Frequently Asked Questions

The Top Ten Frequently Asked Questions about Medicare

1. When will my Medicare begin?
2. What are Parts A, B, C and D of Medicare?
3. How much is the Part A premium?
4. How much is the Part B premium and how do I pay it?
5. What happens if I don't sign up for Part B during my open enrollment period?
6. Does Medicare cover all my health care costs?
7. How do I enroll in the Prescription Drug program?
8. What are Medicare Advantage plans?
9. I am still working or on my spouse's coverage at work. How does this affect my Medicare, and what happens when I or my spouse retires or loses his/her job?
10. Is there any help for low-income people?

Disclaimer

The answers to the “Top 10 Frequently Asked Questions about Medicare" are brief overviews intended to provide some general information. They are not intended to encompass entirely complete answers. For more detailed information or other questions not addressed here, please contact our office at 903-597-6702. We also recommend going to www.medicare.gov, www.socialsecurity.gov and www.cms.gov. Additional information is also available in the Medicare & You handbook distributed by the Dept. of Health & Human Services to each Medicare beneficiary. These handbooks can also be order on the medicare.gov website, or by calling 1-800-Medicare.

Answers

When will my Medicare begin?

If you are receiving a Social Security, RRB or Civil Service benefit before you reach age 65, you should automatically be sent your Medicare information. If you are not receiving a monthly benefit, you will need to contact the Social Security office for an appointment approximately 3 months before you turn 65.

Medicare Part A begins on the first day of the month in which you turn age 65, except in special circumstances. These would include your becoming eligible for Medicare under age 65 due to a disability. If your birthday falls on the first day of the month, your Part A will begin on the first day of the preceding month.

If you choose to enroll in Part B when your Part A starts, you do not need to do anything. You will automatically begin to receive Part B benefits at the same time. However, if you choose to delay enrollment in Part B, there are other rules which come into play. This could include a late-enrollment penalty unless you are covered under employer or union insurance.

What are Parts A, B, C & D of Medicare?

Medicare Part A (Hospital Insurance) is coverage for basic hospital charges. This includes your room and other charges incurred by the facility. Part A also provides coverage for skilled nursing, which includes physical therapy and recuperative care after a hospital stay of at least 3 days. It also covers a limited portion of home health care and durable medical equipment (wheelchairs, walkers, etc.)

Part B (Medical Insurance) covers doctors' visits, x-rays, lab work, tests, surgeons' fees, anesthesia, limited home care, etc.

Part C of Medicare is Medicare Advantage. This is explained in more detail in question number 8.

Part D is Medicare's Prescription Drug Plan (PDP). More information is available in question number 7.

How much is the Part A premium?

Most people don't pay a Part A premium because they paid Medicare taxes while working (payroll taxes or self-employment tax.)

If you don't get Part A premium-free, you may be required to pay up to $443.00* (in 2009) each month.

*If you pay a late enrollment penalty, this amount is higher.

How much is the Part B premium and how do I pay it?

In 2010, the premium is as follows:

If your yearly income in 2008 was		You pay:
File individual tax return	File joint tax return
$85,000 or below	$170,000 or below	$110.50*
$85,001-$107,000	$170,000-$214,000	$154.70*
$107,001-$160,000	$214,000-$320,000	$221.00*
$160,001-$214,000	$320,001-$428,000	$287.30*
Above $214,000	Above $428,000	$353.60*

*If you pay a late enrollment penalty, this amount is higher.

The premium is deducted from your Social Security, RRB or the Civil Service check. If you are not receiving a monthly benefit check and choose to sign up for Part B, you will receive a bill.

What happens if I don't sign up for Medicare Part B or Part D during my open enrollment period?

When you are first eligible for Medicare you have an open enrollment period (3 months before, the month of and 3 months after your birth month) when you can sign up for Part B or Part D without a penalty. If you choose to delay enrollment,you will be charged a penalty of 10% per year for Part B and 1% per month for Part D. This penalty is not imposed if you have creditable coverage from an employer, union, VA, etc. If you lose your creditable coverage, you must enroll within 63 days to avoid a penalty.

If your open enrollment period has passed, your next opportunity is as follows:

The annual enrollment period for Part B is January through March of each year, and the coverage begins on June 1 of that same year. The annual enrollment period for Part D is November 15 through December 31 of each year, becoming effective on January 1 of the following year.

You may also be able to enroll in a Medicare Advantage plan which includes Part D prescription drugs.

Does Medicare cover all my health care costs?

Medicare does NOT cover all health care costs. There is a deductible on Part A ($1,068.00 in 2009) for each time you are hospitalized, except when hospitalized more than once in a 60-day period.

Medicare Part B has a once-yearly deductible ($155.00 in 2010). After the deductible, Medicare only pays a percentage of what they approve for covered services.

Depending upon the plan, many Medicare supplements cover both Part A and Part B deductibles, and any co-pays not covered by Medicare.

How do I enroll in the Prescription Drug Program (PDP)?

This is also known as Medicare Part D. In order to become enrolled in Medicare's Prescription Drug Program you must choose an insurance plan. Some of these cover Medicare's Part D deductible and they offer co-pays for drugs. There is a monthly premium for these plans. However, if you qualify for a low-income subsidy, you may pay little or no premiums and co-pays.

You may contact our office at 903-597-6702 for help in determining if you qualify for help with the premiums or co-pay amounts. We can assist you in choosing a plan and getting enrolled.

If you are covered under an employer or union plan you may not need to enroll in Part D. You should talk to the insurance department where you work to make sure the coverage you have is “creditable coverage at least as good as Medicare's.” Those who are covered for prescription drugs after retirement should receive a letter from their group every year. If you are covered under TRICARE, you do not need to enroll in Part D. Eligibility for VA prescription drug coverage is considered “creditable.”

What are Medicare Advantage plans?

Medicare Advantage plans are health plan options (like HMOs and PPOs) approved by Medicare and run by private companies. These plans are part of the Medicare program and are sometimes called “Part C,” “MA,” or “MA-PD.” Medicare pays an amount for your care every month to these private health plans. Medicare Advantage plans must follow rules set by Medicare.

Medicare Advantage plans are not supplemental insurance.

I am still working or on my spouse's coverage at work. How does this affect my Medicare, and what happens when I or my spouse retire?

There are special rules that apply in this case. Talk to the employer's human resources department or whoever takes care of the insurance to see what happens to your insurance and your spouse's insurance when either of you turn age 65 or become eligible for Medicare.

Depending upon each circumstance, you may want to delay enrolling in Part B if you continue to be covered under your employer's insurance after you turn 65. If you lose your health insurance upon retirement, you have a limited time to enroll in the Medicare Parts B and D without paying a penalty and waiting until the next open enrollment period to be covered.

Is there any help for low-income people on Medicare?

Assistance may be available for both Parts B and D through state or federal government programs.

Contact our office at 903-597-6702 or www.medicare.gov for more information.