Medicare is Health insurance for:
· People 65 or older
· Certain people under 65 with disabilities
· People of any age with End- Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or kidney transplant)
What are the different parts of Medicare?
Original Medicare is a fee-for-services health plan that has two parts:
Part A (Hospital Insurance) and Part B (Medical Insurance)
Medicare Part A (Hospital Insurance) helps cover:
· Inpatient care in a hospital
· Skilled nursing facility care
· Hospice Care
· Home Health Care
You usually don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working for a certain amount of time. This is sometimes call premium-free Part A. If you aren’t eligible for premium-free Part a, you may be able to buy Part A.
Medicare Part B (Medical Insurance) Helps cover
· Services from doctors and other health care providers
· Outpatient Care
· Home health Care
· Durable medical equipment (DME)
· Many preventive services
Most people pay the standard monthly Part B premium.
Note: Original Medicare pays for much, but not all the cost for health care services and supplies. Medicare Supplement Insurance policies, sold by private companies, can help pay some of the remaining health care cost, like copayments, coinsurance, and deductibles. Medicare Supplement Insurance policies are also called Medigap policies.
What are the different parts of Medicare?
Medicare Part C (Medicare Advantage):
· Includes all benefits and services covered under Part A and Part B
· Usually includes Medicare prescription drug coverage (Part D) as part of the plan
· Run by Medicare =approved private insurance companies that follow rules set by Medicare.
· Plans have a yearly limit on your out-of-pocket cost for Medical services
· May include extra benefits and services that are not covered by Original Medicare, sometimes for an extra cost.
Medicare Part D (Medicare prescription drug coverage):
· Helps cover the cost of prescription drugs.
· Run by Medicare-approved drug plans that follow rules set by Medicare.
· May Help lower your prescription drug costs and help protect against higher cost in the future.
Note: If you have limited income and resources, you may qualify for help to pay for some health care and prescription drug cost. For more information on programs that can help pay for your health care cost visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY
What is Extra Help with Medicare prescription drug plan costs?
Anyone who has Medicare can get Medicare prescription drug coverage. Some people with limited resources and income also may be able to get Extra Help with the costs — monthly premiums, annual deductibles, and prescription co-payments — related to a Medicare prescription drug plan. The Extra Help is estimated to be worth about $5,000 per year. Many people qualify for these big savings and don’t even know it. To find out if you qualify, Social Security will need to know the value of your savings, investments, real estate (other than your home), and your income. We need information about you and your spouse if you are married and living together.
Resources and Income
What is the resource limit?
To qualify for Extra Help, your resources must be limited to $14,610 for an individual or $29,160 for a married couple living together.
Resources include the value of the things you own. Some examples are:
Real estate (other than your primary residence).
Bank accounts including checking, savings, and certificates of deposit.
Stocks.
Bonds, including U.S. Savings Bonds.
Mutual funds.
• Individual Retirement Accounts (IRAs).
• Cash at home or anywhere else.
What does not count as a resource?
We do not count:
• Your primary residence.
• Your personal possessions.
• Your vehicle(s).
• Resources you could not easily convert to cash, such as jewelry or home furnishings.
• Property you need for self-support, such as rental property or land you use to grow produce for home consumption.
• Non-business property essential to your self-support.
• Life insurance policies.
• Burial expenses.
• Interest earned on money you plan to use for burial expenses.
Certain other money you are holding is not counted for nine months, such as:
• Retroactive Social Security or Supplemental Security
Income (SSI) payments.
• Housing assistance.
• Tax advances and refunds related to earned income tax credits and child tax credits.
• Compensation you receive as a crime victim.
• Relocation assistance from a state or
local government.
You should contact Social Security for other resource exclusions
What is the income limit?
To qualify for Extra Help, your annual income must be limited to $19,140 for an individual or $25,860 for a married couple living together. Even if your annual income is higher, you may still be able to get some help. Some examples where your income may be higher, and you can still get Extra Help include if you or your spouse:
Support other family members who live with you.
Have earnings from work.
What doesn’t count as income?
Not all cash payments count as income. For example, we don’t count:
Supplemental Nutrition Assistance Program (food stamps).
- Housing assistance.
- Home energy assistance.
- Medical treatment and drugs.
- Disaster assistance.
- Earned income tax credit payments.
- Assistance from others to pay your household expenses.
