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:
- People 65 years of age and older
- Certain younger people with disabilities
- People with End-Stage Renal Disease (people with permanent kidney failure who need dialysis or a transplant).
Who is Eligible for Medicare?
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.
Here are some simple guidelines. You can get Part A at age 65 without having to pay premiums if: You are already receiving retirement benefits from Social Security or the Railroad Retirement Board. You are eligible to receive Social Security or Railroad benefits but have not yet filed for them. You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay premiums if: You have received Social Security or Railroad Retirement Board disability benefits for 24 months. You are a kidney dialysis or kidney transplant patient.
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 2014 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:
- You are 65 or older. You are receiving or eligible for retirement benefits from Social Security or the Railroad Retirement Board, or
- You are under 65. You have received Social Security disability benefits for 24 months, or
- You are under 65. You have received Railroad Retirement disability benefits for the prescribed time and you meet the Social Security Act disability requirements, or
- You or your spouse had Medicare-covered government employment, or
- You are under 65 and have End-Stage Renal Disease.
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 2014. (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:
- General Enrollment Period: If you didn't take Part B, you can only sign up during the general enrollment period, January 1 through March 31 of each year. Your Part B coverage is effective July 1. Your monthly Part B premium may be higher. The Part B premium increases 10% for each 12-month period that you could have had Part B but did not take it.
- Special Enrollment Period: If you didn't take Part B because you or your spouse currently work and have group health plan coverage through your current employer or union, you can sign up for Part B during the special enrollment period. Under the special enrollment period, you can sign up at any time you are covered under the group plan. In addition, if the employment or group health coverage ends, you have 8 months to sign up. The 8-month period starts the month after the employment ends or the group health coverage ends, whichever comes first. Generally, your monthly Part B premium is not increased when you sign up for Part B during the special enrollment period. Contact the Social Security Administration to sign up.
What Are Your "Out-of-Pocket" Costs?
The Original Medicare Plan pays for much of your health care, but not all of it. Your "out-of-pocket" costs for health care will include your monthly Part B premium. In addition, when you get health care services or prescriptions, you will also have to pay deductibles, coinsurance and/or co-payments. You also pay for routine physicals, custodial care, most dental care, dentures, routine foot care, or hearing aids. Physical therapy and occupational therapy services, except for those you get in hospital outpatient departments, are subject to annual limits. The Original Medicare Plan does pay for some preventive care, but not all of it.
Your Out-of-Pocket Costs May Depend On:
- Whether your doctor accepts assignment.
- How often you need health care.
- What type of health care you need.
If You Choose Another Medicare Health Plan or Purchase a Supplemental Policy, Out-of-Pocket Costs May Also Depend On:
- Which Medicare health plan you choose.
- What extra benefits are covered by the plan.
- What your supplemental health insurance covers.
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. Nevada Medicaid and the Nevada Welfare Division are working with the Aging and Disability Services Division to encourage Medicare eligible individuals who may be income eligible to apply for help with their Medicare costs at their local Medicaid District Office.
Questions about Medicare?
| Contact a Nevada SHIP Counselor at (702) 486-3478 or (800) 307-4444. All services of the SHIP Program are completely FREE and CONFIDENTIAL. Additional Medicare information can be also obtained from the Federal Medicare website: www.medicare.gov.|
Do you already receive Medicare benefits?
Nevada Division of Insurance
Medicare Supplemental Insurance (Medigap)
|Visit MyMedicare.gov to check on claims, available benefits and other information that is specific to your Medicare needs.|
|Information and Comparison Guide|
Medicare Part D (Prescription Drug Benefit)
Other Comparison Tools
Be sure to compare different plans each year to see what's right for you.
SHIP can help you!
HMO members should receive information directly from the HMO plan. It is important that you read this information thoroughly. Contact your plan for more information.
The Part D open enrollment period is October 15 - December 7 every year. If you sign up for a plan at that time, your coverage will begin on January 1 of the following year. You might be assessed an extra cost if you did not sign up during your initial enrollment period.
You might be eligible for extra assistance with your prescription costs.
To find out if you qualify, or to fill out the application, go to the Social Security Administration's website or contact SHIP.
Medicaid participants (through the NV Welfare Department) will receive extra assistance. Call your local Medicaid office for more information.
Hospital Compare, a quality tool for adults, including those with Medicare, is now available. Click here to use the tool on U.S. Health and Human Services' website.
Other comparison tools for Home Health Care Agencies, Nursing Homes and Dialysis Facilities are available on www.medicare.gov.