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Medicare Questions and Answers
- What is Medicare?
- Medicare is the health insurance program administered by the federal Centers for Medicare & Medicaid Services (CMS) for people 65 years of age or older, people of any age with permanent kidney failure, and some disabled individuals under age 65. Although Medicare may pay a large part of your health care expenses, it does not pay for them all.
- Who is eligible for Medicare?
- Medicare is available to people age 65 and older, younger people with disabilities and those who have End-Stage Renal Disease (kidney failure that requires kidney dialysis or transplant). You can also use this Medicare Eligibility Tool to determine when you can enroll in Medicare.
- How do I sign up for Medicare?
- The Social Security Administration handles
Medicare eligibility and enrollment. You can contact the Social Security
Administration at 1-800-772-1213 to enroll in Medicare or to ask questions about
whether you are eligible. You can also visit the Social Security website.
- What does Medicare Part A cover?
- Part A helps pay for some (but not all) inpatient hospital services and includes benefits for skilled nursing facilities, hospice care and some home health care. Custodial or long-term care is not covered. Under Medicare Part A, a period of hospitalization is called a benefit period. A benefit period begins the day you are admitted into a hospital. It ends when you have been out of the hospital or a nursing facility for 60 consecutive days. If you are re-admitted within that 60 days, you are still in the same benefit period and would not pay another deductible. If you are admitted to a hospital after that benefit period ends, an entirely new benefit period begins and a new deductible must be paid.
- What does Medicare Part A cost?
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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 $254.00 per month for
people having 30-39 quarters of Medicare-covered employment. -
The Part A premium is $461.00 per month for
people who are not otherwise eligible for premium-free hospital insurance and
have less than 30 quarters of Medicare-covered employment.
- What does Medicare Part B cover?
- Part B helps pay for some (but not all) medically-necessary doctors' services, outpatient care, durable medical equipment, physical and occupational therapy, home health care and preventive care. If you sign up for Part B coverage, the standard premium for 2010 is $96.40 per month. This amount is automatically taken out of your Social Security check each month. Part B has a $155 annual deductible and a 20% coinsurance charge for each doctor visit or qualified medical service.
- What does Medicare Part B cost?
- Most beneficiaries will continue to pay the same
$96.40 premium amount in 2010. 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 2010. For additional details, see our FAQ titled:
"Will my Medicare Part B premium increase in 2010?"
- For all others, the standard
Medicare Part B monthly premium will be $110.50 in 2010, which is a 15% increase
over the 2009 premium. The Medicare Part B premium is increasing in 2010 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
$110.50 per month. For additional details, see our FAQ titled: "2010
Part B Premium Amounts for Persons with Higher Income Levels".
- What are the Medicare Deductibles and co-payments for 2010?
- Part A (Hospitalization)
- $1,100 Deductible per Benefit Period
- $275 Co-payment per Day from the 61st to the 90th Day
- $550 Co-payment for days 91-150 of a hospital stay (Lifetime Reserve Days)
- All costs for each day beyond 150 days.
- Part A (Skilled Nursing Facility)
- $137.50 Co-payment per Day from the 21st to the 100th
- Part B (Medical)
- $155 Deductible per Calendar Year (Note: you pay 20% of the Medicare-approved amount for services after you meet the $155 deductible).
- What is Medicare Supplement insurance?
- Medicare Supplement insurance is a health plan to help cover the costs Medicare may or may not pay. As good as Medicare is, it was never intended to pay all your medical expenses. Most states have standardized Medicare Supplement plans. Additional options (riders) can be added to the plan to increase the benefits of the plan.
- What is Open Enrollment?
- Medicare Supplement insurance companies must make coverage available to you, regardless of your age, for six months beginning with the date you enroll in Medicare Part B. This six-month period is called the open-enrollment period. Insurance companies may not deny or condition the issuance of a policy on your health status, claims experience, receipt of health care, or medical condition.
- What is Guaranteed Issue?
- In addition to the open enrollment period, in some situations you have the right to enroll in a Medicare supplement policy regardless of your health status if your other health coverage terminates. The insurance company must offer you coverage if:
- Your Medicare Advantage or Medicare cost plan stops participating in Medicare or providing care in your service area.
- You move outside the plan's geographic service area.
- You leave the health plan because it failed to meet its contract obligations to you.
- Your employer group health plan ends some or all of your coverage.
- Your Medicare supplement insurance company ends your policy and you're not at fault.
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