How To Check Medicare Benefits

How Do You Know If Your Medicare Coverage Has Started

Medicare and your CalPERS Health Benefits

You will receive a letter from SSA confirming your enrollment choice and the date it will begin.

Your Medicare card will contain pertinent information regarding your enrollment. Once you receive your Medicare Card, be sure to check that your name, Medicare number, and start dates are all on the card and that the information is correct.

The start dates located in the lower right corner of your card indicate when your Part A and B coverage begins. If you see a Medicare Part A start date and not a Part B start date, you are not enrolled in Part B. If any information is missing or incorrect on your card, contact Medicare by telephone immediately.

What Tax Benefits Do I Qualify For

There are lots of different types of tax benefits out there. The best way to make sure youre not missing out on any tax benefits is to meet with a tax accountant before you file each year. Retirees might qualify for the tax credit for the elderly and disabled. To qualify, you must be:

Age 65 or older at the end of the tax year
A legal U.S. citizen or resident alien
Earning less than:
$12,500 if married but living and filing separately

Am I Eligible For Medicare

To receive Medicare, you must be eligible for Social Security benefits.

Part A Eligibility

Most people age 65 or older are eligible for Medicare Part A based on their own employment, or their spouse’s employment. Most people have enough Social Security credits to get Part A for free. Others must purchase it.

You are eligible for Medicare Part A if you meet one of the following criteria:

You are eligible for Social Security or Railroad Retirement benefits, even if you do not receive those benefits.
You are entitled to Social Security benefits based on a spouse’s, or divorced spouse’s work record, and that spouse is at least 62 years old.
You have worked long enough in a federal, state, or local government job to be eligible for Medicare.

If you are under 65, you are eligible for Medicare Part A if you meet one of the following criteria:

You have received Social Security disability benefits for 24 months.
You have received Social Security benefits as a disabled widow, divorced disabled widow, or a disabled child for 24 months.
You have worked long enough in a federal, state, or local government job and meet the requirements of the Social Security disability program.
You have permanent kidney failure that requires maintenance dialysis or a kidney transplant.
You are diagnosed with ALS or Lou Gehrig’s disease.

Part B Eligibility

If you are eligible for Part A, you can enroll in Medicare Part B which has a monthly premium.

Will I Need To Prove My Age?

Automatic Enrollment

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Already Enrolled In Medicare

If you have Medicare, you can get information and services online. Find out how to .

If you are enrolled in Medicare Part A and you want to sign up for Part B, please complete form CMS-40B, Application for Enrollment in Medicare Part B . If you are applying for Medicare Part B due to a loss of employment or group health coverage, you will also need to complete form CMS-L564, Request for Employment Information.

You can use one of the following options to submit your enrollment request under the Special Enrollment Period:

Fax or mail your CMS-40B, CMS-L564, and secondary evidence to your local Social Security office .

Note: When completing the forms CMS-40B and CMS-L564:

State I want Part B coverage to begin in the remarks section of the CMS-40B form or online application.
If possible, your employer should complete Section B.
If your employer is unable to complete Section B, please complete that portion as best as you can on their behalf and submit one of the following forms of secondary evidence:

Income tax form that shows health insurance premiums paid.
W-2s reflecting pre-tax medical contributions.
Pay stubs that reflect health insurance premium deductions.
Health insurance cards with a policy effective date.
Explanations of benefits paid by the GHP or LGHP.
Statements or receipts that reflect payment of health insurance premiums.

Some people with limited resources and income may also be able to get .

People Who Have Both Medicare & Medicaid

4 Simple Steps to Understanding Medicare

People who have both Medicare and full Medicaid coverage are dually eligible. Medicare pays first when youre a dual eligible and you get Medicare-covered services. Medicaid pays last, after Medicare and any other health insurance you have.

You can still pick how you want to get your Medicare coverage: Original Medicare or Medicare Advantage . Check your Medicare coverage options.

If you choose to join a Medicare Advantage Plan, there are special plans for dual eligibles that make it easier for you to get the services you need, include Medicare coverage , and may also cost less, like:

Special Needs Plans
Medicare-Medicaid Plans
Program of All-Inclusive Care for the Elderly plans can help certain people get care outside of a nursing home

Advantages Of Dual Eligibility

Dual Eligibility opens a path for Medicare savings programs such as the QMB for the benefit of low-income Medicare members. Medicaid pays expenses, premiums, and costs consistent with their budgets. The goal is to get the most favorable situation for a low-income person getting health benefits through Medicare.

A small boost from Medicaid can add a much larger amount of needed benefits from Medicare. Medicare Part B leaves a standard cost share amount of twenty percent for the consumers payment. Members with dual eligibility can get some coverage of the cost share gap from Medicaid.

Applied Behavior Analysis Medical Necessity Guide

The Applied Behavior Analysis Medical Necessity Guide helps determine appropriate levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. The ABA Medical Necessity Guide does not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any matters related to their coverage or condition with their treating provider.

Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member’s benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply.

The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered for a particular member. The member’s benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary.

Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change.

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Can I Get Meals On Wheels

Meals on Wheels operates through different local programs throughout the nation. Each programs eligibility requirements are slightly different, but for the most part, you will need to be homebound and over the age of 60 . Some people may be able to get Medicare Advantage plans that offer Medicare meal delivery services through Meals on Wheels.

