Medicare is a federal health insurance program for people 65 and older, and for eligible people who are under 65 and disabled. Medicare is run by the Centers of Medicare and Medicaid Services, an agency of the U.S. Department of Health and Human Services. It is controlled by Congress. Medicare was never intended to pay 100% of medical bills. Its purpose is to help pay a portion of medical expenses. Medicare beneficiaries
also pay a portion of their medical expenses, which includes deductibles, copayments, and services not covered by Medicare. There are four parts to Medicare: To receive Medicare, you must be eligible for Social Security benefits. Most people age 65 or older are eligible for Medicare Part A (Hospital Insurance) based on their own employment, or their spouse's employment. Most people have enough Social Security credits to get Part A for free. Others must purchase it. You are eligible for Medicare Part A if you meet one of the following criteria: If you are under 65, you are eligible for Medicare Part A if you meet one of the following criteria: If you are eligible for Part A, you can enroll in Medicare Part B
(Medical Insurance) which has a monthly premium. Back to top You apply for Medicare with the Social Security Administration. Contact the Social Security Administration in the way that is most convenient for you. Yes. You will need to have proof of your age, such as a birth certificate, your previous year's W-2 form or tax return, and
possibly other proof. Call Social Security ahead of time to find out what proof you will need. Back to top There are several ways to enroll in Medicare: Automatic Enrollment Initial Enrollment
Did You Miss The Initial Enrollment Period?General Enrollment If you did not enroll during the three months prior to your 65th birthday, the month of your 65th birthday, or the three months after your 65th birthday, you must wait for a General Enrollment period. The General Enrollment period is January 1 through March 31 of each year. Your Medicare coverage will begin July 1 of that year. You will pay a Part B Late Penalty: 10% surcharge for each year you are late in enrolling. This penalty continues forever. For example, if you enrolled four years late, then you will pay a 40% surcharge for every year that you buy Part B. Are You Covered By An Employer Group Health Plan?Special Enrollment If you continue to work past age 65 and are covered by an employer group health plan, or if you are covered under an employer group health plan of an actively working spouse, you can delay enrollment in Medicare without penalty. Enroll in Medicare Part A when you turn 65 (remember: it is usually free!). When you, or your spouse retires, or your active employment health insurance ends, you have eight months to enroll in Medicare Part B without any penalty. Note: Health plans offered as a retiree benefit are not considered active employment group health plans. If you are in doubt about when to enroll, contact the Social Security Administration. Back to top What does Medicare cover?Medicare helps pay for certain health care services and durable medical equipment. To have full Medicare coverage, Medicare beneficiaries must have Part A (Hospital Insurance) and Part B (Medical Insurance). The following is a partial list of Medicare-covered services. The covered services listed below may require payment of deductibles and Co-Payments. If you have questions about covered services, call Medicare at 1-800-633-4227. Part A CoverageInpatient Hospital Care
Inpatient Skilled Nursing Facility Care
Inpatient Psychiatric Care
Home Health Care
Hospice Care
Part B Coverage
Preventive Services
Services not covered by Medicare
Services rendered outside the United States (Canada and Mexico may be exceptions) If you have questions about covered services, call Medicare at 1-800-633-4227. Back to top How much does Medicare cost?Original MedicareOriginal Medicare is divided into Part A (Hospital Insurance) and Part B (Medical Insurance).
Part A - Monthly PremiumIf you are eligible, Part A is free because you or your spouse paid Medicare taxes while you were working. You earn Social Security "credits" as you work and pay taxes. For each year that you work, you earn 4 credits.
You are 65 or older, and you receive or are eligible to receive full benefits fr om Social Security or the Railroad Retirement Board You are under 65, and you have received Social Security disability benefits for 24 months You are under 65, and you have received Railroad Retirement disability benefits and you meet Social Security disability requirements You or your spouse had Medicare-covered government employment You are under 65 and have End-Stage Renal Disease If you do not qualify for premium-free Part A, you may be able to buy it. Contact the Social Security Administration at 1-800-772-1213 for more information. Part A - Deductibles and CopaymentsHospital Deductible
Hospital Stay CopaymentIn 2022:
Skilled Nursing Facility Co-PaymentIn 2022:
Usually, a Medicare Supplement policy will pay for Part A deductibles and Co-Payments. Part B - Monthly Premium 2022
Part B - Deductibles and CopaymentsAnnual Deductible
Copayments
Doctors and other providers who accept assignment agree to accept the Medicare-approved amount for a service. Providers who do not accept assignment may charge you a 15% surcharge. You would be responsible for paying the surcharge (or limiting charge) as well as any copayments. Therefore, you should always ask a provider to accept the assignment. For a list of providers in Indiana who accept assignment, contact 1-800-MEDICARE. Some Medicare Supplement policies help pay Part B deductibles and Copayments. Back to top Should I take Medicare Part B?You should take Medicare Part A when you are eligible. However, some people may not want to apply for Medicare Part B (Medical Insurance) when they become eligible. You can delay enrollment in Medicare Part B without penalty if you fit one of the following categories.
Employer group health plans may cover items normally not covered by Medicare Part B. If so, and you meet one of the categories above or below, then you may not need to enroll in Medicare Part B and pay the monthly premium. If you are:
and choose coverage under the employer group health plan, you can refuse Medicare Part B during the automatic or initial enrollment period. You wait to sign up for Medicare Part B during the special enrollment period, an eight month period that begins the month the group health coverage ends or the month employment ends, whichever comes first. You will not be enrolling late, so you will not have any penalty. If you choose coverage under the employer group health plan and are still working, Medicare will be the "secondary payer," which means the employer plan pays first. If the employer group health plan does not pay all the patient's expenses, Medicare may pay the entire balance, a portion, or nothing. An employer group health plan must be primary or nothing. They are NOT allowed to offer Medicare supplemental coverage to people who are actively employed--unless the company has under 20 employees, or if disabled, under 100 employees. Back to top What are my rights as a Medicare beneficiary?As a Medicare beneficiary, you have certain guaranteed rights. These rights protect you when you get health care, they assure you access to needed health care services, and protect you against unethical practices. You have these rights whether you are in Original Medicare or another Medicare health plan. Your rights include, but are not limited to:The Right to Receive Emergency CareIf you have severe pain, an injury, or a sudden illness that you believe may cause your health serious danger without immediate care, you have the right to receive emergency care. You never need prior approval for emergency care, and you may receive emergency care anywhere in the United States. The Right to Appeal Decisions About Payments or Services for Medical CareIf you are enrolled in Original Medicare, you have the right to appeal denial of a payment for a service you have been provided. If you are enrolled in another Medicare health plan, you have the right to appeal the plan's denial for a service to be provided. The Right to Information About All Treatment OptionsYou have the right to know about all your health care treatment options from your health care provider. Medicare forbids its health plans from making any rules that would stop a doctor from telling you everything you need to know about your health care. If you think your Medicare health plan may have kept a provider from telling you everything you need to know about your health care options, then you have the right to appeal. The Right to Know How Your Medicare Health Plan Pays Its DoctorsYou must request this information. If you request information on how a Medicare health plan pays its doctors, then the plan must give it to you in writing. You also have a right to know whether your doctor has a financial interest in a health care facility since it could affect the medical advice he or she gives you. Your other rights include:
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