Medicare FAQs

When can I join Part A?
You can join Part A as soon as you turn 65 or otherwise become eligible for Medicare. Just sign up in your “initial enrollment period.” You can also join later on.

How do I sign up?
If you are receiving Social Security benefits when you become eligible, you’ll automatically be enrolled in Parts A and B. If you’re not receiving Social Security benefits, you can sign up for Part A at your local Social Security office.

Can Part A refuse to cover me or delay coverage?
Assuming you are eligible for Medicare, you can’t be refused Part A because of your medical history or a pre-existing illness. The time when your coverage begins depends on when you sign up. If you sign up promptly at the start of your initial enrollment period, your coverage will begin on the fi rst day of the month you become eligible.

How does renewal work?
Your Part A coverage renews automatically from year to year. You don’t have to do anything.

Costs

Premium
Part A is free if you, or your spouse, have made payroll contributions to Social Security for at least 10
years (40 quarters). If you otherwise qualify for Medicare but neither you nor your spouse has worked for 10 years, you’ll pay a monthly premium ranging from $233 to $423 per month in 2008. If you don’t enroll in Part A when you become eligible for Medicare, but later you decide to sign up, your premium could be higher—the later you sign up, the greater the penalty. However, if you, or your spouse, continue to work, your Part A premium will drop to zero and any late penalty will be waived once one of you has worked for 10 years (40 quarters).

Cost sharing

Deductible
Before Part A begins paying a share of your costs, you must first pay a deductible. In 2008, your Part A deductible is $1,024. You’ll pay this deductible for each hospital stay, subject to certain limits.

Co-payments
You pay a co-payment after you have stayed a certain number of days. For hospital stays, you’ll pay
$256 per day for days 61 through 90, and $512 per day for days 91 through 150. In a skilled nursing
facility, you’ll pay $128 per day for days 21 through 100 that you stay. You’ll also pay a co-payment of $5 for each outpatient drug prescription you receive in hospice care.

Co-insurance
You will pay a small co-insurance payment if you use inpatient respite care for hospice patients.
Advantages

What’s not covered by Original Medicare?
Here are some things Medicare doesn’t cover.

Medicare Part D

Description
Part D helps pay for the prescription drugs you use. Whether you buy Part D coverage is up to you.
Prescription drug coverage is an insurance policy you buy from private companies. You can buy a separate policy just for drugs, called a prescription drug plan (PDP). Or you can buy some types of Medicare Advantage plans that include drug coverage. The federal government has created guidelines for which drugs must be offered by drug plans and set minimum standards of benefits. Insurance companies that offer Part D plans must meet these standards.

What pharmacies may I use?
Each drug plan decides which pharmacies plan members may use. Some pharmacy networks are
very limited and some are very broad. Some plans allow you to use only pharmacies locally while some plans have a national network of pharmacies. Some plans also offer mail order services, so you can have drugs mailed to your home.

Coverage limits
Part D coverage involves significant cost sharing until you have spent $4,050 (2008) out of your
pocket in a single year. At that point, you are eligible for what Part D calls “catastrophic coverage.” You pay only a small co-insurance or co-payment for a covered drug, and your plan pays the rest for the remainder of the year. Drug plans generally offer coverage in a specific geographic area, like a state. Some do offer nationwide coverage. You may not be covered, or you may have to pay more, if you use pharmacies outside the plan’s geographic area.

What won’t I get help with?
Part D plans vary in which specific drugs they cover. The federal government excludes a few types of
drugs from drug plan coverage. In most plans, there is also a stage of cost sharing called the “coverage gap,” or “doughnut hole,” in which you must pay all
of your own costs.

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