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Deciphering Medicare Coverage

   
 
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Medicare coverage can be confusing. Teresa Banda, Lead Benefits Counselor for the Bexar Area Agency on Aging Benefits Counseling Department, explained the different Medicare benefits at the May MS/Cancer Support Group conference call. The group is co-sponsored by the National MS Society and the American Cancer Society.

Banda said, "Medicare is health insurance for people 65 or older; people under 65 with certain disabilities; and people of any age with End-Stage Renal Disease."

Banda explained that different parts of Medicare help cover specific services.

Medicare Options

Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals and skilled nursing facility, hospice and home health care.

Medicare Part B (Medical Insurance) helps cover doctors' and other health care providers' services, outpatient care, durable medical equipment and home health care.

Medicare Part C, (Medicare Advantage), offers health plans run by Medicare-approved private insurance companies.

Medicare Part D (Medicare Prescription Drug Coverage) also is run by Medicare-approved private insurance companies, Part D helps cover the cost of prescription drugs, can help lower prescription drug costs and help protect against higher costs in the future.

Enrollment

When you reach retirement age, the earliest being age 62, you can begin receiving your Social Security Administration (SSA) retirement benefits. Upon reaching the age of 65, you automatically will be enrolled in Medicare A and B.

Banda said, "For those receiving SSA Disability benefits after the 24 month waiting period you, too, automatically will be enrolled in Medicare A and B."

If you live in one of the 50 states or Washington, D.C., you will be enrolled in Medicare Parts A and B automatically. If you currently are receiving Social Security retirement or disability benefits or railroad retirement checks, you will be contacted a few months before you become eligible.

After enrollment, you will receive a Medicare card showing you have Part A, Part B and the effective dates of your enrollment. During the initial enrollment period you have a seven month period that begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65. Usually a late fee will not apply for this period.

"After enrollment, you will receive a Medicare card showing whether you have Part A, Part B or both. When you first become eligible for hospital insurance (Part A), you have a seven-month period to sign up for medical insurance (Part B)," Banda said.

If you choose not to enroll in Medicare Part B due to current employment or that of a spouse, special enrollment period applies at the time that your group employment coverage ends.

If you do not enroll in Medicare Part B during your initial enrollment period, you can enroll each year between January 1 and March 31. Your coverage begins on July 1 of the year you enroll. The monthly premium increases 10 percent for each 12-month period you were eligible for, but did not enroll in, Medicare Part B.

Medicaid

Medicaid is a joint federal and state program that helps pay medical costs for some people with limited income and resources and meet other eligibility requirements. Medicaid may include benefits not usually covered by Medicare, such as help with personal care and rides to doctor appointments. If you qualify for Medicaid in your state, you automatically qualify to get help paying for Medicare prescription drug coverage.

You can request a copy of Medicare & You (Publication No. CMS-10050) at the Medicare toll-free number, 1-800-MEDICARE (1-800-633-4227) or go to www.medicare.gov.

The following are additional guides that Banda recommended to the MS/Cancer Support Group participants:

11579 - 2012 Medicare Costs
10110 - Guide to Medicare preventive services
11533 - Welcome to Medicare Preventive visit
11514 - A quick look at Medicare
02110 - Medigap 2012

Carol Smith
SmithEditing

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