Most frequently asked questions about Medicare - Spokane, North Idaho News & Weather KHQ.com

Most frequently asked questions about Medicare

The following questions and answers are the most frequently asked questions by callers to the Medicare + Choice toll free line.

1. How can I get a Replacement Medicare card?

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.

2. 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.

3. 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 Helpful Contacts 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. In most states, the 2000 monthly income limits are $716 for an individual and $958 for a couple.

The Specified Low Income Medicare Beneficiary Program (also known as SLMB) helps pay the Medicare monthly Part B premium for qualified Medicare beneficiaries. In most states, the 2000 Monthly Income Limits are $855 for an individual and $1145 for a couple.

4. 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 and 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.

5. How, when and where do I sign up for Medicare when I turn 65 if I am not yet receiving Social Security benefits?

Some people are not automatically enrolled in Medicare. You need to file an application if you are:

  • eligible for Social Security or Railroad Retirement benefits but have not yet signed up for them;

  • have permanent kidney failure treated with dialysis or a transplant; or

  • are not eligible for Premium Free Part A; or

  • are a government employee who is not eligible for Social Security or Railroad Retirement benefits.

You can call the Social Security Administration to set up an appointment or go to your local Social Security Office. The phone number for the Social Security office in your area can be found in the Helpful Contacts site. Social Security will take your application, determine if you are eligible for Medicare and send you a Medicare card.

6. Who submits my bills to Medicare? How much do I have to pay?

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 Helpful Contacts 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.

7. 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.

8. I receive Social Security Disability checks. Am I eligible for Medicare?

You are eligible for Medicare Part A (hospital insurance) if you are under 65 and have been getting Social Security or Railroad Retirement Disability checks for 24 months. You may also enroll in Part B (medical insurance) for a month premium of $45.50.

9. What is Medicare + Choice?

Medicare + Choice is a term used to describe the various health plan options available to Medicare beneficiaries.

10. How can I leave a Medicare Health Plan?

You can leave a plan in one of 3 ways. You can:

  • call the plan you wish to leave and ask for a disenrollment form; or

  • call 1-800-MEDICARE (1-800-633-4227) to request that your disenrollment be processed over the phone; or

  • call the Social Security Administration or visit your Social Security Office to file your disenrollment request. The phone number for the Social Security office in your area can be found at Helpful Contacts.

In most cases, you are disenrolled the month after your request is made as long as your request was filed before the 10th day of the month. If your request was made after the 10th of the month, you will be disenrolled the first day of the second calendar month after your request was made. You do not need to fill out a disenrollment form if you decide to join another managed care plan. You will be automatically disenrolled from your old plan when your new plan enrollment becomes effective.

11. 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:

  • arm, leg, back and neck braces

  • medical supplies such as ostomy bags, surgical dressings, splints and casts

  • breast prostheses following a mastectomy

  • one pair of eyeglasses with an intraocular lens after cataract surgery

Medicare pays for different kinds of durable medical equipment in different ways. Some equipment must be rented, other equipment must be purchased. Your Durable Medical Equipment Regional Carrier can provide more specific information. Check the Helpful Contacts section of this web site for the phone number for your Durable Medical Equipment Regional Carrier.

12. 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 Helpful Contacts 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.

*Medicare's Prescription Drug Program (Part D) helps older and disabled people cover the cost of prescription drugs.  To be eligible for Part D, you must have or be eligible for Medicare Hospital Insurance (Part A) or Medicare Medical Insurance (Part B), or both.

Open enrollment is from Nov. 15 to Dec. 31 each year. During this time, anyone can change plans, drop plans, or sign up. People new to Medicare eligibility have their own initial enrollment period around their 65th birthday, or when they first get Medicare due to a disability.  Some people may enroll or change plans at other times, such as when they move out of their current plan's service area, or if they move into a nursing home.

All Medicare clients are eligible for Part D, but enrollment is voluntary. If you already have prescription drug coverage, it may be as good as Part D. You should research your options before taking any action. Please note that if you qualify for extra help with Medicare's prescription drug coverage costs, you can apply for prescription drug coverage at any time.

For complete information, contact the Insurance Consumer Hotline at 1-800-562-6900 or contact the Centers for Medicare and Medicaid Services (CMS) at 1-800-MEDICARE or www.medicare.gov .

13. 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:

  • any month in which you are still covered under your current enrollment; or

  • the 8-month period beginning with either the date your employment ends or the date your group health plan ends, whichever comes first.

You should contact the Social Security Administration to file an application. The phone number for the Social Security office in your area can be found in the Helpful Contacts site.

14. How do I apply for Medicaid?

You will need to contact your local Medical Assistance Office to file an application for Medicaid. They will determine if you qualify for help in paying your medical and hospital bills. They may also help pay your Medicare premiums, deductibles, and co-insurance. Check the Helpful Contacts site for the phone number of your Medicaid office.

15. 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 Helpful Contacts site for the phone number of your State Insurance Department.

16. 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

  • 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 Helpful Contacts site for the phone number.

17. 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 begin 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.

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).

18. Does Medicare pay for dental services?

Medicare does not cover routine dental care or most dental procedures such as cleanings, fillings or tooth extractions 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 Helpful Contacts site for the phone number.

19. 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:

  • 65 or older; or

  • Disabled and receiving disability benefits from Social Security or the Railroad Retirement Board for 24 months; or

  • Have permanent kidney failure treated with dialysis or a transplant

You should contact the Social Security Administration to file an application. Check the Helpful Contacts site for the phone number of the Social Security Office in your area.

20. How do Medicare managed care plans work?

Medicare managed care plans are another way for you to receive Medicare benefits. All plans must provide all of the services that you would receive under Original Medicare with some added benefits.

You usually must use the doctors, hospitals and providers in the plan's network. You may have to pay a monthly premium to your health plan. However, you would not need a supplemental Medigap policy if you join a managed care plan.