1966, residents 65 or older have been able to sign up
for Medicare, the federal government’s health plan for
seniors. But there are now private plans available, as
well as a drug plan, giving people more options — but
also raising more questions for beneficiaries.
P. Holzer, program manager for the Maryland Department
of Aging’s State Health Insurance Assistance Program,
offers answers to some of the most common questions
people have about the program.
When do you apply for Medicare, and if you work, do you
If you are retired, you have a seven-month initial
enrollment period to sign up for Medicare Part A and/or
Part B, which begins three months before the month you
turn 65, includes the month you turn 65, and ends three
months after the month you turn 65.
you are still working and are covered by an employer
group health plan, then you may be able to delay the
start of monthly Medicare Part B benefits (medical), but
it is generally recommended you consider enrolling in
Medicare Part A (hospital). Check with your employer’s
health benefits office and Social Security for the rules
regarding the Special Enrollment Period to sign up for
Medicare Part B. If you miss the Initial Enrollment
Period and are not entitled to a Special Enrollment
Period, then you may face penalties and delays in
getting your Medicare coverage.
you are under age 65 and on Social Security because of a
disability (SSDI), your Medicare coverage will begin
after you receive 24 months of cash payments.
How do you get the most out of Medicare, such as
accessing preventive and wellness care?
Medicare covers many preventive and wellness services,
such as annual wellness exams, mammograms, and flu
shots, for example, without co-payments. Check your
Medicare & You 2014 Handbook for a complete list of
preventive and wellness benefits available to all
What is the difference between Medicare and Medicare
Medicare is the federal government’s health insurance
coverage for people 65 or older, people under 65 with
disabilities and people of any age with end-stage renal
disease (permanent kidney failure requiring dialysis or
a kidney transplant). Medicare coverage consists of Part
A (hospital) and Part B (medical) services. Most
individuals pay monthly Medicare Part B premiums.
Advantage Plans (Part C) are a way to get your Medicare
coverage through a private plan. They are managed-care
plans and often referred to as HMOs and PPOs. Medicare
Advantage Plans are run by Medicare-approved private
insurance companies. They include all benefits covered
under Medicare A and B, and may cover prescription drugs
and extra benefits. Individuals pay monthly Medicare
Advantage Plan premiums.
What is a Medigap plan, and how do you know if you need
Medigap plans (Medicare supplemental plans) are sold by
private insurance companies and help pay some of the
health care costs that Medicare does not cover. …
Medigap plans do not offer prescription drug coverage.
Individuals pay monthly Medigap premiums. It is very
important to join a Medigap plan during your "open
enrollment period" — that is, six months from the
time your Medicare Part B begins. Different rules for
open enrollment apply for Medicare beneficiaries under
and over the age of 65 regarding which plans you may
you consider purchasing a Medicare Advantage Plan (Part
C) or buying a Medigap plan, then note that the start
date for Medigap coverage or a Medicare Advantage Plan
should coincide with the start date for Medicare.
Will Medicare cover all of my medications?
Medicare does not cover most outpatient prescription
drugs. There is some limited specific coverage of
medications under Medicare Part A and Medicare Part B.
Medicare offers prescription drug coverage to everyone
with Medicare. A Medicare Part D Prescription Drug Plan
or Medicare Advantage Plans offer prescription drug
coverage. Medicare Part D plans are run by
Medicare-approved private insurance companies. Not all
medications are covered by all the Part D or Medicare
Advantage Plans. Visit the Medicare plan finder at the
federal website Medicare.gov, and do a search to
determine whether your medications are covered and to
find out the plan cost.
Do Medicare Part A and B and Medigap supplemental plans
have separate premiums?
Many people receive Medicare Part A (hospital) coverage
free of charge if they have worked the appropriate
number of quarters under Social Security. Most people
pay a monthly Medicare Part B (medical) premium ($104.90
monthly in 2014). Medigap, Medicare Advantage and
Medicare Part D premiums are paid to the private
insurance company sponsoring the plan.
are several financial assistance programs available for
people who meet specific eligibility criteria to help
pay for Medicare Part A premiums, deductibles and
co-payments; Medicare Part B premiums and deductibles;
Medicare Part D premiums and prescription drug
co-payments; and Medicare Advantage costs.
How do you find the best doctors and specialists who
Ask your medical providers if they accept Medicare and
if they accept Medicare-assigned payments. The Medicare
website, Medicare.gov, lists doctors and specialists in
your area and whether they accept Medicare assignment.
Does Medicare cover nursing home care?
Medicare covers semiprivate rooms, meals, skilled
nursing and rehabilitative services, and other medically
necessary services and supplies after a
three-day-minimum medically necessary inpatient hospital
stay for a related illness or injury. There are
co-payments and limits on the number of coverage days
for nursing home care. To qualify for care in a skilled
nursing facility, your doctor must certify that you need
daily skilled care like intravenous injections or
physical therapy. Medicare doesn’t cover long-term
care or custodial care.