Top 20 Medicare/Medicaid Questions and Answers

The following 20 questions and answers are the most frequently asked questions by callers to the Medicare + Choice toll free line for the time period from February 1, through February 28, 2001. 

1. How can I get a Replacement Medicare card?

If you lose your card, you can obtain a replacement card by phone at 1-800-772-1213, or online at the Social Security Administration web site. Make sure you have your Medicare number ready when you call. You should receive your new card in about four weeks.

2. How can I find out if I have Medicare coverage?

You must call the Social Security Administration at 1-800-772-1213 or contact your local Social Security Office to verify your Medicare Part A and Part B coverage. This information can also be found on your red, white, and blue Medicare card.

3. I can't afford my Medicare premiums. What can I do?

If your income is limited, your State may help pay your Medicare costs such as your premiums and deductibles. Check the Helpful Contacts section of this web site for the phone number of your State Medical Assistance Program. They can help you determine if you are qualified.

If you have Medicare Part A, your income is limited, and your financial resources such as bank accounts, stocks, and bonds are not more than $4,000 for an individual, or $6000 for a couple, you may qualify for assistance as a Qualified Medicare Beneficiary or Specified Low Income Medicare Beneficiary.

The Qualified Medicare Beneficiary Program (also known as QMB) pays the Medicare monthly Part B premium, deductibles and coinsurance. In most states, the 2000 monthly income limits are $716 for an individual and $958 for a couple.

The Specified Low Income Medicare Beneficiary Program (also known as SLMB) helps pay the Medicare monthly Part B premium for qualified Medicare beneficiaries. In most states, the 2000 Monthly Income Limits are $855 for an individual and $1145 for a couple.

4. Will I automatically be enrolled in Medicare when I turn 65?

If you are receiving Social Security or Railroad Retirement or disability benefits, you will be automatically enrolled in Medicare Part A and Part B. About 3 months prior to your 65th birthday or 24th month of disability, you will be sent an Initial Enrollment Package that will contain information about Medicare, a questionnaire and your red, white and blue Medicare card. If you want both Medicare Part A (hospital insurance) and Part B (medical insurance), you should sign your Medicare card and keep it in your wallet. If you don't want Part B coverage, you must put and X in the refusal box on the back of the Medicare card form; sign the form and return it with the card to Social Security at the address shown. You will then be sent a new Medicare card showing that you only have Part A.

5. Does Medicare pay for dental services?

Medicare does not cover routine dental care or most dental procedures such as cleanings, fillings, tooth extractions or dentures. There are rare cases in which Medicare Part B will pay for certain dental services. In addition, there are some situations in which Medicare Part A will pay for certain dental services delivered on an inpatient basis. You should contact your local Carrier for more information.

6. Who submits my bills to Medicare? How much do I have to pay?

If you are in Original Medicare, your doctor or other health care provider will file your claim with Medicare. You'll receive a statement showing how much you'll need to pay. If you do not receive a Medicare statement (Medicare Summary Notice or Explanation of Medicare Benefits), you'll need to contact your local carrier to have them send you a copy. If you have supplemental insurance or Medigap, they may pay part of your costs. Check with your supplemental insurance company to find out what they will pay.

7. What is Medicare?

Medicare is a Federal health insurance program for people 65 years or older, certain people with disabilities, and people with permanent kidney failure treated with dialysis or a transplant. Medicare has two parts - Part A which is hospital insurance, and Part B which is medical insurance.

8. Who do I contact to change my name and address for Medicare purposes?

If you have had a recent name or address change, it will need to be reported to the Social Security Administration. Social Security will notify Medicare of the change when they change their records.

If you are in the Original Medicare Plan, you should also notify the Part B carrier of your new name or address change. The carrier processes your claims for doctor bills and other medical expenses.

If you are in a Medicare managed care plan, you should contact your plan of any name or address changes.

9. What is Medicare + Choice?

Medicare + Choice is a term used to describe the various health plan options available to Medicare beneficiaries.

