Top 20 Medicare Questions
The following 20 questions and answers are the most frequently asked questions by callers to the Medicare + Choice toll free line.
|1.||What is medicare?|
|2.||If I lose my Medicare card, how can I replace it?|
|3.||How can I find out if I have Medicare coverage?|
|4.||I can't afford my Medicare premiums. What can I do?|
|5.||Will I automatically be enrolled in Medicare when I turn 65?|
|6.||Does Medicare pay for dental services?|
|7.||Who submits my bills to Medicare? How much do I have to pay?|
|8.||Who do I contact to change my name and address for Medicare purposes?|
|9.||How can I leave a Medicare Health Plan?|
|10.||What medical supplies and equipment does Medicare Part B cover?|
|11.||Does Medicare pay for prescription drugs?|
|12.||I didn't enroll in Medicare Part B when I turned 65 because I was still working. Can I enroll now?|
|13.||I originally refused Medicare Part B when I turned 65. Can I enroll now?|
|14.||What is a Medigap policy?|
|15.||Who is eligible for Medicare Part A (hospital insurance)?|
|16.||What types of services are covered under Medicare Part B?|
|17.||What diabetic supplies does Original Medicare cover?|
|18.||What is a Medicare deductible?|
|19.||How do Medicare managed care plans work?|
|20.||What is an Observation Bed?|
|1.||What is Medicare? |
Medicare is a Federal health insurance program for people 65 years or older, certain people with disabilities, and people with permanent kidney failure treated with dialysis or a transplant. Medicare has two parts - Part A which is hospital insurance, and Part B which is medical insurance.
|2.||If I lose my Medicare card, how can I replace it? |
If you lose your card, you can obtain a replacement card by phone at 1-800-772-1213, or online at the Social Security Administration web site. Make sure you have your Medicare number ready when you call. You should receive your new card in about four weeks.
|3.||How can I find out if I have Medicare coverage? |
You must call the Social Security Administration at
1-800-772-1213 or contact your local Social Security Office to verify your Medicare Part A and Part B coverage. This information can also be found on your red, white, and blue Medicare card.
|4.||I can't afford my Medicare premiums. What can I do? |
If your income is limited, your State may help pay your Medicare costs such as your premiums and deductibles. Check the Important Phone Numbers page of this web site for the phone number of your State Medical Assistance Program. They can help you determine if you are qualified. If you have Medicare Part A, your income is limited, and your financial resources such as bank accounts, stocks, and bonds are not more than $4,000 for an individual, or $6000 for a couple, you may qualify for assistance as a Qualified Medicare Beneficiary or Specified Low Income Medicare Beneficiary. The Qualified Medicare Beneficiary Program (also known as QMB) pays the Medicare monthly Part B premium, deductibles and coinsurance. The Specified Low Income Medicare Beneficiary Program (also known as SLMB) helps pay the Medicare monthly Part B premium for qualified Medicare beneficiaries.
|5.||Will I automatically be enrolled in Medicare when I
turn 65? |
If you are receiving Social Security or Railroad Retirement or disability benefits, you will be automatically enrolled in Medicare Part A and Part B. About 3 months prior to your 65th birthday or 24th month of disability, you will be sent an Initial Enrollment Package that will contain information about Medicare, a questionnaire and your red, white and blue Medicare card. If you want both Medicare Part A (hospital insurance) and Part B (medical insurance), you should sign your Medicare card and keep it in your wallet. If you don't want Part B coverage, you must put an X in the refusal box on the back of the Medicare card form; sign the form and return it with the card to Social Security at the address shown. You will then be sent a new Medicare card showing that you only have Part A.
|6.||Does Medicare pay for dental services? |
Medicare does not cover routine dental care or most dental procedures such as cleanings, fillings, tooth extraction or dentures. There are rare cases in which Medicare Part B will pay for certain dental services. In addition, there are some situations in which Medicare Part A will pay for certain dental services delivered on an inpatient basis. You should contact your local Carrier for more information. Check the Important Phone Numbers of this web site for the phone number.
|7.||Who submits my bills to Medicare? How much do I have to
If you are in Original Medicare, your doctor or other health care provider will file your claim with Medicare. You'll receive a statement showing how much you'll need to pay. If you do not receive a Medicare statement (Medicare Summary Notice or Explanation of Medicare Benefits), you'll need to contact your local carrier to have them send you a copy. Check the Important Phone Numbers page of this web site for the phone number of your carrier. If you have supplemental insurance or Medigap, they may pay part of your costs. Check with your supplemental insurance company to find out what they will pay.
|8.||Who do I contact
to change my name and address for Medicare purposes? |
If you have had a recent name or address change, it will need to be reported to the Social Security Administration. Social Security will notify Medicare of the change when they change their records. Their phone number can be found in the Important Phone Numbers page of this web site. If you are in the Original Medicare Plan, you should also notify the Part B carrier of your new name or address change. The carrier processes your claims for doctor bills and other medical expenses. Check the Important Phone Numbers section of this web site for the phone number of your carrier. If you are in a Medicare managed care plan, you should contact your plan of any name or address changes.
