medicare Part D?
Prescription drug insurance is now available for everyone with Medicare. This is called "Part D." Part D insurance plans may help lower prescription drug costs and help protect you against higher costs in the future. The plans are run by insurance companies and other private companies approved by Medicare. Each plan has a monthly premium. If you have limited income and resources, you may qualify for "extra help." Extra help will assist in the payment of the monthly premium, copays, and the deductible. Applications for "Extra Help" are processed through the Social Security Administration. You can visit your local office or apply online at www.socialsecurity.gov.
How do I enroll in Medicare?
If you are receiving Social Security or Railroad Retirement you will be automatically enrolled in Medicare Part A and B. Once you are enrolled in Part B or entitled to Part A, then you can enroll in Part D. Enrolling in Medicare is optional. However, if you decide not to enroll in Medicare when you are first eligible and you do not have sufficient insurance coverage, you will pay a penalty if you choose to join later. You should check with the Social Security Administration before deciding not to enroll.
Do I pay for Medicare once I am enrolled?
You are charged monthly premiums for Part B and Part D as follows:
- Part B (Doctor visits, outpatient services and more). The Part B premium is deducted from your social security check each month. The amount changes each year. You are notified in January of the Part B premium cost. In 2009, the premium is $96.40 each month. Keep in mind that if you qualify for QMB, SLMB or QI1 you do not have to pay the Part B premium. Your income must be below $1,218 (individual) or $1,639 (couple) and you must apply for QMB, SLMB or QI1 at your county office of the Department for Community Based Services, Cabinet for Health and Family Services. If you do not know where the county office is located you can get that information online here.
- Part D (Prescription Plans). The Part D monthly premium may be deducted from your social security check if you choose to have it deducted, otherwise you pay a premium each month to the company you have chosen for your Part D prescription insurance. The premiums vary from company to company, but average $35 each month. Keep in mind that if you qualify for a program called "extra help" you may not have to pay the Part D premium. Applications for "Extra Help" are processed through the Social Security Administration. You can visit your local office or apply online at www.socialsecurity.gov
You will receive a red, white and blue card from Medicare for your Part A and Part B insurance. You will receive a separate card from the company you choose to provide you with Part D prescription insurance. If you purchase a Medicare Supplement, you will receive another card for that coverage.
Do I need a Medicare Supplement or Medigap policy?
If you do not qualify for Medicaid or Medical Savings Programs (QMB) or have not enrolled in a Medicare Part C Health Plan, you may need a Medicare Supplement to cover medical expenses not paid by Medicare. For example, most Medicare Supplements pay the co-pays when you go to the doctor, or pay your deductible if you go to the hospital. Medicare Supplements or Medigap policies are available through private insurance companies. There is a monthly premium that varies with the type of plan you choose. If you have any questions regarding Medicare Supplements you can contact your State Health Insurance Assistance Program (SHIP) at 1-877-293-7447 or the Kentucky Department of Insurance at 1-800-595-6053. You can compare premium costs on the Kentucky Department of Insurance website.
If I have questions regarding Medicare, where can I find answers?
If you have any questions regarding Medicare please call 1-800-633-4227, (that is 1-800-MEDICARE), or contact your State Health Insurance Assistance Program (SHIP) at 1-877-293-7447. You can also visit the Medicare website at www.medicare.gov. For a more detailed look at Medicare Part D benefits, see Medicare Part D.
Reviewed August 2009