- Victim’s compensation payments.
- Scholarships and education grants.
You should contact Social Security for other income exclusions.
Applying for Extra Help
How do I apply?
Applying for Extra Help is easy. Just complete Social Security’s Application for Extra Help with Medicare Prescription Drug Plan Costs (Form SSA-1020). Use one of these methods:
Apply online at www.socialsecurity.gov/extrahelp.
Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to apply over the phone or to request an application.
Apply at your local Social Security office.
After you apply, Social Security will review your application and send a letter to you to let you know if you qualify for Extra Help. After you qualify, you can choose a Medicare prescription drug plan. If you do not select a plan, the Centers for Medicare & Medicaid Services will do it for you. The sooner you join a plan, the sooner you begin receiving benefits. If you aren’t eligible for Extra Help, you still may be able to enroll in a Medicare prescription drug plan.
Late Enrollment Penalty
Medicare Prescription Drug Plan Penalty
If you don’t enroll in a Medicare drug plan when you’re first eligible, you may pay a late enrollment penalty if you join a plan later. You’ll have to pay this penalty for as long as you have Medicare prescription drug coverage. However, you won’t pay a penalty if you get Extra Help or other eligible prescription drug plan coverage.
NOTE: The Medicare prescription drug plan late enrollment penalty is different than the Medicare Part B late enrollment penalty. If you don’t enroll in Part B when you’re first eligible for it, you may have to pay a late enrollment penalty for as long as you have Part B coverage. Also, you may have to wait to enroll, which will delay Part B coverage.
For information about enrollment periods, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048).
Why should I apply online?
Our online application is secure and offers several advantages. It takes you through the process step-by-step with a series of self-help screens. The screens will tell you what information you need to complete the application and will guide you in answering the questions fully. You can apply from any computer and at your own pace. You can start and stop at any time during the process, so you can leave the application and return later to update or complete any of the required information. We are careful to protect your personal information.
What do I need to know?
Most of the questions on the application are about resources and income. If you are married and living with your spouse, we need to know this information about both of you. Family members, caregivers and other third parties can help you complete the application. The information below can help you decide if you are eligible and can assist you in completing the actual application for Extra Help. The worksheet is not an application.
To prepare:
Identify the things you own alone, with your spouse, or with someone else, but do not include your home, vehicles, burial plots, life insurance policies, or personal possessions.
Review all your income.
Gather your records in advance to save time.
The records you’ll need are:
- Statements that show your account balances at banks, credit unions, or other financial institutions.
- Investment statements.
- Stock certificates.
- Tax returns.
- Pension award letters.
- Payroll slips.
We won’t ask for proof to support the information you provide, but we’ll compare your information with data available from other government agencies to make sure the figures match. We need to know information about your (and your spouse’s, if you are married and living together) resources and income. The dollar value of your resources for: Bank accounts, including checking, savings, and certificates of deposit. Stocks, bonds, savings bonds, mutual funds, individual retirement accounts (IRAs), or other investments. Cash at home or anywhere else. Any real estate other than your home. The monthly dollar amount of your income from:
Where to Get Your Medicare Questions Answered? When to Contact Medicare?
Visit Medicare.gov to:
· See what services Medicare covers
· Get detailed information about Medicare health and prescription drug plans in your area, including cost and services.
· Choose and enroll in a Medicare Health or prescription drug plan that meets your needs.
· Find Medicare Supplement Insurance (Medigap) policy in your area.
· Find doctors, health care providers, and suppliers who participate in Medicare.
· Get information and forms for filing a Medicare appeal or for letting someone speak with Medicare on your behalf.
· Compare the quality for care provided by plans, nursing homes, hospitals, home health agencies, and dialysis facilities
· View Medicare publications
Call 1-800-MEDICARE (1-800-633-4227: TTY: 1-877-486-2048) to:
· Find out your claim status
· Find out deductibles
· Get answers to premium payment questions
· Report fraud
· Appeal a coverage or payment decision you do not agree with
· Find your level of Extra Help with Medicare prescription drug coverage (Part D) cost of you automatically qualified and didn’t apply
· Get information about coverage, benefits, and preventive services
Create an account at MyMedicare.gov to:
· View and print a copy of your new Medicare card
· Track Original Medicare claims and your Part B (Medical Insurance) deductible
· Sign up for Electronic Medicare Summary Notices (eMSNs)