Medicare Part D (Prescription Drug Benefit)
HMO members should have received information directly from the HMO plan.
Medicaid participants (through the NV Welfare Department) will receive extra assistance.
Be sure to compare different plans each year to see what's right for you. SHIP can help you!
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What is Medicare?
Medicare is a federal health insurance program for people age 65 and older, people of any age with permanent kidney failure, and certain disabled people under age 65. Medicare is managed by the Centers for Medicare and Medicaid Services (CMS), which is part of the Department of Health and Human Services.
Medicare Is a Health Insurance Program for:
Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are a younger person with a disability or with chronic kidney disease.
While you do not have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it. The Part B monthly premium in 2013 begins at $104.90 per month. It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check.If you have questions about your eligibility for Medicare Part A or Part B, or if you want to apply for Medicare, call the Social Security Administration. The toll-free telephone number is: 1-800-772-1213. The TTY-TDD number for the hearing and speech impaired is 1-800-325-0778. You can also get information about buying Part A as well as Part B if you do not qualify for premium-free Part A.
What is the Original Medicare Plan?
The Original Medicare Plan is the traditional pay-per-visit arrangement. You can go to any doctor, hospital, or other health care provider who accepts Medicare. You must pay the deductible. Then Medicare pays its share and you pay your share (coinsurance). The Original Medicare Plan has three parts: Part A (Hospital Insurance), Part B (Medical Insurance) and Part D (Prescription Insurance). If you are in the Original Medicare Plan now, the way you receive your health care will not change unless you enroll in another Medicare health plan.
What is Part A (Hospital Insurance)?
Part A (Hospital Insurance) helps pay for care in hospitals and skilled nursing facilities, and for home health and hospice care. If you are eligible, Part A will be premium free -- that is, you don't pay a premium because you or your spouse paid Medicare taxes while you were working. Your SHIP Counselor will be able to help you answer many of your questions. Please call (702) 486-3478 or (800) 307-4444.
You are eligible for premium-free Medicare Part A (Hospital Insurance) if:
If you don't qualify for premium-free Part A, and you are 65 or older, you may be able to buy it. (Contact the Social Security Administration.)
What is Part B (Medical Insurance)?
Part B (Medical Insurance) helps pay for doctors, outpatient hospital care and some other medical services that Part A doesn't cover, such as the services of physical and occupational therapists. Part B covers all doctor services that are medically necessary. Beneficiaries may receive these services anywhere (a doctor's office, clinic, nursing home, hospital, or at home).
You are automatically eligible for Part B if you are eligible for premium-free Part A. You are also eligible if you are a United States citizen or permanent resident age 65 or older. Part B costs begin at $104.90 per month in 2013. (See below.)
Part B is voluntary. If you choose to have Part B, the monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement payment. Beneficiaries who do not receive any of the above payments are billed by Medicare every 3 months.
If you didn't take Part B when you were first eligible, you can sign-up during 2 enrollment periods:
What Are Your "Out-of-Pocket" Costs?
Your Out-of-Pocket Costs May Depend On:
If You Choose Another Medicare Health Plan or Purchase a Supplemental Policy, Out-of-Pocket Costs May Also Depend On:
Help for Low-Income Medicare Beneficiaries
For certain older, low-income or disabled individuals entitled to Medicare Part A, your State Medicaid program will pay some or all of Medicare's premiums, and may also pay Medicare's deductibles and coinsurance if you have Part A, and your bank accounts, stocks, bonds, or other resources do not exceed $7,160 for an individual, or $10,750 for a couple, you may qualify for assistance. For more information go to Medicaid.
Medicare/Medicaid Dual EligibilityNevada Medicaid and the Nevada Welfare Division are working with the Division of Aging to encourage Medicare eligible individuals who may be income eligible to apply for help with their Medicare costs at their local Medicaid District Office. The income guidelines are given at Medicare/Medicaid Dual Eligibility. We hope you take time to look over the information and call if you have any questions.
Information is available. Call:
Deductible: Per Benefit Period $1,216
Coinsurance: Days 61-90 $296
Lifetime Reserve Days (60) $592
Skilled Nursing Facility
Coinsurance: Days 21-100 $148.00
40 quarters of Social Security work credit ----------------- Free
30-39 quarters of Social Security work credit ------------- $243
Less than 30 quarters of Social Security work credit ---- $441
Deductible: Per Calendar Year $147
*Beginning in 2007 the Part B premium paid will be based on adjusted gross income from prior year’s tax return. Individuals who have to pay a higher Part B premium in 2012 include:
· Individuals with income greater than $85,000
· Individuals who are married but file separately with incomes greater than $85,000
· Married filing a joint tax return with income greater than $170,000
The 2012 Part B monthly premium rates to be paid by beneficiaries who file an individual tax return (including those who are single, head of household, qualifying widow[er] with dependent child, or married filing separately who lived apart from their spouse for the entire taxable year), or who file a joint tax return are:
In addition, the monthly premium rates to be paid by beneficiaries who are married, but file a separate return from their spouse and lived with their spouse at any time during the taxable year are:
Additional Medicare information can be obtained
If you have any questions about Medicare
Questions or Comments for the Aging and Disability Services Division?