Medicare
Overview
Part A & Part B
General Enrollment Period
Medicare Part D Enrollment
Gap Coverage
Help to Pay for Healthcare Costs
Links
Overview
The Centers for Medicare & Medicaid Services (CMS) administers Medicare, the nation's largest health insurance program, which covers nearly 40 million Americans. Medicare is a Health Insurance Program for people 65 years of age and older, some disabled people under 65 years of age, and people with End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant).
Medicare Has Two Parts:
Helps Pay For: Care in hospitals as an inpatient, critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas), skilled nursing facilities, hospice care, and some home health care. Information about your coverage under Medicare Part A can be found in the Your Medicare Coverage database.
Cost: Most people get Part A automatically when they turn age 65. They do not have to pay a monthly payment called a premium for Part A because they or a spouse paid Medicare taxes while they were working.
If you (or your spouse) did not pay Medicare taxes while you worked and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show "Hospital Part A" on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call or visit your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772.
Helps Pay For:
Doctors' services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. Information about your coverage under Medicare Part B can be found in the Your Medicare Coverage database.
Cost:
You pay the Medicare Part B premium of $88.50 per month in 2006. This amount may change January 1, 2007. In some cases this amount may be higher if you did not choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you could have had Part B but did not sign up for it, except in special cases. You will have to pay this extra 10% for the rest of your life.
Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Please call the Social Security Administration at 1-800-772-1213 or visit or call your local Social Security office to sign up. If you choose to have Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not get any of the above payments, Medicare sends you a bill for your Part B premium every 3 months. You should get your Medicare premium bill by the 10th of the month. If you do not get your bill by the 10th, call the Social Security Administration at 1-800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772.
General Enrollment Period
If you did not take Part B when you were first eligible for Medicare, you may sign up during the General Enrollment Period. The General Enrollment Period runs from January 1 through March 31 of each year.
Remember, the cost of your Part B may go up 10% for each 12-month period that you could have had Part B but did not take it, and you will have to pay this extra amount as long as you have Part B, except in special cases.
If you already have Medicare Part A and need Part B you can sign up for Part B at your local Social Security office or by calling 1-800-772-1213.
For more information on how delaying enrollment in Medicare Part B could result in paying higher Part B premiums, see our FAQ: What if I'm over 65 and didn't enroll in Part B during my Initial Enrollment Period?
For more information on delaying enrollment in Medicare Part B if you or your spouse is still working, see our FAQ: Can I delay my Medicare Part B enrollment without paying higher premiums? If you can delay your enrollment because you or your spouse are still working, the General Enrollment Period will not affect you until after you (or your spouse) stop working.
If you are a military retiree or the spouse or dependent child of either a military retiree or an active duty sponsor, see our FAQ: How does the Medicare Prescription Drug Improvement and Modernization Act impact enrollment in Medicare Part B for military retirees or the spouse or dependent child of either a military retiree or an active duty sponsor?
Medicare Part D Enrollment
The Open Enrollment Period (OEP) for Medicare's Part D Prescription Drug Coverage continues through December 31. However, anyone making a change should do so by December 8th, 2006. This will help ensure that prescriptions are covered on January 1.
About that Coverage Gap - many health insurance plans have limits on how much they will cover for prescription drugs. Medicare drug plans are no different. The good news is that Medicare drug plans provide special coverage if you have an unexpected illness or injury that results in extremely high drug costs. It assures that once you have paid $3,600 out-of-pocket for drug costs in a calendar year, almost all of your drug costs above that amount are covered.
For additional information, you can review the Bridging the Coverage Gap (PDF 132.71 KB) fact sheet.
Help to Pay Your Healthcare Costs
Most of your health care costs are covered if you have Medicare and you qualify for Medicaid. Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. People on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on cms.hhs.gov.
States also have programs that pay some or all of Medicare's premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have:
Links
www.medicare.gov
You can also get information on a wide range of programs that may assist you with your prescription drug and other health care costs in our Medicare Prescription Drug Plan Finder tool.