FAQ

Who is eligible for Medicare assistance?

Medicare is available to U.S. citizens and permanent residents who are
65 years or older, younger people with certain disabilities, and those with
certain medical conditions.

Medicare Part A, which serves as hospital insurance, is available
without any premiums for U.S. citizens and permanent residents who are age 65
or older, provided that they, or their spouses, have paid Medicare taxes for at
least 10 years. For those who are under age 65, aren’t citizens or permanent
residents, and don’t have a qualifying medical condition, Medicare Part A may
still be available at cost.

What is the difference between Medicare and Medicaid?

Although they have similar names, the two programs are quite different
from one another. While Medicare is a federally sponsored program, Medicaid
works at the state level. Generally speaking, Medicaid is set up to benefit
low-income recipients, including pregnant women, minors, people who are blind
or disabled, and those who need nursing home care.

Although there are some people who qualify for assistance from both
Medicare and Medicaid (usually referred to in government literature as
“dual eligible”), it is still necessary to apply for benefits to the
appropriate agency. If you’d like to find out more about Medicaid, contact your
state office.

How do I apply for Medicare?

You can apply for Medicare coverage online through the Social Security
office at http://www.ssa.gov/medicareonly/ when you file
for retirement or disability assistance. Or, you can file for Medicare only if
you do not wish to start receiving your retirement benefits yet.

In addition to applying over the web, you can also make an appointment
over the phone by calling 1-800-772-1213. There is also a TTY number for the
hearing impaired, which is 1-800-325-0778.

You will automatically be enrolled in Medicare Parts A and B once you
start receiving Social Security. Since there is a fee for Part B coverage,
however, you will have the option of accepting or declining it. Remember also
that you will receive information in the mail about these programs and premiums
a few months before you become eligible.

I have specific questions about what Medicare covers, the bills my healthcare provider has sent to me, or the right way to file a claim for reimbursement

This site seeks to offer seniors some of the best and most
up-to-date information on Medicare, Social Security, and retirement, specific
questions about your coverage, or other details, are best directed to the
Medicare helpline at 1-800-MEDICARE (1-800-633-4227).

Operators on these lines speak both English and Spanish, and can provide
you with general Medicare information, provide answers about Part A and Part B
insurance coverage, and offer information about coverage choices, costs,
prescription plans, and other details.

Why do I read so much about prevention on Medicare sites like this one?

Preventing health problems, especially through a healthy diet and
exercise, can greatly reduce your chances of serious illness, lower your
medical and drug costs, and lead to a significantly higher quality of life. In
addition, Medicare programs will pay for many preventive services that help you
get and stay healthy. Talk to your doctor or healthcare provider to see if you
could be doing more to prevent future health issues by changing your living
habits now.

When am I eligible to join a Medicare drug plan?

Most of the time, you can join a Medicare drug plan when you are first
eligible to participate in any part of the Medicare plan. If you choose not to
join at that time, however, you may have to wait until later in the year
(usually between October 15 and December 7), and you may have to pay a penalty
and/or higher monthly premium for as long as you have Medicare prescription
coverage. So, anticipating Medicare enrollment and prescription costs should be
an important part of your retirement planning.

How do I pay my Medicare drug plan premiums?

Paying Medicare drug plan premiums is similar to paying any other bill.
You can pay through automatic transfer from your checking account, through a
credit or debit card, or have your premiums billed to you monthly. In some
cases, you may even be able to have your Medicare prescription premiums
deducted from your Social Security check, although these arrangements typically
have to be made three months in advance.

What is a “Medigap” policy?

This term typically refers to an insurance policy that a senior takes
out to cover “gaps” in their medical or prescription coverage. While
these have their own premiums and coverage limits, they can help avoid large
amounts of out-of-pocket expenses that can easily add up when there are serious
or ongoing health issues.

Another advantage to Medigap policies is that they may cover treatments,
procedures, and supplies that aren’t covered by Medicare, and may even offer
coverage outside the United States. While these policies are not mandatory for
seniors with Medicare coverage, they can often be a powerful tool for retirement
planning.

What is a Medicare Advantage Plan?

Also referred to as Medicare Part C, a Medicare Advantage Plan allows
you to choose a health plan that is offered by a private company, but is approved
by Medicare. In this situation, the healthcare provider receives payments from
Medicare, but may offer additional services, such as vision and dental care.