Frequently Asked Questions

What is Medicare?

Who is Eligible?

Enrolling in Medicare?

Enrollment Period?

What is Medicare?

• People 65 years of age and older.
• Some people with disabilities under age 65.
  
• People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

Medicare has Two Parts:

• Part A (Hospital Insurance)
  Most people don't have to pay for Part A.
   
• Part B (Medical Insurance)
  Most people pay monthly for Part B.

You can choose different ways to get the services covered by Medicare. Depending on where you live, you may have different choices. In most cases, when you first get Medicare, you are in the Original Medicare Plan. You may want to consider a Medicare Prescription Drug Plan to add drug coverage. Or, you may want to consider a Medicare Advantage Plan (like an HMO or PPO) that provides all your Part A, Part B, and often Part D coverage. You make a choice when you are first eligible for Medicare. Each year you can review your health and prescription needs and switch to a different plan in the fall.

As long as you have both Part A and Part B, items covered by Part A and Part B are covered whether you have the Original Medicare Plan, or you belong to a Medicare Advantage Plan (like an HMO or PPO). For more information see the Your Medicare Coverage database.

Part A (Hospital Insurance)

Helps Pay For:

Care in hospitals as an inpatient, critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas), skilled nursing facilities (not custodial or long-term care), hospice care, and some home health care. Information about your coverage under Medicare Part A can be found in the Medicare Coverage database.

If you aren’t sure if you have Part A, look on your red, white, and blue Medicare card. If you have Part A, “HOSPITAL (PART A)” is printed on your card.

Cost:

Most people get Part A automatically when they turn age 65. They do not have to pay a monthly payment called a premium for Part A because they or a spouse paid Medicare taxes while they were working.

If you don’t automatically get premium-free Part A, you may be able to buy it if

• you (or your spouse) aren’t entitled to Social Security because you didn’t work or didn’t pay enough Medicare taxes while you worked and you are age 65 or older, or

• you are disabled but no longer get premium-free Part A because you returned to work.

   

If you have limited income and resources, your state may help you pay for Part A and/or Part B. For more information, visit www.socialsecurity.gov on the web or call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772.

Part B (Medical Insurance)

Helps Pay For:

Doctors' services, outpatient care, and other medical services that Part A doesn't. Part B helps pay for these covered medical services and items when they are medically necessary. Part B also covers some preventive services. Information about your coverage under Medicare Part B can be found in the Your Medicare Coverage database.

Cost:

Starting January 1, 2007, your Part B premium will be based on your income. Most people pay the standard monthly Part B premium of $93.50 in 2007. For more information, see our FAQ: Medicare Part B Monthly Premiums in 2007.

In some cases this amount may be higher if you did not choose Part B when you first became eligible. The cost of Part B may go up 10% for each full 12-month period that you could have had Part B but didn't sign up for it, except in special cases. You may have to pay this penalty as long as you have Part B.

Enrolling in Part B is your choice. You can sign up for Part B from three months before you turn 65 to three months after you turn 65. To sign up, call the Social Security Administration at 1-800-772-1213 or visit or call your local Social Security office to sign up. If you choose to enroll in Medicare Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Office of Personnel Management payment. In these cases, you won’t get a bill for your premium. If you don’t get any of these payments, Medicare sends you a bill for your Medicare Part B premium every three months. If you don’t get your bill by the 10th of the month, call the Social Security Administration at 1-800-772-1213. TTY users should call 1-800-325-0778. If you get benefits from the Railroad Retirement Board (RRB), call your local RRB office or 1-800-808-0772

Medicare Eligibility

Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years or older and a citizen or permanent resident of the United States. If you aren’t yet 65, you might also qualify for coverage if you have a disability or with End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant)

Here are some simple guidelines. You can get Part A at age 65 without having to pay premiums if:

• You already get retirement benefits from Social Security or the Railroad Retirement Board.
  
   

• You are eligible to get Social Security or Railroad benefits but haven't yet filed for them.
  
   

• You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A without having to pay premiums if you have:

• received Social Security or Railroad Retirement Board disability benefits for 24 months.
  
   

• End-Stage Renal Disease and meet certain requirements.

While you do not have to pay a premium for Part A if you meet one of these conditions, you must pay for Part B if you want it. Starting January 1, 2007, the Part B premium will be based on your income. Most people pay the standard monthly Part B premium of $93.50 in 2007. For more information, see our FAQ: Medicare Part B Monthly Premiums in 2007.

The Part B monthly premium

Note: You will be eligible for Medicare when you turn 65 even if you aren't eligible for Social Security retirement benefits. To contact a local insurance agent who specializes in medicare, request information about medicare supplemental insurance and medigap.

Note: For more information about eligibility for Medicare, call the Social Security Administration at 1-800-772-1213 or visit your local Social Security Office. TTY users should call 1-800-325-0778.

Enrolling in Medicare

Medicare has two parts:

• Part A (Hospital Insurance)

  Most people don't have to pay for Part A.

• Part B (Medical Insurance)

  Most people pay monthly for Part B.

Most people do not have to pay for Medicare Part A. Most people pay for Medicare Part B. Request information about your medicare insurance options and companies.

Enrollment Period

If you didn’t sign up for Medicare Part B when you first became eligible, you may be able to sign up during the General Enrollment Period. This period runs from January 1 through March 31 of each year. During this time, you can sign up for Medicare Part B at your local Social Security office. If you get benefits from the Railroad Retirement Board (RRB), call your local RRB office or 1-800-808-0772. Your Medicare Part B coverage will start on July 1 of the year you sign up.

Request health coverage information from local agents

Important: The cost of Medicare Part B will go up 10% for each full 12-month period that you could have had Medicare Part B but didn’t take it, except in special cases. You will have to pay this penalty as long as you have Medicare Part B.

If you already have Medicare Part A and need Part B you can sign up for Part B at your local Social Security office or by calling 1-800-772-1213 (TTY users should call 1-800-325-0778).

For more information on how delaying enrollment in Medicare Part B could result in paying higher Part B premiums, see the Medicare.gov website:

What if I'm over 65 and didn't enroll in Part B during my Initial Enrollment Period?

For more information on delaying enrollment in Medicare Part B if you or your spouse is still working, see the Medicare.gov website

Can I delay my Medicare Part B enrollment without paying higher premiums?

If you can delay your enrollment because you or your spouse are still working, the General Enrollment Period will not affect you until after you (or your spouse) stop working.

If you are a military retiree or the spouse or dependent child of either a military retiree or an active duty sponsor, see the medicare.gov website for more information:

How does the Medicare Prescription Drug Improvement and Modernization Act impact enrollment in Medicare Part B for military retirees or the spouse or dependent child of either a military retiree or an active duty sponsor?

Starting January 1, 2007, your Part B premium will be based on your income. Most people pay the standard monthly Part B premium of $93.50 in 2007.

For more information, see: Medicare Part B Monthly Premiums in 2007.

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