10. How can I leave a Medicare Health Plan?

You can leave a plan in one of 3 ways. You can:

In most cases, you are disenrolled the month after your request is made as long as your request was filed before the 10th day of the month. If your request was made after the 10th of the month, you will be disenrolled the first day of the second calendar month after your request was made. You do not need to fill out a disenrollment form if you decide to join another managed care plan. You will be automatically disenrolled from your old plan when your new plan enrollment becomes effective.

11. What medical supplies and equipment does Medicare
Part B cover?

Medicare Part B helps pay for durable medical equipment such as oxygen equipment, wheelchairs, and other medically necessary equipment that your doctor prescribes to use in your home. Other items covered by Medicare include:

Medicare pays for different kinds of durable medical equipment in different ways. Some equipment must be rented, other equipment must be purchased. Your Durable Medical Equipment Regional Carrier can provide more specific information.

12. 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.

13. I didn't enroll in Medicare Part B when I turned 65 because I was still working. Can I enroll now?

You qualify to enroll in Medicare during a Special Enrollment Period if you delayed enrolling in Part B because you were working and had group health insurance through your employer or your spouse's employer. If you sign up during the Special Enrollment Period, you do not have to pay the Part B premium surcharge. Signing up for Medicare Part B will begin your 6 month open enrollment period for buying a Medigap policy. You can enroll in Part B:

You should contact the Social Security Administration to file an application.

14. I originally refused Medicare Part B when I turned 65.
Can I enroll now?

Anyone who has refused, terminated, or withdrawn from Medicare Part B or Premium Free Part A coverage can enroll again. You can enroll during January, February, or March of each year. This is referred to as the General Enrollment Period. Your Medicare coverage will not begin until July 1st. You may or may not have to pay a premium surcharge. Call the Social Security Administration at 1-800-772-1213 for an appointment or visit your local Social Security Office to file an application. They will also tell you the amount of any premium surcharge you may have to pay.

15. What is a Medigap policy?

Supplemental insurance policies are sometimes called Medigap plans. Medigap plans are private health insurance policies that cover many of the costs the Original Medicare Plan does not cover. Some Medigap policies will cover services not covered by Medicare such as prescription drugs. Medigap has 10 standard plans called Plan "A" through Plan "J". Each plan has a different set of benefits. Your State Insurance Department can answer questions about the Medigap policies sold in your area. Check the Helpful Contacts section of this web site for the phone number of your State Insurance Department.

16. Who is eligible for Medicare Part A (Hospital Insurance)?

If you have worked at least 10 years in Medicare covered employment you will qualify for premium free Medicare Part A (Hospital Insurance). To qualify, you must be:

1. 65 or older; or
2. Disabled and receiving disability benefits from Social Security or the Railroad Retirement Board for 24 months; or
3. Have permanent kidney failure treated with dialysis or a transplant

You should contact the Social Security Administration to file an application.

17. What types of services are covered under Medicare
Part B?

Medicare Part B helps pay for doctors’ services, outpatient hospital care, blood, medical equipment and some home health services. It also pays for other medical services such as lab tests and physical and occupational therapy. Some preventive services such as mammograms and flu shots are also covered.

Medicare Part B does NOT cover routine physical exams; eye glasses; custodial care; dental care; dentures; routine foot care; hearing aids; orthopedic shoes; or cosmetic surgery. It also does not cover most prescription drugs or health care you get while traveling outside the United States (except under limited circumstances).

18. What diabetic supplies does Original Medicare cover?

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

Some frequency limitations may apply. Medicare does not cover insulin and syringes. Contact your Durable Medical Equipment Regional Carrier for more information. Check the Helpful Contacts section of this web site for the phone number.

19. What is a Medicare deductible?

A deductible is the amount you must pay each year before Medicare begins paying its portion of your medical bill. There are deductibles for both the Part A (Hospital Insurance) and Part B (doctor services) portions of Medicare. Your deductible is taken out of your claims when Medicare receives them. Medicare will not start paying on your claims until you have met your annual deductible.

The Medicare Part A deductible for 2001 is $792.00 per benefit period. The Medicare Part B deductible for 2001 is $100.00. If you have any questions on the status of your deductible please contact your Medicare carrier.

20. 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.