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FREQUENTLY ASKED QUESTIONS

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My husband is retiring but I am still working. Will he still be covered by my health insurance at work, or does he have to go on Medicare?

Check with your insurance plan at work, but usually they require any employees or dependent family to go on Medicare once they turn 65, and to go on a company plan that is supplemental to Medicare.

Will Medicare pay me to stay home and take care of an elderly parent as a caregiver?

Unless you are a licensed professional such as a home health care nurse working for a Medicare-approved agency, the answer is no. Medicare covers home health care, but only for professional services.

If I go on Medicare at age 65 but keep on working, do I still have to pay Medicare taxes out of my paycheck?

Yes.

I Am Not Eligible For Social Security Until Age 66. Can I Get Medicare At Age 65?

Yes. You can enroll in Medicare at age 65 even if you don’t get Social Security until age 66. To determine eligibility and enroll in Medicare, go to this link. Note also that if you are still working past 65, many company health plans require employees to go on Medicare at age 65, with the company plan as a supplemental.

I Am Moving To Another State. What Do I Do?

You must notify Social Security, either by calling them at 1-800-772-1213, or if you prefer; a change of address may also be reported by calling or visiting your local Social Security office. To find a local office by zip code, go to their website. You may also change your address online with Social Security if you have received a password. Social Security is now offering limited password services. Only people who received a letter from Social Security about password services can have a password at this time. Social Security will be offering additional opportunities to get a password soon. If you have received your password, you can change your address at this link: www.socialsecurity.gov/coa/.Also note that if she wishes to change plans, she can do so after the 3/31 deadline if she has moved.les

Does Medicare Cover The New Shingles Vaccine?

The so-called “shingles vaccine” is a vaccine for the zoster virus. It is made by Merck Pharmaceutical under the trade name Zostavax®. It is not covered by Medicare Part B. Part B only covers flu, pneumonia, and Hepatatis B shots. There is no charge for a flu shot (once per flu season) nor for a pneumonia shot, provided the doctor or health care provider accepts Medicare assignment. The Hepatitis B shot is for certain people who are at medium to high risk for Hepatitis B. You pay 20% of the Medicare approved amount for the Hepatitis B shot given in a doctor's office. For Hepatitis B shots given in a hospital outpatient department, you pay a co-payment. See the Medicare website. However, the shingles vaccine will be available for reimbursement under Part D, although it may vary by plan. Contact your Part D plan for more information about costs and reimbursement. More information is available at the CMS website. You can also visit the Zostavax® website.

Does Medicare Cover Assisted Living and Nursing Homes?

Medicare only covers care in a Skilled Nursing Facility (SNF). This is a facility that provides skilled nursing care after you have been discharged from the hospital. Medicare covers only the first 100 days within a 'benefit period.' It pays 100% for the first 20 days, and then $124 a day for the next 80 days. Medicare will not pay for custodial care in a nursing home or an assisted living facility (although it will cover skilled nursing care you may receive there). If you need information on assisted living, go to the US Administration on Aging. Two other organizations that may be helpful are the Assisted Living Federation of America and National Center for Assisted Living.

How Do I Enroll in the Medicare Prescription Drug Plan?

Choose a Medicare Prescription Drug Plan from a private company that offers the coverage that best suits your needs and budget. To find a list of such companies in your state, go to the Medicare Landscape of Local Plans State-By-State Breakdow. Click on your state, contact a company, and ask for an application. Most companies allow you to do this via the mail, over the telephone, or on the Internet.

How Do I Find a Medicare Approved Physician?

Medicare has a list of approved physicians on their web site. You can search by a specific doctor’s name, or by location (zip code, city/town, state, or even region). Then you would select a specialty. You can access this at Medicare's Participating Physician Directory.

How Much Will I Have To Pay And How Do I Know This?

Like any insurance, you must first meet your yearly deductible before Medicare pays anything. Further, there is a co-payment for each service you get. Note that your co-pays do not figure into your deductibles. For example, if a procedure costs $100 and your co-pay is $10, only $90 goes toward the deductible.

Note as well that Medicare doesn't cover everything, so there may be some things you have to pay 100%. There are many factors that are used to figure out how much you pay, including what others around the country are charged, the cost of living, the cost of medical care in your area, if your hospital chooses a lower co-pay for a particular service, and whether you have more than one procedure at the same time.

How Are The Bills Processed?

