MedicarePhD.com: Answering Medicare Questions

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TWELVE MOST ASKED QUESTIONS ON

PART A and B

AM I ELIGIBLE?

You are eligible for Medicare Part A & B if you have paid into the system through payroll deductions for 40 quarters or 10 years. You do not have to be drawing social security and you can still work full time. IF YOU ARE SELF EMPLOYED IN A FAMILY BUSINESS WHERE BOTH YOU AND YOUR SPOUSE WORK, MAKE SURE BOTH OF YOU TAKE A SALARY, NOT JUST THE HUSBAND, OR THE WIFE WILL NOT BE ELIGIBLE! If an individual has not attained the 40 quarter minimum, they can still join but the monthly premium is significant.

In addition to the Part B premium, you are responsible for a variety of deductibles, co-pays, and co-insurance (co-pays are a set amount, say $20, and co-insurance is a % of cost, usually 20%). There are a variety of these deductions but the most important is a $1,100 deductible every time you are hospitalized, if there are 60 or more days between visits, and a basic $155/year deductible for Part B. Also, you can expect to pay around 20% of the total cost on most other covered services.

WHAT IS THE COST?

If you have not worked 40 quarters, obtaining Part A & B can cost you a premium up to $461/month in 2010. However, if you have worked 40 quarters, Part A is free and Part B’s premium is $96.40/month if you are in the system, but $110.50/month for new enrollees and those individuals not drawing social security. This $96.40/month can go as high as $353/month if you make over $85,000 yearly as an individual and $170,000 as a couple. The Kaiser Family Foundation, a very credible Medicare monitoring organization, predicts the Part B premium will go to $120 by 2011.

HOW DO I PAY?

If you are drawing Social Security, the Part B premium will be deducted from your monthly Social Security check. If you have postponed taking Social Security benefits, you will be billed in three month increments in advance.

HOW DO I SIGN UP?

If you started drawing Social Security before you turned 65, you will automatically be enrolled in Part A & B. However, if you are not taking Social Security, generally you will receive a letter approximately 90 days before you turn 65 and you fill out the enclosed form and return it.

You will soon be contacted by a representative who will have your IRS earning records in front of them to determine your Part B premium, and also confirm that you wish to sign up for Part B. If you do not receive this form in the mail, contact your local Social Security branch office.

The agents are very helpful and will basically call you an idiot if you do not take Part B, and they would be correct with one major exception. If you are currently working and have excellent coverage, there is no reason to sign up and pay the Part B premium. However, and this is important, when you retire you should sign up for Part B because your company retirement health coverage will usually only pay what Medicare does not cover.

WHEN CAN I ENROLL?

You can enroll in Part A and B ninety days before you turn 65 and your Medicare insurance becomes effective the first day of the month you were born. You can enroll for three months after your birthday month if you procrastinate, but do not let this window close because you will then be penalized unless you are covered under an employer health plan. If you lose your employer health plan, you have 8 months to sign up before penalties kick in.

If you do not enroll in Part A & B when eligible, you will pay a monthly premium penalty of 10% for every 12 month period you procrastinate. So put your drink down, turn off the I Love Lucy reruns, and get yourself signed up.

Remember, MEDICARE IS GOOD---NO MEDICARE IS JUST PLAIN STUPID. There are also penalties if you do not sign up for Part D when eligible, 1% per month, and these will be discussed further in an upcoming section.

WHO ACCEPTS MEDICARE?

Practically every physician and health care facility provide Part A & B coverage. The reason is simple in that very few health care providers can afford to ignore 45 million potential customers. However, there are a few specialists who do not participate and you would do well to avoid them if possible.

HOW DO I FILE A CLAIM?

You do not have to file a claim, the provider of medical services is required to do this for you. See, I told you Medicare is a really good deal.

PRE-EXISTING CONDITIONS?

One of Medicare’s biggest advantages is that pre-existing conditions do not apply to Part A & B eligibility.

CAN I KEEP MY CURRENT PRIVATE COVERAGE?

If you are turning 65, continue working, and have a no cost or low cost employer plan equal to Part A & B coverage, there is no reason to give this up. Also, you will not be penalized for waiting to sign up for Part B. One caution, if your employer has less than 20 employees, their insurance company can say Medicare is primary and not cover you. Thus, in this situation you need to sign up for Part B.

Regardless of your Part B situation, you have nothing to lose by signing up for Part A as it comes at no cost if you have paid in for ten years. Remember, if you retire or lose your private coverage, you only have 8 months to sign up for Part B without penalty, but then there really is no viable reason to wait.

RECORD KEEPING--
WHO DOES IT?

You will receive what is called a Medicare Summary Notice every three months that will detail all Medicare transactions during the period including items billed, items paid, and any balance due providers from deductibles or co-pays. You can obtain the identical information on line at Mymedicare.gov and when you sign up for Part A & B, you will receive a letter on how to access your account and passwords that will be required.

I WANT TO KNOW MORE!

NO YOU DON’T! There are literally hundreds of thousands of pages of information concerning Medicare and MedicarePhD.com will supply you with 99% of the basic information you need. However, there is one publication you will receive from Medicare each fall called “Medicare and You.” Do not discard this booklet as it is by far the most comprehensive and clear cut “Bible” of the field, and it can be used as a source of information throughout the year.

Hopefully by now you are getting the picture that Original Medicare, Part A & B, are a very good deal. However, there are some options to Original Medicare that may be well worth pursuing and this is our next topic.