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Clearing up Medicare mysteries

By Meredith Cohn

The Baltimore Sun (MCT)

Published: Monday, May 5 2014 10:04 a.m. MDT

Since 1966, residents 65 or older have been able to sign up for Medicare, the federal government’s health plan for seniors. But there are now private plans available, as well as a drug plan, giving people more options — but also raising more questions for beneficiaries.

Joe Kline, Associated Press

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Since 1966, residents 65 or older have been able to sign up for Medicare, the federal government’s health plan for seniors. But there are now private plans available, as well as a drug plan, giving people more options — but also raising more questions for beneficiaries.

Michelle P. Holzer, program manager for the Maryland Department of Aging’s State Health Insurance Assistance Program, offers answers to some of the most common questions people have about the program.

QUESTION: When do you apply for Medicare, and if you work, do you still apply?

ANSWER: If you are retired, you have a seven-month initial enrollment period to sign up for Medicare Part A and/or Part B, which begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65.

If you are still working and are covered by an employer group health plan, then you may be able to delay the start of monthly Medicare Part B benefits (medical), but it is generally recommended you consider enrolling in Medicare Part A (hospital). Check with your employer’s health benefits office and Social Security for the rules regarding the Special Enrollment Period to sign up for Medicare Part B. If you miss the Initial Enrollment Period and are not entitled to a Special Enrollment Period, then you may face penalties and delays in getting your Medicare coverage.

If you are under age 65 and on Social Security because of a disability (SSDI), your Medicare coverage will begin after you receive 24 months of cash payments.

Q: How do you get the most out of Medicare, such as accessing preventive and wellness care?

A: Medicare covers many preventive and wellness services, such as annual wellness exams, mammograms, and flu shots, for example, without co-payments. Check your Medicare & You 2014 Handbook for a complete list of preventive and wellness benefits available to all Medicare beneficiaries.

Q: What is the difference between Medicare and Medicare Advantage?

A: Medicare is the federal government’s health insurance coverage for people 65 or older, people under 65 with disabilities and people of any age with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant). Medicare coverage consists of Part A (hospital) and Part B (medical) services. Most individuals pay monthly Medicare Part B premiums.

Medicare Advantage Plans (Part C) are a way to get your Medicare coverage through a private plan. They are managed-care plans and often referred to as HMOs and PPOs. Medicare Advantage Plans are run by Medicare-approved private insurance companies. They include all benefits covered under Medicare A and B, and may cover prescription drugs and extra benefits. Individuals pay monthly Medicare Advantage Plan premiums.

Q: What is a Medigap plan, and how do you know if you need one?

A: Medigap plans (Medicare supplemental plans) are sold by private insurance companies and help pay some of the health care costs that Medicare does not cover. … Medigap plans do not offer prescription drug coverage. Individuals pay monthly Medigap premiums. It is very important to join a Medigap plan during your “open enrollment period” — that is, six months from the time your Medicare Part B begins. Different rules for open enrollment apply for Medicare beneficiaries under and over the age of 65 regarding which plans you may choose.

If you consider purchasing a Medicare Advantage Plan (Part C) or buying a Medigap plan, then note that the start date for Medigap coverage or a Medicare Advantage Plan should coincide with the start date for Medicare.

Q: Will Medicare cover all of my medications?

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