| Medicare Information |
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| The ABCs - and D - of Medicare |
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What is Medicare?
Medicare is health insurance for:
- People 65 and older
- People of all ages with end-stage renal disease (permanent kidney failure) or certain other disabilities.
Because Medicare is health insurance, you share the costs of your care.
Part A (Hospital Insurance)
Part A helps pay for hospital stays and some skilled nursing facility stays. Most people get Part A without having to pay for it. You must enroll in Medicare Part A during your Initial Enrollment Period (when you first become eligible for Medicare) even if you are still working and receiving employer medical benefits. (See below, "How do I get Medicare?")
Part B (Medical Insurance)
Part B helps pay for doctor visits and outpatient services such as X-rays and physical therapy. Most beneficiaries pay a monthly premium of $96.40 in 2008. Many health insurance experts recommend that you buy Part B when you are first eligible. Here's why:
- Health insurers will refuse to sell you a Medicare Advantage or Medigap plan if you don't have Parts A and B.
- Some employer group health plans only pay claims beyond what Part B would cover and you would have to pay the rest.
- You may be charged more if you don't enroll in Part B when first eligible. Call the Social Security Administration for details: 1-800-772-1213.
Help Paying Part B Premiums
You may receive help paying your Part B premium if:
- Your monthly income is less than $1,169 for an individual ($1,561 for a couple)
AND
- Your *assets are less than $4,000 for an individual ($6,000 for a couple)
*Assets do not include your home or car.
To see if you qualify, contact your local office of Seniors and People with Disabilities for an application. This office is part of Oregon's Department of Human Services (DHS). You may call DHS at: 1-800-282-8096. Or, you may visit the Web site and click on health/medical services.
Beginning in 2008, single beneficiaries with annual incomes over $82,000 and married couples with income over $164,000 will pay a higher percentage of the cost of Medicare Part B coverage, reducing Medicare's share. The income-related Part B premiums in 2008 will be $122.20, $160.90, $199.70 or $238.40, depending on the beneficiary's income.
Medicare Supplements, also called Medigap plans
Parts A and B don't cover all your health care costs. For example, you pay a $135 deductible and 20 percent of doctor bills under Part B. Because of these "gaps" in coverage, you may want to buy additional insurance. Private companies sell Medigap plans (Plans A-L) that cover some of these gaps. No Medigap plan sold after January 1, 2006, includes prescription drug coverage.
To learn more about what these plans cover, review the Oregon Guide to Medigap, Medicare Advantage & Prescription Drug Plans.
Part C: Medicare Advantage Plans
Private Medicare Advantage plans combine all your Medicare-covered benefits into a single package. Typically, you must live in the plan's service area and use doctors and hospitals in the plan's network or pay extra to go outside the network. You can purchase Medicare Advantage plans with or without prescription drug coverage.
To learn more about what these plans cover, review the Oregon Guide to Medigap, Medicare Advantage & Prescription Drug Plans.
Part D: Prescription Drug Coverage
Medicare offers prescription drug insurance to all people with Medicare, regardless of income or health. Private companies sell prescription drug plans. You may want to purchase a prescription drug coverage plan if:
- You have Parts A or B and no other drug coverage
- You have parts A and B and a Medigap plan
- You have a Medicare Advantage Plan that does not offer drug coverage. (Contact your plan and ask about options.)
For more about prescription drug coverage, visit Medicare's Web site.
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| Employer Group Health Plans (EGHP) and Medicare |
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Employer group health insurance is private insurance you purchase through an employer or union membership. You need to consider what to do:
- If you are working and have group coverage when you become eligible for Medicare
- When you retire
Still working when eligible for Medicare?
An employee may work beyond age 65. If so, and if the employer has 20 or more employees and provides an employer group health plan, the worker over age 65 must be covered under the same group plan with the same benefits as those employees under age 65. The employer plan is primary to Medicare, providing full benefits before Medicare benefits are applied.
Should I also get Medicare Part A?
Yes. For most 65-year-olds there is no premium for Part A. Additionally, Part A may supplement your employer plan.
How do I get Medicare?
- If you already receive Social Security or Railroad (RR) cash benefits when you turn 65, you are automatically enrolled in Part A and will get a Medicare card in the mail.
- If you are not receiving retirement benefits, contact Social Security about four months before your 65th birthday to sign up for Medicare.
