MEDICARE

 

1-800-MEDICARE

 

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.

 

Eligibility Requirements

 

Part A (Hospital Insurance) 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.

 

Find Out If You Are Eligible

 

Costs

 

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 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.

 

Part A Costs: Most people don't pay a monthly premium for Part A (sometimes called "premium-free Part A"). If you buy Part A, you'll pay up to $437 each month. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $437. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $240.

 

Part A hospital inpatient deductible and coinsurance:

 

You pay:

 

  • $1,364 deductible for each benefit period

 

  • Days 1-60: $0 coinsurance for each benefit period

 

  • Days 61-90: $341 coinsurance per day of each benefit period

 

  • Days 91 and beyond: $682 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime)

 

  • Beyond lifetime reserve days: all costs

 

 

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 Your Medicare Coverage database.

 

Part B Costs: The standard Part B premium amount is $135.50 (or higher depending on your income). 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.

 

Part B deductible and coinsurance

 

$185 per year. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy, and Durable medical equipment (DME)

 

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. Visit your local Social Security office, or call the Social Security Administration at 1-800-772-1213 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.

 

You may have choices in how you get your health care including the Original Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare Private Fee-for-Service Plans.

 

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