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Explanation of What is Medicare:

GENERAL MEDICARE

U.S. government health insurance program for seniors 65+ and approved disabled individuals <65.

  • If you are already receiving Social Security you will be automatically enrolled for Parts A & B and get your Medicare card 3 months before the month of your 65th birthday and start receiving your benefits the first day of the month of your 65th birthday or the previous month if your birthday is on the lst.  If you do not automatically receive your Medicare card call Social Security at 1-800-772-1213.
    • If you do nothing you will keep Part B and Part B premiums will start coming out of your Social Security.
  • There are different rules for those that live in Puerto Rico or those that have serious health issues like end-stage renal failure and Lou Gehrig’s disease, please check with Medicare.gov or call 1-800-Medicare.
  • You must be a U.S. citizen or lawfully present in the U.S. to get Medicare Parts A &B.
  • If you meet certain requirements, you can delay Medicare Part B but you have to respond to their notification and have creditable insurance otherwise face penalty fees that will be added to your monthly Medicare premiums.  If in doubt ask?
  • Your initial Enrollment Period is three months before the month of your 65th birthday and three months after.

MEDICARE PLANS:

Medicare Part A:  Everyone (who is eligible) receives Medicare Part A at age 65.  Part A is your basic coverage for hospital, skilled nursing facility (not long-term or custodial)  hospice care, and home health care it pays 80% after a deductible of $1,260 (2015) and covers 1-60 days and there is no premium.  If you did not sign up during your initial enrollment period you can sign-up between January 1 and March 31 of each year but your coverage won’t start until July first and you may be assessed a penalty (if you did not have other creditable insurance). 

Medicare Part B:  This is coverage  for your Dr.  and other out-patient medical services and the premiums vary depending on your taxable income and usually comes out of your Social Security check or for those not taking Social Security they may pay a premium.  There is an annual deduction of $147 (2015).  Part B pays 80% of the total Medicare approved charge.   If you do not sign-up for Part B when you are first eligible for Medicare (and did not have creditable insurance) you will incur a penalty that will be added monthly to your premium for the rest of your life.

Medicare Part C:  Medicare has sub-contracted Part C to private insurance companies called Advantage Plans.  The government oversees these plans and decides which insurance companies can sell in which zip code.  You are officially a client of the insurance company  and have to use their insurance card and cannot use your Medicare card (keep your Medicare card for use if you ever go back to  original Medicare).  You still have to pay your Part B premiums but these are sent to the insurance company managing your Advantage Plan and you may also have an additional premium to pay to the insurance company for your Advantage Plan.  Advantage Plans are either HMO’s which are usually free or PPO’s that usually have an additional premium.  Advantage Plans include your drug plan Medicare Part D.

Medicare Part D:  You have to have a separate drug plan (Part D) if you are on original Medicare  (and have a Medicare supplement plan).  If you have a Medicare Advantage Plan (Medicare Part C ) you do not need to buy a separate drug plan.  Advantage plans usually include your drug plan.  You need to purchase a Medicare Part D plan from an independent insurance company but if you do not purchase a plan when you are first on Medicare (and do not have an Advantage Plan or other creditable insurance) you will incur penalty fees if you sign up later.

Open enrollment for the above is October 15 thru December 7 each year, there are a few exceptions

    1. When you are first eligible for Medicare (three months before your 65 birth month and three months after).    
    2. Move out of your plan’s service area. (Medicare Part C & D)
    3. Lose other creditable insurance coverage

ALL INFORMATION CAN BE FOUND IN DETAIL IN YOUR ANNUAL MEDICARE BOOK OR ON-LINE AT MEDICARE.GOV.  YOU CAN ALSO CALL 1-800-MEDICARE.

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