Medicare 101

When do I enroll?

These are a few examples

1. Social Security Retirement, Spouses or survivors receiving benefits before the age of 65 do not need to do anything. automatically enrolled in Medicare Part A Hospital and Part B Medical.

1.1 Each citizen should receive a letter informing them of their Medicare effective date approximately 3 months before their 65th birthday.

1.2 No additional action is needed.

2. At the age of 65, if working and COVERED by health insurance from your current employer or spouse who is working and COVERED under spouse’s current employer’s plan

2.1 Steps to take: Apply for Medicare Part A Hospital only

2.2 Each citizen is allowed to refuse Part B because it is covered under their current employer’s health insurance.

2.2.1 Please check with your Human Resources before applying for Medicare and correspondences the HR department information with Center of Medicare Services

2.3 Important: 2 months before separation, contact Social Security at 1-800-772-1213 to request Special Enrollment Forms

2.3.1 Request 2 forms-1 for HR department and 1 for the worker)

2.3.2 Return both forms back to local Social Security office ASAP

2.3.3 You have 8 months from the date of separation to enroll into Medicare Part B—Medical to avoid the penalty

2.3.4 Failure to enroll in Medicare Part B Medical on time Results in a 10% penalty of the current Medicare Part B-Medical premium for every 12 months you did not enroll into Medicare Part B Medical when you should have

Medicare Health Plans

The standard Medicare pays 80% of the Medicare-approved amount. Some consider buying a Medicare Supplement insurance plan or Medigap plan to pay the out-to-pocket costs you are responsible for unless you have other insurance such as Retiree, Union or COBRA) that pays after Medicare

Always check with your current insurance company or ask the State Health Insurance Program if you need a Medicare health plan.

What is a Part A hospital?

Medicare Part A (Hospital)

Benefits: In-patient Hospital Care, Skilled Nursing Facility care, Hospice, Home Health Services

Premiums: $0 if paid Medicare taxes while working at least 40 quarters

                                                **99% of people receive premium-free Part A**

                        IF YOU DON’T HAVE THE WORK CREDIT HOURS YOU HAVE TO PAY OUT OF POCKET FOR PART B MEDICAL

                        $232 monthly if worked 30-39 quarters

                        $422 monthly if worked less than 30 quarters

Deductible: $1,340 for each benefit period. (each benefit period is 60 days between each admission)

Hospital Costs: $0 for 0-60 days per benefit period, #335/day for days 61-90; $670/day for days 91-150

Medicare Part B Medical

(this comes out of your Social Security check every month automatically for $135) you may qualify for a WAVIER

Benefits: Outpatient Hospital, Emergency Room, Doctor Services, Preventive Services, Durable Medical Equipment, Laboratory and Diagnostic tests, Surgeries, Ambulance Services, Mental Health Services

Premiums: $135 is the standard premium, but those with higher incomes pay more. More information at “income-related monthly adjustment amount” at http://www.socialsecurity.gov/pubs/10536.html

Deductible: $183 for the year (January 1-December 31)

Costs: $0-20% depending on the type of service

Medicare Part D (Prescription Drug Plans)

Benefits: Medicare Part D is prescription drug coverage available to anyone on Medicare. If you do not have other prescription drug coverage as good as or better than Medicare Part D plans, carefully consider enrolling in a Medicare drug plan.

You could pay a penalty of 1% of the national base premium ($35.63) for every month if you don’t join a plan when you are first eligible.

The best Medicare drug plan for you covers your medications and works with your pharmacy.

Premiums: $15-$108 per month

Deductible: $0-$325 per year

Costs: $0-$33 depending upon the plan and generic vs. brands

Formulary: A list of medications that each plan covers

Note: Please do not contact Social Security about Medicare coverage and billing. Social Security has no access to coverage information.

Open enrollment is October 15-December 7 each year