Medicare - Frequently Asked Questions...

How to Select a Medicare Health Plan?

Who is eligible for Medicare?

I thought Medicare was always primary. How do you determine if Medicare is primary or secondary?

What are the Medicare premiums and coinsurance rates for 2008?

What are the differences between Medicare Parts A, B, C and D?

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

I have a Medicare Advantage Plan. The plan offers two options in 2008, one with drug coverage and one without.  If I choose the option without drug coverage, can I also join a Medicare Prescription Drug Plan?

 Before you buy health coverage, you should consider the following:

1. How much insurance protection do you want?

For example, how concerned are you about the possibility of unexpected or unusually high health costs? Even people in excellent health can have an unexpected event and suddenly have a lot of medical expenses. If you want this protection, it is important to protect yourself with good coverage before you are ill or have a change in health status.

The Original Medicare Plan has substantial cost sharing for many covered services and does not cover some types of health care (e.g., dental or prescription drugs). Therefore, many people with Medicare obtain some type of additional coverage beyond Original Medicare that protects them. Additional coverage that might be available to you could be:

• Retiree insurance coverage from a current or former employer or union;
• Medicaid and Medicare Savings Programs (for those with limited income and resources);
• Medicare Advantage Plans
• Medicare supplemental (Medigap) insurance;
• Medicare Prescription Drug Plans
• Veteran's benefits; or
• Military retiree benefits (e.g., Tricare for Life).

2. Do you want coverage for certain benefits, like prescription drugs or routine physical exams?

Determine the benefits of the most interest to you. The Original Medicare Plan does not cover extra benefits such as prescription drugs, routine physical exams, or dental services. In addition, many Medigap policies and Medicare Advantage plans do cover extra benefits. Check the Detailed Plan Report in this tool to see which options offer the benefits that are of interest to you.

3. How important is doctor choice to you?

• You can go to any doctor under the Original Medicare Plan but you may pay more if your doctor does not participate in Medicare (i.e., does not always take assignment).
• You can go to any doctor under the Original Medicare Plan with a Medigap policy*. Some Medigap policies even cover the extra charges you may be billed for if your physician does not accept assignment (these include Medigap Plans F, G, I, and J).
• Many Medicare Advantage plans require you to see a physician that is in the plan's network. Some Medicare Advantage plans allow you to see any physician but you may have to pay more (or you may have higher cost-sharing).

* If you enroll in a Medicare SELECT Medigap plan, you must use specific hospitals, and in some cases, specific doctors to get full benefits.

4. What do other people with Medicare think about the plan?

Medicare provides information on beneficiary satisfaction for the Original Medicare Plan and for Medicare Advantage plans. You can view this information under the Quality tab in this tool.

5. How do the plans compare on the quality of care they provide?

Medicare provides information on quality of care for Medicare Advantage plans. Medicare also provides some quality of care information for the Original Medicare Plan.

In most cases, Medicare is primary. Some of the most common situations where Medicare can pay secondary are:

1. The individual or his/her spouse is currently employed/working and covered under an employer group health plan as a result of current employment.
2. The company has 20 or more employees or participates in a multiple-employer or multi-employer group health plan where at least one employer has 20 or more employees.
3. The individual in question is entitled to Medicare as a result of a disability, the company has 100 or more employees, or participates in a multi-employer/multiple-employer group health plan where one employer has 100 or more employees.
4. The individual in question is Medicare entitled due to end-stage renal disease. Medicare is the secondary payer to a group health plan until a 30-month coordination period has ended.

The following is a listing of the Medicare premium, deductible, and coinsurance rates that will be in effect in 2008:

Medicare Premiums for 2008:

Part A: (Hospital Insurance) Premium

• Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
• The Part A premium is $216.00 for people having 30-39 quarters of Medicare-covered employment.
• The Part A premium is $423.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.

Part B: (Medical Insurance) Premium

$96.40 per month.

Medicare Deductible and Coinsurance Amounts for 2008:

Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2008 = $1024 during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.

For each benefit period you pay:

• A total of $1024 for a hospital stay of 1-60 days.
• $238 per day for days 61-90 of a hospital stay.
• $476 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
• All costs for each day beyond 150 days

Skilled Nursing Facility Coinsurance

• $124.00 per day for days 21 through 100 each benefit period.

Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)

• $135.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $135.00 deductible.)

What are the differences between Medicare Parts A, B, C and D?

There are four parts to Medicare: Medicare Part A, Hospital Insurance; Medicare Part B, Medical Insurance; Medicare Part C (Medicare Advantage), which was formerly known as "Medicare + Choice" and the new Medicare Part D, prescription drug coverage. Generally, people who are over age 65 and getting Social Security automatically qualify for Medicare Parts A and B. So do people who have been getting disability benefits for two years, people who have amyotrophic lateral sclerosis (Lou Gehrig's disease) and receive disability benefits, and people who have permanent kidney failure and receive maintenance dialysis or a kidney transplant.

Part A is paid for by a portion of Social Security tax. It helps pay for inpatient hospital care, skilled nursing care, hospice care and other services.

Part B is paid for by the monthly premiums of people enrolled and by general funds from the U.S. Treasury. It helps pay for doctors' fees, outpatient hospital visits, and other medical services and supplies that are not covered by Part A.

Part C (Medicare Advantage) plans allow you to choose to receive all of your health care services through a provider organization. These plans may help lower your costs of receiving medical services, or you may get extra benefits for an additional monthly fee. You must have both Parts A and B to enroll in Part C.

Part D (prescription drug coverage) is voluntary and the costs are paid for by the monthly premiums of enrollees and Medicare. Unlike Part B in which you are automatically enrolled and must opt out if you do not want it, with Part D you have to opt in by filling out a form and enrolling in an approved plan.

More information about all four parts of Medicare can be found at the Centers for Medicare and Medicaid Services website.

I did not apply for Medicare when I turned 65. Can I apply later?

An open enrollment period from January 1 through March 31 of each year permits people 65 or over who failed to enroll or dropped their Part B Medicare coverage to sign up. Their coverage will begin July 1.

Generally, a 10 percent premium penalty will be added to the monthly premium for each year they could have enrolled but did not. However, if you are covered by an employer or union group health plan through you or your spouse's current or active employment, you may qualify for a special enrollment period.

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

Yes. In certain cases, you can delay your Medicare Part B enrollment without having to pay higher premiums. If you didn’t take Medicare Part B when you were first eligible because you or your spouse were working and had group health plan coverage through your or your spouse’s employer or union, you can sign up for Medicare Part B during a Special Enrollment Period. You can sign up:

• Anytime you are still covered by the employer or union group health plan through your or your spouse’s current or active employment, or

During the 8 months following the month the employer or union group health plan coverage ends, or when the employment ends (whichever is first).

If you are disabled and working (or you have coverage from a working family member), the Special Enrollment Period rules also apply.

Effective date if you sign up during a Special Enrollment Period

If you enroll in Medicare Part B while covered by the group health plan or during the first full month after coverage ends, your Medicare Part B coverage starts on the first day of the month you enroll. You also can delay the start date for Medicare Part B coverage until the first day of any of the following 3 months.

If you enroll during any of the 7 remaining months of the Special Enrollment Period, your Medicare Part B coverage begins the month after you enroll.

Remember: If you do not enroll in Medicare Part B during your Special Enrollment Period, you'll have to wait until the next General Enrollment Period, which is January 1 through March 31 of each year. You may then have to pay a higher Medicare Part B premium because you could have had Medicare Part B and did not take it. Call the Social Security Administration at 1-800-772-1213 for more information or to enroll in Medicare. You can visit the Social Security web site. 

 I have a Medicare Advantage Plan. The plan offers two options in 2008, one with drug coverage and one without.  If I choose the option without drug coverage, can I also join a Medicare Prescription Drug Plan?

Who is eligible for Medicare?

Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Medicare has two parts, Part A (Hospital Insurance) and Part B (Medicare Insurance). You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:

• You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
• You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.
• You or your spouse had Medicare-covered government employment.

If you (or your spouse) did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A. If you are under age 65, you can get Part A without having to pay premiums if:

• You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months. (Note: If you have Lou Gehrig's disease, your Medicare benefits begin the first month you get disability benefits.)
• You are a kidney dialysis or kidney transplant patient.

While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. The monthly Part B premium in 2008 is $96.40. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.

To compare your Medicare Prescription Drug Plan choices, please call

Toll free number @ 888.995.2821 or Complete our Medicare Information Request Form.

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