Healthcare Advocates

EpicMed FAQs

Answers To Your Important Medicare Questions

1. What is Medicare?

Medicare is the federal health insurance program for:
• Most people age 65 and over
• Certain people younger than 65 with disabilities
• People with amyotrophic lateral sclerosis (ALS) , also known as Lou Gehrig's disease
• People with end-stage renal disease (ESRD) , also known as permanent kidney failure

2. If I am eligible for Medicare, how do I enroll?

If you are receiving Social Security or Railroad Retirement benefits, you may be automatically enrolled. If you are automatically enrolled, you don't need to pay a premium for Part A. For more information about automatic enrollment, see Medicare Enrollment or call Social Security at 1-800-706-4184. If you are not automatically enrolled, you can enroll by calling Social Security.

3. What does Medicare cover?

Medicare covers health care services and items that are medically necessary and reasonable as follows:
• Medicare Part A covers inpatient hospital stays, inpatient skilled nursing facility stays, home health care and hospice care.
• Medicare Part B covers outpatient medical services such as doctor visits, diagnostic lab tests and preventive care.
• Medicare Part D covers most prescription drugs.

For more information, see Medicare Basics.
Note: Medicare Part C refers to Medicare Advantage (MA) plans. An MA plan is an alternative to Original fee-for-service Medicare. MA plans are sponsored by Medicare, which pays private insurance companies to provide health services to beneficiaries who enroll in these plans. For more information, see Medicare Advantage.

4. How much does Medicare cost?

Medicare requires premiums, deductibles and other cost-sharing for certain services. For specific amounts, see our Medicare cost-sharing chart summary. Several assistance programs can help cover some or all of these costs for beneficiaries with limited income and assets. For more information, see Low-Income Help.

5. Medicare premiums and coinsurance rates for 2011?

The following is a listing of the Medicare premium, deductible, and coinsurance rates that will be in effect in 2011: Medicare Premiums for 2011:

Part A: (Hospital Insurance) Premium
- Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.

- The Part A premium is $248.00 per month for people having 30-39 quarters of Medicare-covered employment.
- The Part A premium is $450.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.

Part B: (Medical Insurance) Premium
Most beneficiaries will continue to pay the same $96.40 or $110.50 premium amount in 2011. Beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium and have incomes of $85,000 or less (or $170,000 or less for joint filers) will not have an increase in their Part B premium in 2011. For additional details, see our FAQ titled: "Will my Medicare Part B premium increase in 2011?"

For all others, the standard Medicare Part B monthly premium will be $115.40 in 2011, which is a 4.4% increase over the 2010 premium. The Medicare Part B premium is increasing in 2011 due to possible increases in Part B costs. If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $115.40 per month. For additional details, see our FAQ titled: "2011 Part B Premium Amounts for Persons with Higher Income Levels".

Medicare Deductible and Coinsurance Amounts for 2010:
Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2011 = $1,132) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.

For each benefit period you pay:
- A total of $1,132 for a hospital stay of 1-60 days.
- $283 per day for days 61-90 of a hospital stay.
- $566 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
- All costs for each day beyond 150 days

Skilled Nursing Facility Coinsurance
- $141.50 per day for days 21 through 100 each benefit period.

Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment) - $162.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $162.00 deductible.)

6. How can I get a Replacement Medicare card?

If you lose your card, you can obtain a replacement card by phone at 1-800-706-4184. Make sure you have your Medicare number ready when you call. You should receive your new card in about four weeks.

7.What diabetic supplies does Original Medicare cover?

Medicare covers the same supplies for both insulin and non-insulin dependent diabetics.

They include:
• Glucose testing monitor;
• Blood glucose test strips;
• Lancets;
• Spring powered devices for lancets
• Glucose control solutions
Some frequency limitations may apply. Medicare does not cover insulin and syringes. Contact your Durable Medical Equipment Regional Carrier for more information.

8. What is the difference between Medicare and Medicaid?

While Medicaid and Medicare sound similar, they are in fact very different programs. One of the biggest differences is Medicaid is a state governed program and Medicare is a federal governed program. Here are some other differences:

Medicaid is for low income:
•Pregnant women
•Children under the age of 19
•People 65 and over
•People who are blind
•People who are disabled
•People who need nursing home care

Application for Medicaid is at the State's Medicaid agency.
Medicare is for:
•People 65 and over
•People of any age who have kidney failure or long term kidney disease
•People who are permanently disabled and cannot work

Medicare is applied for at the local Social Security office.
Some people qualify for both Medicaid and Medicare, Medicaid is sometimes used to help pay for Medicare premiums.
People who qualify for both programs are called 'dual eligible'.

9. Who is eligible for Medicare?

Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Medicare has two parts, Part A (Hospital Insurance) and Part B (Medical Insurance). You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:

- You are receiving retirement benefits from Social Security or the Railroad Retirement Board.

- You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.

- You or your spouse had Medicare-covered government employment.

If you (or your spouse) did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A. If you are under age 65, you can get Part A without having to pay premiums if:

- You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months. (Note: If you have Lou Gehrig's disease, your Medicare benefits begin the first month you get disability benefits.)

- You are a kidney dialysis or kidney transplant patient.

While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.

10. How do Medicare managed care plans work?

Medicare managed care plans are another way for you to receive Medicare benefits. All plans must provide all of the services that you would receive under Original Medicare with some added benefits.
You usually must use the doctors, hospitals, and providers in the plan's network. You may have to pay a monthly premium to your health plan. However, you would not need a supplemental Medigap policy if you join a managed care plan.

11. Does Medicare pay for Prescription Drugs?

Generally, Original Medicare does not cover prescription drugs. However, Medicare does cover some drugs in certain cases such as immunosuppressive drugs (for transplant patients) and oral anti-cancer drugs. You should call your Durable Medical Equipment Regional Carrier for more information.

There are some Medicare Health Plans that cover prescription drugs. You can also check into getting a Medigap or supplemental insurance policy for prescription drug coverage. Medicaid may also help pay for prescription drugs for people who are eligible.