The A-B-C-D’s of Medicare

A

Part A: Hospital/Inpatient Insurance

Part A helps pay for your care while you are in the hospital. It also pays some of the costs if you stay in a skilled nursing facility after a hospitalization and if you have a medical need for limited, skilled health care at home. You can’t be turned down because of your medical history or pre-existing illness.

B

Part B: Outpatient Health Insurance

Part B helps pay for doctors’ services, outpatient hospital care, and home health care that Part A does not pay for. It also provides coverage for laboratory tests, ambulance services, and many screenings and preventive services that can help you to stay healthy, including a Welcome to Medicare Exam and Annual Wellness Visits. A monthly premium is charged for Part B services.

C

Part C: Medicare Advantage (MA)

Medicare Advantage plans (sometimes called Part C) are private insurance plans that deliver Medicare Part A and Part B coverage. Some of these plans also provide Medicare drug coverage. Medicare Advantage plans also may cover additional services that Original Medicare does not pay for—for example, coverage for vision and hearing care. Most Medicare Advantage plans have a network of doctors and hospitals.

D

Part D: Prescription Drug Coverage

Medicare Part D helps you pay for your prescription drugs. If you have or are eligible for Medicare Part A or Part B or have both, you are eligible to join a Part D plan. You must join a private insurance plan to get Medicare’s drug coverage. There is no screening for pre-existing conditions. Plans must accept everyone who is eligible and enrolls, but you can only join at certain times of the year. Most people can join or change Part D plans during the Annual Election Period from October 15th through December 7th, with coverage starting on January 1, 2022.

Medicare Contact Information:

800-633-4227, www.medicare.gov

Register and keep track of your personalized Medicare benefits and services at: www.medicare.gov

 

Medicare Enrollment:

If you are not drawing Social Security you can enroll in Medicare by doing the following 90 days prior to when you want your Part B(Medical) to start:

  1. Register online at: www.socialsecurity.gov/medicareonly
  2. Call Social Security at 800-772-1213
  3. Visit your local Social Security office and register in person

Applying for Medicare Part B after 65:

If you have PART A (Hospital) but did not apply for your PART B (Medical) when you turned 65 because you were still working and covered under your employers group coverage or you were covered under your spouse’s group coverage because they were still working, here are the 2 forms you will need and instructions on what to do:

  1. Have the company or HR department under which you have the group insurance coverage fill out the CMS-L564 Form. This will show Social Security that you were covered since you were 65 under credible coverage. You can visit your local Social Security office with the completed form up to 90 days prior to you needing your Part B (Medical) to start. Here is the link to that form you can print off: https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS-L564E.pdf
  2. You will also need to complete the CMS-40B form which is the application for your Part B (Medical) up to 90 days prior to you needing it to start. You will turn this completed form along with the CMS-L564 completed form into your local Social Security office. Here is the link to that form you can print off: www.swcaa.org/wp-content/uploads/2014/01/CMS-40B_508.pdf
  3. You are done!!! Welcome to MEDICARE with your Part A (Hospital) and now your Part B (Medical) referred to as ORIGINAL MEDICARE.

Apply for Social Security Benefits Online:

www.socialsecurity.gov/planners/about.htm

Apply for Railroad Retirement:

You can check eligibility or apply for Medicare by calling: 877-772-5772, www.rrb.gov

Medicare and You Handbook:

https://www.medicare.gov/pubs/pdf/10050-Medicare-and-You.pdf

Replace a Medicare Card:

https://secure.ssa.gov/apps6z/IMRC/main.html

Extra Help with Medicare Prescription Drug Plan Costs:

  • Medicare beneficiaries may qualify for Extra Help also called LIS (Low Income Subsidy) for their prescription drug costs premiums if they have limited resources and income. The below information may change so be sure to get updated information by call 800-772-1213 or by going to the following link: http://www.socialsecurity.gov/prescriptionhelp
  • Single person—Income less than $17,235 and resources less than $13,300 per year
  • Married person living with a spouse and no other dependents—Income less than $23,265 and resources less than $26,580 per year

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