Questions and Answers About Medicare
Q. After I enroll in Medicare, how do I get my benefits?
A. You can choose Original Medicare, often referred to as Part A and Part
B, or enroll in a Medicare health plan such as a Medicare Advantage Plan.
If you do not make a choice when you are first eligible for Medicare,
you will be automatically enrolled in Original Medicare.
Q. What is the difference between Medicare Part A and Part B?
A. Part A provides hospital insurance and Part B covers medical expenses.
You are eligible for Part A if you are age 65 or older, and you or your
spouse worked and paid Medicare taxes for at least 10 years. You can be
covered by Part A at age 65 without having to pay premiums if you are
receiving retirement benefits from Social Security or the Railroad Retirement
Board. If you want Part B coverage, you must pay for it. This monthly
premium is deducted from your Social Security, Railroad Retirement, or
Civil Service Retirement check
Q. If I am still working, should I sign up for Medicare Part A or B?
A. Even if you keep working after age 65, you should sign up for Medicare
Part A. Part A benefits may help pay some of the costs not covered by
your group health plan. Because you have to pay the monthly Part B premium,
you may want to wait to sign up for Medicare Part B if you or your spouse
are working and have group health coverage through your work.
Q. What if I'm over 65 and didn't enroll in Part B during my Initial
A. Automatic enrollment in Part B if you are receiving Social Security
or Railroad Retirement benefits when you turn 65 – unless you say
you don’t want medical insurance. Your Initial Enrollment Period
starts 3 months before you turn age 65 and lasts for 7 months. Except
in certain cases, if you do not enroll in Medicare Part B during your
Initial Enrollment Period, you will have wait until the next General Enrollment
Period to enroll. General Enrollment Periods are between January 1 and
March 31 each year. When March 31 falls on a non-business day, the General
Enrollment Period is extended to the next business day. If you sign up
for Medicare Part B during a General Enrollment Period, your coverage
starts on July 1 of that year. Your Medicare Part B premium may go up
10 percent for each 12 month period that you could have had Medicare Part
B, but did not take it.
Q. Does Medicare Cover Prescription Drugs?
A. Medicare Part D prescription drug coverage is available to anyone covered
by Original Medicare. Part D coverage is provided through a private insurance
company that is contracted with Medicare to offer these plans. Insurers
offer various types of plans, so your premium and your out-of-pocket expenses
(copayments, coinsurance and deductible) will vary.
Q. What is a Medicare Advantage plan?
A. Similar to an HMO or PPO, Medicare Advantage Plans provide all of your
Part A (hospital insurance) and Part B (medical insurance) coverage. Medicare
Advantage Plans may also offer cover vision, hearing, dental, and wellness
programs. Most include Medicare prescription drug coverage (Part D).
Q. What is a Medicare deductible?
A. A deductible is the amount you must pay each year before Medicare begins
covering its portion of your medical bill. There are deductibles for both
Part A and Part B. Medicare will not start paying on your claims until
you have met your annual deductible.
Q. What is the difference between Medicare and Medicaid?
A. Medicare is a federal health program provided with Social Security.
It covers people 65 years of age or older and those with certain disabilities,
and is available regardless of income. Medicaid is a joint federal and
state program that helps low-income individuals and families pay for medical
care. Unlike Medicare, which is available to everyone, Medicaid has strict
eligibility requirements and income restrictions. People who qualify for
both Medicaid and Medicare (called 'dual eligible') may use Medicaid
to help pay for Medicare premiums.
Q. What is a Medigap policy?
A. Medigap is a health insurance policy sold by private companies to fill
gaps in the Original Medicare Plan coverage. Medigap policies must follow
federal and state laws and must clearly identify themselves as "Medicare
Supplemental Insurance." You must have both Medicare Parts A &
B to buy a Medigap Policy.
Q. If a person with Medicare is covered by another health insurance plan, who pays?
A. It depends. In some cases, the other health insurance pays the person's
health care bills first, and the patient’s Original Medicare plan
or Medicare Advantage plan pays second. There are rules about whether
Medicare or the other insurer pays health care bills first, in a process
called "coordination of benefits." If you have other insurance,
it is important to tell your doctor, hospital, and pharmacy so that your
bills get paid correctly.
Q. What if I disagree with a decision Medicare makes about coverage or
payment for a service?
A. If you have Medicare, you have the right to appeal any decision about
your Medicare coverage. You can find instructions on how to file an appeal
on your Medicare Summary Notice (MSN), or in your health plan or drug
Q. How do I assure that Good Samaritan Hospital is my hospital of choice?
A. People with Original Medicare can visit any hospital they choose, as
long as the hospital is a Medicare-certified hospital. And Good Sam has
been Medicare-certified for years, so you have access to our full range
of high-quality services. Those with a Medicare Advantage Plan should
check with their insurer to see if Good Sam is listed among their plan’s
contracted hospitals. You can find an up-to-date list of plans accepted
at Good Sam at
http://goodsam.org/healthplans/index.php, or feel free to call 1-855-275-2562. If not, be sure to select a plan
that includes Good Sam during your next open enrollment.
If you have other questions that are not answered here, don’t hesitate
to call 1-855-275-2562.
If you would prefer to contact Medicare directly, call 1-800-MEDICARE (1-800-633-4227).
Good Samaritan Hospital. Where great doctors care for seniors.