1.  What is Medicare?

Medicare is the Federal health insurance program established in 1965 which is administered by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health Services. Medicare is health insurance for the following people:

• Age 65 or older;
• Under age 65 with certain disabilities who qualify for disability benefits from Social Security or Railroad Retirement Board (RRB);
• Any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant);

• Diagnosed with ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig’s disease) the month your disability benefits begin.

2.  How do I enroll in Medicare Part A (Hospital) and Part B (Medical)? 

•  If you aren’t getting Social Security or Railroad Retirement (RRB) benefits, you will need to sign up in one of three ways: 1) online at www.socialsecurity.gov; 2) call Social Security at 1-800-772-1213, or; 3) visit your local Social Security office.
•  In most cases, if you’re already getting benefits from Social Security or the Railroad Retirement Board (RRB), you will automatically get Part A and Part B starting the first day of the month you turn 65. If your birthday is on the first day of the month, Part A and Part B will start the first day of the prior month.
• If you’re under 65 and disabled, you automatically get Part A and Part B after you get Social Security disability benefits (SSDI) or certain disability benefits from the RRB for 24 months.

3.  What does Medicare Part A (hospital) cover?

• Inpatient care in hospitals;
• Inpatient care in a skilled nursing facility (not custodial or long-term care);
• Home health care services;
• Hospice care services;
• Blood.

4.  What does Medicare Part B (medical) cover?

• Doctor’s services and tests;
• Outpatient care;
• Home health care services;
• Durable medical equipment and other medical services;
• Ambulance services;
• Chiropractic services;
• Diabetes supplies;
• Preventive services.

5.  What is NOT covered by Medicare Part A and Part B?

Medicare doesn’t cover everything. If you need certain services that Medicare doesn’t cover, you will have to pay for them yourself unless you have other insurance to cover the costs. Even if Medicare covers a service or item, you generally have to pay deductibles, coinsurance, and copayments. Some of the items and services that Medicare does not cover include the following:

• Long-term care;
• Routine dental care;
• Dentures;
• Cosmetic surgery;
• Acupuncture;
• Hearing aids;
• Exams for fitting hearing aids.

6. What are Medicare Advantage (MA) plans (Part C plans)?

Medicare Advantage plans are offered by private insurance companies that contract with Medicare to provide Part A and Part B benefits to people with Medicare who enroll in the plan. MA plans in Lake, Mendocino, Marin, Napa, Solano, and Sonoma counties may include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee for Service (PFFS), and Special Needs Plans (SNPs). For more information on which companies and plans are offered in your county, a brief description of benefits, and the rules for joining, changing, or disenrolling from a plan, call the HICAP office at 1-800-434-0222.

NEW: In the fall of 2011, the Annual Enrollment Period (AEP) will change to October 15, 2011 ending on December 7, 2011. If you make a change during this period, your new coverage will begin on January 1, 2012.

7. What is Medicare Part D (Prescription Drug Plan)?

Medicare offers prescription drug coverage to everyone with Medicare. Even if you don’t take a lot of prescriptions now, you should still consider joining a Medicare Prescription Drug Plan (PDP). To get Medicare prescription drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered. If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, you will likely pay a late enrollment penalty. For a list of the stand-alone PDP plans in your county, call HICAP at 1-800-434-0222.

NEW: In the fall of 2011, the Annual Enrollment Period (AEP) will change to October 15, 2011 ending on December 7, 2011. If you make a change during this period, your new coverage will begin on January 1, 2012.

8. How can I get help paying for my prescription drugs?

You may qualify for “Extra Help”, also called the low-income subsidy (LIS), from Medicare to help pay prescription drug costs if your yearly income and resources are below the following limits in 2011:

• Single Person: Monthly income less than $1,361 and resources less than $12,640;
• Married Person Living with a Spouse and no other Dependents: Monthly income less than $1,839 and resources below $25,260.

The local HICAP office can assist you by completing an online application through Social Security’s website at www.socialsecurity.gov. Call HICAP at 1-800-434-0222 to have a counselor help explain the “Extra Help” program and complete the online application or call Social Security at 1-800-772-1213.

9. What other Low-Income programs are available?

You may qualify for the Medicaid (Medi-Cal in California) program or any of the Medicare Savings Programs (MSP) if you meet certain monthly income and asset levels. To find out more information about these programs, call HICAP at 1-800-434-0222 or go to this website’s Resource page for available programs in your county.

10. What are Medicare Supplement plans (Medigap plans)?

A Medigap policy, sold by private insurance companies, can help pay some of the health care costs (“gaps”) that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Medicare Parts A and B and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share. Medicare doesn’t pay any of the premiums for a Medigap policy. For more information on what companies sell Medigaps and the benefits for each of the ten plans available, call HICAP at 1-800-434-0222 and ask for the Medicare Supplement (Medigap) packet.

11. What if I am still covered by my Employer Group Health Plan when I become eligible for Medicare (either while I am still working or now that I have retired)?

Do you have, or are you eligible for other types of health insurance or prescription drug coverage (like from a former or current employer or union)? If so, read the materials from your insurer or plan, or call them to find out how the coverage works with Medicare. If you have coverage through a former or current employer or union or other source, talk to your benefits administrator, insurer, or plan before making any changes to your coverage. If you drop your coverage, you may not be able to get it back.

This website is not intended to address all of the myriad situations that can affect Medicare beneficiaries. One of the best resources for answers to your Medicare questions is reviewing the Medicare & You publication that you receive each year in September-October. You can pick one up at your local Social Security office or call Medicare at 1-800-Medicare (1-800-633-4227) to order a copy. See our Resource page for other informational websites and their phone numbers.