|9.||How can I leave a Medicare Health Plan? |
You can leave a plan in one of 3 ways.You can:
|10.||What medical supplies and equipment does Medicare Part
B cover? |
Medicare Part B helps pay for durable medical equipment such as oxygen equipment, wheelchairs, and other medically necessary equipment that your doctor prescribes to use in your home. Other items covered by Medicare include:
|11.||Does Medicare pay for prescription drugs? |
Generally, Original Medicare does not cover prescription drugs. However, Medicare does cover some drugs in certain cases such as immunosuppressive drugs (for transplant patients) and oral anti-cancer drugs. You should call your Durable Medical Equipment Regional Carrier for more information. Check the Important Phone Numbers section of this web site for the phone number. There are some Medicare Health Plans that cover prescription drugs. You can also check into getting a Medigap or supplemental insurance policy for prescription drug coverage. Medicaid may also help pay for prescription drugs for people who are eligible.
|12.||I didn't enroll in Medicare Part B when I turned 65
because I was still working. Can I enroll now? |
You qualify to enroll in Medicare during a Special Enrollment Period if you delayed enrolling in Part B because you were working and had group health insurance through your employer or your spouse's employer. If you sign up during the Special Enrollment Period, you do not have to pay the Part B premium surcharge. Signing up for Medicare Part B will begin your 6 month open enrollment period for buying a Medigap policy. You can enroll in Part B:
|13.||I originally refused Medicare Part B when I turned 65.
Can I enroll now? |
Anyone who has refused, terminated, or withdrawn from Medicare Part B or Premium Free Part A coverage can enroll again. You can enroll during January, February, or March of each year. This is referred to as the General Enrollment Period. Your Medicare coverage will not begin until July 1st. You may or may not have to pay a premium surcharge. Call the Social Security Administration at 1-800-772-1213 for an appointment or visit your local Social Security Office to file an application. They will also tell you the amount of any premium surcharge you may have to pay.
|14.||What is a Medigap policy? |
Supplemental insurance policies are sometimes called Medigap plans. Medigap plans are private health insurance policies that cover some of the costs the Original Medicare Plan does not cover. Some Medigap policies will cover services not covered by Medicare such as prescription drugs. Medigap has 10 standard plans called Plan "A" through Plan "J". Each plan has a different set of benefits. The states of Minnesota, Wisconsin and Massachusetts have choices other than Plan "A" through Plan "J". Your State Insurance Department can answer questions about the Medigap policies sold in your area. Check the Important Phone Numbers section of this web site for the phone number of your State Insurance Department.
|15.||Who is eligible for
Medicare Part A (hospital insurance)? |
If you have worked at least 10 years in Medicare covered employment you will qualify for premium free Medicare Part A (Hospital Insurance). To qualify, you must be:
|16.||What types of services are covered under Medicare Part
Medicare Part B helps pay for doctors' services, outpatient hospital care, blood, medical equipment and some home health services. It also pays for other medical services such as lab tests and physical and occupational therapy. Some preventive services such as mammograms and flu shots are also covered. Medicare Part B does NOT cover routine physical exams; eye glasses; custodial care; dental care; dentures; routine foot care; hearing aids; orthopedic shoes; or cosmetic surgery. It also does not cover most prescription drugs or health care you get while traveling outside the United States (except under limited circumstances).
|17.||What diabetic supplies does original Medicare cover? |
Medicare covers the same supplies for both insulin and non-insulin dependent diabetics. They include: Glucose testing monitor, Blood glucose test strips, Lancets, Spring powered devices for lancets, and Glucose control solutions. Some frequency limitations may apply. Medicare does not cover insulin and syringes. Contact your Durable Medical Equipment Regional Carrier for more information. Check the Important Phone Numbers section of this web site for the phone number.
|18.||What is a Medicare deductible? |
A deductible is the amount you must pay each year before Medicare begins paying its portion of your medical bill. There are deductibles for both the Part A (Hospital Insurance) and Part B (doctor services) portions of Medicare. Your deductible is taken out of your claims when Medicare receives them. Medicare will not start paying on your claims until you have met your annual deductible. If you have any questions on the status of your deductible please contact your Medicare carrier.
|19.||How do Medicare managed care plans work? |
Medicare managed care plans (or replacement policies) are another way for you to receive Medicare benefits. All plans must provide all of the basic Medicare services and many have added benefits. One of those may ne that you would not need a supplemental insurance after Medicare. However, your co=payment and deductible may be very different from the basic Medicare plan and you may need to pay a monthly premium to your health plan. You also may need to use specific doctors, hospitals and other providers that are in your plan's network.
|20.||What is an Observation Bed? |
An Observation Bed is an Outpatient service which allows your doctor to assess your condiftion for up to 48 hours in a hospital bed.
Your doctor decides whether you will be an Observation patient or admitted as an Inpatient based on your medical condition.
Any self administered drugs (pain medicines, prescription drugs, etc.) are not covered when you are in an Outpatient status. You may also have an outpatient coinsurance and/or deductible associated with that visit.