Should I also get Medicare Part B?
You may want to delay enrollment in Part B as long as you or your spouse are working and are both covered by an employer plan. You will qualify for Medicare supplement open enrollment once you leave the employer plan and start Part B. Consider:
- How fully your employer plan covers doctor and other health services also covered by Part B.
- Whether the secondary benefits Part B would pay are worth the cost of the monthly premium.
Can I delay applying for Medicare Part B?
Yes, but do not do so unless you or your spouse are working and you are covered by an employer plan, or else you face a penalty. To avoid higher premiums for late enrollment in Medicare Part B, notify Social Security that you are still working and covered by your employer plan (not a plan for retirees) and wish to decline enrollment in Part B. Document your conversation by recording the date, name of person you speak with and notes on what is said.
If I delay enrollment in Part B, what happens when my employer coverage ends?
If you are 65 or over, you have a Special Enrollment Period for people covered under an employer group health plan. This allows you to enroll in Part B during the eight-month period beginning with whichever of these comes first:
- The month you or your spouse end employment.
- The month your group health coverage ends.
Special Enrollment Period rules do not apply to you if you stop working or lose your employer coverage during your Initial Enrollment Period (the time you first are eligible for Medicare).
Contact Social Security to discuss the best time to enroll in Part B.
Can I enroll in Medicare Part B while I'm still working and covered by my employer plan?
Yes, you may contact Social Security and enroll in Medicare Part B at any time while you are working and covered by the employer plan.
If you enroll while you are still working, you may start coverage at the first of the month in which you enroll or at the first of any of the three months after that.
Note: Contact your benefits administrator at work to find out whether enrolling in Part B at this time is required or to your advantage.
When you retire
Some employers offer continuation or conversion as a "retirement benefit." This allows retirees to continue group coverage or convert to a plan that serves as a Medicare supplement. Such a plan is not subject to minimum standards for Medicare supplements and may provide more or fewer benefits than Medicare supplemental insurance. It is secondary to Medicare benefits.
In deciding whether to continue with group coverage or convert to a plan that serves as a Medicare supplement:
- Check the price and the benefits of your employer plan, including benefits for your spouse.
- Look for coverage that pays for health care services not covered by Medicare, such as prescriptions, hearing aids, routine dental care, and physical checkups.
- Check what effect your continued coverage will have on your spouse's insurance protection.
- Check on the term of coverage. Will the employer coverage always be there?
Employer long-term-care insurance (ELTC)
Your employer may offer long-term care insurance as an additional benefit. Employer-provided long-term-care insurance is similar to what you could buy from an agent. Features include:
- ELTC usually gives employees a choice of benefit periods, maximum payments, and waiting periods.
- ELTC may offer non-forfeiture benefits and allow employees to keep their coverage after they leave the group.
- Many employers also allow you to buy coverage for your parents (typically, your parents would have to pass the company's medical screening in order to qualify for coverage).
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| Enrollment for People with Medicare by Reason of Disability |
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People who are eligible for Medicare by reason of disability have two Open Enrollment Periods. At these times, they can purchase any Medicare supplement plan approved for sale in the State of Oregon. The two periods are: - The first six months of enrolling in Medicare Part B, and again
- The six months following their 65th birthday. For example, someone who became Medicare-eligible due to a disabling condition at age 50 would have six months beginning at age 65 during which no Medicare supplement company could deny coverage.
Outside the open-enrollment window?
Oregon law says that insurance companies cannot treat people who have Medicare by reason of disability differently than they treat those who have Medicare by reason of age. If an insurance company cannot deny or require a health application for individuals who have Medicare by reason of age, then the company cannot deny or require a health application for individuals who have Medicare by reason of disability. The Oregon Guide to Medigap, Medicare Advantage, and Prescription Drug Plans describes the Medicare supplement plans available in Oregon.
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| Help with Medicare |
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- SHIBA is a statewide network of volunteers trained to provide accurate and impartial health insurance counseling to people with Medicare. For information about enrolling in Medicare Parts A and B, supplemental insurance, or how Medicare fits with employer coverage, call toll-free: (800) 722-4134.
- Social Security Administration: For general questions about Medicare enrollment, premiums, or to replace a lost or stolen card. (800) 772-1213.
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