Each time you get medical service, the bills get sent to a company in your area called a “Medicare Administrative Contractor” (or MAC for short). The MAC is a private company under contract to Medicare that handles bills. After the MAC processes the bill, you will get a “Medicare Summary Notice’. This shows how much Medicare paid, and how much you have to pay. Check this carefully to make sure you or Medicare weren’t billed incorrectly, or for something you didn't get. If you disagree with what is covered or paid, you have the right to file an appeal. For more information, see our section at billing by clicking here.

Who Do I Call If I Have A Problem With A Bill?

If you have questions about your bill, call the doctor, hospital, or other health care provider that treated you. You can also call the “Medicare Administrative Contractor” (MAC) in your state. Their telephone number should be at the top of the Medicare Summary Notice. If it’s not there, call Medicare at 1-800-633-4227 to get it. (TTY users call 1-877-486-2048). You can also get contact information for your state MAC online. You can get contacts for MACs in your state from the CMS Intermediary Carrier Directory. Scroll down to Section I, find your state, and then select the MAC. Note that in some cases the MAC that handles Part A bills (hospital) may be different from the MAC than handles Part B bills. You can access this free directory at the this link. For more information, see our section at billing by clicking here.

What About Bills For Medical Equipment?

Bills for approved medical equipment are handled somewhat differently than bills for hospital and doctor services. Only 4 MACs handle billing for what Medicare calls “Durable Medical Equipment” (DME). Each handles a region of the country. You can find your region below and then click on the link if you need to contact them about a bill for medical equipment.

The CMS Intermediary Carrier Directory also gives information on durable medical equipment in Section IV. Again, you can access this at the CMS Intermediary Carrier Directory. For more information, see our section at billing by clicking here.

What If I Paid More Than The Amount Listed On The Summary?

Some doctors and hospitals may require you to pay them your portion of the bill ‘up front.’ If so, check that the amount you paid is not more than what is listed on the Medicare Summary Notice. If it is, call the doctor, hospital, or other provider and demand a refund.

By law they cannot charge you more than amount listed on the Medicare Summary Notice. (Note that if you paid less, the hospital or doctor may bill you for the difference, but if you have other insurance it may pay this for you).

What If I Suspect Fraud?

If you suspect fraud, contact your local police or the US Department of Health and Human Services, Office of Inspector General. You can call them at 800-447-8477. You can access them at the HHS Inspector General. You can also access the free booklet Protecting Medicare and You From Fraud (or in Spanish at ¡Pague lo Justo! Proteger a Medicare Contra el Fraude).

Will My Bill Now Be More Or Less Than What I Paid Before?

It could be more, it could be less, or it could be the same. In the past, Medicare required that you pay a set percentage of the hospital bill. Thus people who got the same service at different hospitals paid different amounts, because one hospital might charge more than another for the same service.

Now however, Medicare sets a standard amount a hospital may charge, and you pay a percentage of this. This means that people will pay similar amounts for the same service no matter which hospital they go to.

However, if you find that the amount you pay now is higher than in the past, it is probably because your hospital in the past charged less than the new standard set my Medicare. By the same token, if you find that you are paying less, it’s probably because your hospital in the past charged more than the new standard.

What If I Have Both Medicare And Other Insurance?

If you have other insurance, such as from an employer, a union, or a Medigap policy, it may pay for things that Medicare doesn't. It may also pay for some things before Medicare pays. If you have questions about who pays first, or how your other insurance pays, call your insurance company or benefits administrator.

What Can I Do If I'm Concerned About The Quality Of My Care?

If you think you are not getting good quality care, contact the Quality Improvement Organization (QIO) in your state. For a list of these, go to the American Health Quality Association.

What Are My Rights As A Consumer?

You have certain guaranteed rights to help protect you, including the right to a fair, efficient, and timely process for appealing decisions about health care payment or services. For example, if you don't agree with the amount that is paid, or; if something isn’t covered and you think it should be, you can appeal this.

Instructions for filing an appeal are on the Medicare Summary Notice. If you decide to file an appeal, ask your doctor or provider for any information that may help your case. You can also call the State Health Insurance Assistance Program [SHIP] in your state for help in filing an appeal. You can access a local list at Your State Health Insurance Assistance Program.

Do You Have A Specific Question You Would Like To Ask?

Send us an email with your question and we'll get back to you as soon as possible. Email us at info@medicarebenefits.com.

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