Labor Laws

Medicare

Medicare provides health insurance services to:

• People at least 65 years old
• Disabled people under 65 years old
• People with end-stage renal disease

Medicare is made up of two components:

• Part A Hospital Insurance: Majority of patients don't pay for it
• Part B Medical Insurance: Majority of patients pay on a monthly basis

Depending on where you live, you have different choices available to you in terms of how you receive Medicare coverage. Usually, your initial Medicare coverage begins under the Original Medicare Plan. In addition, you may add drug coverage through a Medicare Prescription Drug Plan. If you choose a Medicare Advantage Plan, such as an HMO or PPO, you will be entitled to Part A and B coverage. As soon as you become eligible for Medicare, you can decide between the two plans. If you want to switch plans after analyzing your health and prescription necessities, you can do so annually in the fall. As long as you request Part A and B coverage, the Original Medicare Plan and Medicare Advantage Plan will provide both to you.

What is covered under Part A coverage?

Part A covers inpatient hospital care, including:

• Critical Access Hospitals (facilities that provide outpatient and inpatient care to people living in the country)
• Skilled Nursing Facilities (excluding custodial or long-term care)
• Hospice Care
• Some Healthcare

If you are unsure whether you are covered by Part A, check your red, white, and blue Medicare card for the words "HOSPITAL (PART A)."

How much does Part A coverage cost?

Many people receive Part A at no cost once they turn 65. There is no monthly premium payment as long as you or your spouse paid Medicare taxes while working. If you don't get Part A for free, you may be eligible to purchase it if:

• You or your partner are 65 or older and cannot receive Social Security because you were unemployed or didn't pay enough Medicare taxes while you were employed.

or

• You suffer from a disability and are no longer eligible for Part A at no cost because you went back to work.

If you have a low income, the state government may offer financial assistance for Part A and/or Part B. For more information, log on to www.socialsecurity.gov, or call the Social Security office at 1-800-772-1213. TTY users should call 1-800-325-0778. If you receive benefits from the Railroad Retirement Board (RRB), contact your local RRB office or 1-800-808-0772.

What is covered under Part B coverage?

• Doctor services
• Outpatient care
• Medical care not paid for by Part A
• Other care when it is medically necessary
• Some preventive care

How much does Part B coverage cost?

As of January 1, 2007, the amount contributed to Part B is based on your annual income. This year, people are mostly paying the standard monthly premium of $93.50. If you did not originally sign up for Part B when your Medicare coverage began, your monthly premium may increase at a rate of ten percent for each annual period that you were eligible for Part B and chose not to enroll. You may be subject to this penalty for the remainder of your Part B coverage.

Part B enrollment is entirely up to you, and you have the option of signing up during a six-month window that lasts from three months prior to your 65th birthday to three months following. To enroll, call the Social Security Administration at 1-800-772-1213, or get in touch with your local Social Security office. If you are paying for Part B, the monthly premium is normally deducted from your Social Security, railroad retirement, or Office of Personnel Management stipends, and you won't get billed by Medicare. However, if you don't receive any of these payments, you will receive a bill from Medicare once every three months. If your bill doesn't arrive in the mail by the 10th of the month call the Social Security Administration. TTY users should call 1-800-325-0778, or if you receive benefits from the Railroad Retirement Board, call the nearest RRB office or 1-800-808-0772.