Medicare: Frequently Asked Questions

What is Medicare?

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 is a Health Insurance Program for:

• People 65 years of age and older
• Some people with disabilities under age 65
• People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant)

Medicare has Two Parts:

• Part A (Hospital Insurance) -- most people do not have to pay for Part A
• Part B (Medical Insurance)-- most people pay monthly for Part B

If you want to know more about Medicare, please click here to visit the government's official Medicare site.

What is Medicare Part A?

Part A (Hospital Insurance)

Part A Helps Pay For:

Care in hospitals as an inpatient, critical access hospitals (small hospitals that give limited outpatient and inpatient services to people in rural areas), goodd nursing services, hospice care, and some home health care.  Information about your coverage under Medicare Part A can be found in the 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.

What is Medicare Part B?

Part B (Medical Insurance)

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 Medicare Coverage database.

Cost:

You pay the Medicare Part B premium of $66.60 per month in 2004.  This amount may change January 1, 2004.  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.

Who can get Medicare?

Generally, you can get Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States.  You might also qualify for coverage if you are a younger person with a disability or with End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant).

Here are some simple guidelines.  You can get Part A at age 65 without having to pay premiums if:

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

If you are under 65, you can get Part A without having to pay premiums if:

• You have received Social Security or Railroad Retirement Board disability benefit for 24 months
• You are a kidney dialysis or kidney transplant patient

Note: You can get Medicare when you turn 65 even if you are are not receiving or if you cannot get Social Security retirement benefits.  For more information, please visit Medicare's retirement age FAQ.

If you have questions about your eligibility for Medicare Part A or Part B, or if you want to apply for Medicare, please call the Social Security Administration toll-free at 1-800-772-1213 or visit or call your local Social Security office.  The TTY-TDD number for the hearing and speech impaired is 1-800-325-0778.  You can also get information about buying Part A as well as Part B if you do not qualify for premium-free Part A.

When should I sign up for Medicare?

If you’re already getting Social Security retirement or disability benefits or railroad retirement checks, you will be contacted a few months before you become eligible for Medicare and given the information you need.  You will automatically be enrolled in Medicare Parts A and B.  However, because you must pay a premium for Part B coverage, you have the option of turning it down./p>

If you aren’t already getting retirement benefits, you should contact Social Security Administration about three months before your 65th birthday to sign up for Medicare.  You can sign up for Medicare even if you don’t plan to retire at age 65.  You also should contact Social Security about applying for Medicare if:

• You’re a disabled widow or widower between age 50 and age 65 but haven’t applied for disability benefits because you’re already getting another kind of Social Security benefit
• You’re a government employee and became disabled before age 65
• You, your spouse or your dependent child has permanent kidney failure
• You had Medicare medical insurance in the past but dropped the coverage
• You turned down Medicare medical insurance when you became entitled to hospital insurance

Initial Enrollment Period:

When you first become eligible for hospital insurance (Part A), you have a seven-month period to sign up for medical insurance (Part B).  This is called your "initial enrollment period."  If you are eligible at age 65, your initial enrollment period begins three months before your 65th birthday, which includes the month you turn age 65 and ends three months after that birthday.  If you can get Medicare based on disability or permanent kidney failure, your initial enrollment period depends on the date your disability or treatment began.

If you already receive retirement or disability benefits, you will be automatically enrolled in Part B when you become entitled to Part A.  However, because you must pay a premium for Part B coverage, you have the option of paying for the coverage or turning it down.

When Does My Enrollment In Part B Become Effective?

If you accept the automatic enrollment in Medicare Part B, or if you enroll in Medicare Part B during the first three months of your initial enrollment period, your medical insurance protection will start with the month you are first eligible.  If you enroll during the last four months, your protection will start from one to three months after you enroll.  Click here to view a chart that shows when your Medicare Part B becomes effective.

General Enrollment Period:

If you don’t enroll in Medicare Part B during your initial enrollment period, you have another chance each year to sign up during a "general enrollment period" from January 1 through March 31.  Your coverage begins the following July.  However, your monthly premium increases 10 percent for each 12-month period you were eligible but didn’t enroll.

If you want more information about when you should sign up for Medicare, visit Medicare's official site by clicking here.

How much does Medicare cost?

In addition to the monthly premiums you pay, there are other “out-of-pocket” costs for Medicare.  These are the amounts you pay when you actually receive medical services, known as "deductibles" and "coinsurance."

For example, if you are hospitalized, you will be required to pay a deductible amount, and may have to pay coinsurance amounts, depending on how long you stay.  If you receive medical services from a doctor, you pay a yearly deductible amount as well as a coinsurance amount for each visit.  Click here to see the details of what Medicare covers.

The monthly premiums, deductibles and coinsurance for Medicare change each year.  You can find out the current amount of these Medicare charges by contacting your local Social Security office or calling Social Security’s toll-free number 1-800-772-1213.

If I am not a U.S. citizen, can I still enroll in the Medicare program?

If you are not a U.S. citizen or a lawfully admitted alien who has lived in the U.S. continuously for a five-year period, please contact the Social Security Administration at 1-800-772-1213 for your Medicare enrollment and eligibility.

Where can I get more information?

If you want more detailed information about Medicare, please vist the official Medicare website by clicking here.  If you have a question, you can ask it to the Social Security Administration from this computer by email or by phone or by clicking here.  If you speak Spanish, please click here.