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Medicare Part D (Prescription Drug Benefit)

Contact Nevada's State Health Insurance Assistance Program (SHIP) today!
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.

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.
TALK to a SHIP COUNSELOR about your rights.

HMO members should have received information directly from the HMO plan.
It is important that you read this information thoroughly. Contact your plan for more information.

Medicaid participants (through the NV Welfare Department) will receive extra assistance.
Call your local Medicaid office for more information.

Be sure to compare different plans each year to see what's right for you. SHIP can help you!

Get the facts today. All services of the SHIP Program are completely FREE and CONFIDENTIAL.

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.

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:

bulletPeople 65 years of age and older
bulletCertain younger people with disabilities
bulletPeople 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:
bulletYou are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
bulletYou are eligible to receive Social Security or Railroad benefits but have not yet filed for them.
bulletYou or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A without having to pay premiums if:
bulletYou have received Social Security or Railroad Retirement Board disability benefits for 24 months.
bulletYou 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 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:
bulletYou are 65 or older. You are receiving or eligible for retirement benefits from Social Security or the Railroad Retirement Board, or
bulletYou are under 65. You have received Social Security disability benefits for 24 months, or
bulletYou are under 65. You have received Railroad Retirement disability benefits for the prescribed time and you meet the Social Security Act disability requirements, or
bulletYou or your spouse had Medicare-covered government employment, or
bulletYou 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 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:
bulletGeneral 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.
bulletSpecial 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:
bulletWhether your doctor accepts assignment.
bulletHow often you need health care.
bulletWhat 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:
bulletWhich Medicare health plan you choose.
bulletWhat extra benefits are covered by the plan.
bulletWhat 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 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 Eligibility

Nevada 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:

bulletContact your local Welfare office if you have questions or to request an application. The application is also available on the Nevada State Welfare Division's website.
bulletState Health Insurance Assistance Program (SHIP) for more information.  Their number is 486-3478 in Las Vegas or 1-800-307-4444 statewide.  

Medicare Amounts for the Year 2014

Part A

Inpatient Hospital

          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

 Monthly Premium:

          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

 

Part B

           Deductible:          Per Calendar Year                $147

             Premium:            *$104.90

*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: 

Beneficiaries who file an individual tax return with income:

Beneficiaries who file a joint tax return with income:

Income-related monthly adjustment amount

Total monthly Part B premium amount

Less than  or equal to $85,000

Less than or equal to $170,000

$0.00

$104.90

Greater than $85,000 and less than or equal to $107,000

Greater than $170,000 and less than or equal to $214,000

$42.00

$146.90

Greater than $107,000 and less than or equal to $160,000

Greater than $214,000 and less than or equal to $320,000

$104.90

$209.80

Greater than $160,000 and less than or equal to $214,000

Greater than $320,000 and less than or equal to $428,000

$167.80

$272.70

Greater than $214,000

Greater than $428,000

$230.80

$335.70

 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:

Beneficiaries who are married but file a separate tax return from their spouse:

Income-related monthly adjustment amount

Total monthly premium amount

Less than or equal to $85,000

$0.00

$104.90

Greater than $85,000 and less than or equal to $129,000

$167.80

$272.70

Greater than $129,000

$230.80

$335.70

 


Do you already receive Medicare benefits? Visit
MyMedicare.gov to check on claims, available benefits and other information that is specific to your Medicare needs.

Additional Medicare information can be obtained 
from the Federal Medicare website: www.medicare.gov  

If you would like to view the Nevada Medicare Supplemental
Insurance Comparison Guide (Medigap), click here.

To have one mailed to you, email us by clicking here.

If you have any questions about Medicare 
please contact a SHIP Counselor at 
(702) 486-3478 or (800) 307-4444
send us an e-mail

 

Questions or Comments for the Aging and Disability Services Division?
Please contact a Regional Office.
We look forward to speaking with you!

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