User License Agreement And Consent To Monitoring

Medicare Coverage and Payment of Virtual Services

End User Agreements for Providers

Some of the Provider information contained on the Noridian Medicare web site is copyrighted by the American Medical Association, the American Dental Association, and/or the American Hospital Association. This includes items such as CPT codes, CDT codes, ICD-10 and other UB-04 codes.

Before you can enter the Noridian Medicare site, please read and accept an agreement to abide by the copyright rules regarding the information you find within this site. If you choose not to accept the agreement, you will return to the Noridian Medicare home page.

THE LICENSES GRANTED HEREIN ARE EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THESE AGREEMENTS. BY CLICKING ABOVE ON THE LINK LABELED “I Accept”, YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THESE AGREEMENTS.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK ABOVE ON THE LINK LABELED “I Do Not Accept” AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THESE AGREEMENTS CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, “YOU” AND “YOUR” REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

LICENSE FOR USE OF “PHYSICIANS’ CURRENT PROCEDURAL TERMINOLOGY”, FOURTH EDITION

Consent to Monitoring

What Services Does The Partnership Provide

Medicare and Medicaid information and education
Help with original Medicare eligibility, enrollment, benefits, complaints, rights and appeals
Explain Medicare Supplemental insurance policy benefits and comparisons
Explain Medicare Advantage and provide comparisons and help with enrollment and disenrollment
Explain Medicare Prescription Drug coverage, help compare plans and search for other prescription help
Information about long-term care insurance

The partnership also helps with the following programs. Benefit Counselors are specially trained to help you understand all the fine print to find and apply to a plan that works for you. They advocate for you with these programs and help you get the services you need.

How Much Does Medicare Cost

Original Medicare

Original Medicare is divided into Part A and Part B .

Part A helps pay for inpatient hospital care, some skilled nursing care, home health care and hospice care.
Part B helps pay for doctor services, outpatient hospital care, durable medical equipment, home health care not covered by Part A, and other services. Medicare was never intended to pay 100% of medical bills. Its purpose is to help pay a portion of medical expenses. Medicare beneficiaries also pay a portion of their medical expenses, which includes deductibles, copayments, and services not covered by Medicare. The amounts of deductibles and copayments change at the beginning of each year.

Part A – Monthly Premium

If you are eligible, Part A is free because you or your spouse paid Medicare taxes while you were working. You earn Social Security “credits” as you work and pay taxes. For each year that you work, you earn 4 credits.


$471	$499

You are 65 or older, and you receive or are eligible to receive full benefits fr om Social Security or the Railroad Retirement Board

You are under 65, and you have received Social Security disability benefits for 24 months You are under 65, and you have received Railroad Retirement disability benefits and you meet Social Security disability requirements You or your spouse had Medicare-covered government employment You are under 65 and have End-Stage Renal Disease

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What Are The Ways To Check Your Medicare Coverage Status

Your account on the SSA website monitors both your SSA and Medicare benefits.
The easiest and most inclusive way to monitor your Medicare coverage is on the agencys website. To log on to an existing account or create a new account, click the Log in link in the upper right corner of the homepage. Here you can log in to your current account or create a new account by choosing the Create an account now link.
Chat by going to the Medicare website and choosing Chat in the upper right corner.
Medicare Advantage, PDP, and Supplement Plans are administered by private health insurance companies that contract with Medicare. You can check your enrollment status by calling the private insurer that administers your plan or logging on to the plan providers website. There you can create a users account and track your coverage, billing, and payment history. The phone number and web address are located on your membership card, or you can do a search in your web browser.

Medicare Supplement Plan Deductible Coverage

Process of Medical Billing for Medicaid & Medicare

Medicare Supplement Insurance is also known as Medigap. Medigap is supplemental insurance sold by private insurers. It is designed to fill in the cost gaps for people who have Original Medicare.

If you have a Medicare Advantage plan, you are not able to get Medigap.

Medigap pays for some of the out-of-pocket costs that Original Medicare doesnt cover. It wont pay for extras not covered by Original Medicare, such as prescription drugs or hearing aids. Rather, it covers some or all of your portion of the costs that are covered under Original Medicare.

Medigap plans typically carry a monthly premium. These plans are standardized by Medicare and must follow state and federal laws that are designed to protect Medicare beneficiaries. Not every Medigap plan is available in every state, county or zip code.

Since the coverage provided by Medigap plans are standardized, they all offer the same basic benefits. Some also offer additional coverage. If you live in Wisconsin, Minnesota or Massachusetts, your Medigap plan may vary from those offered in the rest of the country.

Just like Medicares parts, Medigap plans are designated by letter. They are A, B, C, D, F, G, K, L, M and N.

Medigap may cover some or all of your:

Medigap plans sold to newly eligible Medicare recipients do not cover the Part B deductible.

However, if you already have Plan C or Plan F, it will continue to cover your Part B deductible as is stated in your plan.

Plan A No coverage

What Is My Benefits Checkup

BenefitsCheckUp is a free financial and healthcare benefits check up tool offered by the National Council on Aging. They scan over 2,500 federal, state, and private benefits programs for eligibility standards to keep their tool up-to-date. When you visit benefitscheckup.org and click on Find My Benefits, youll get results for all the programs that you might be eligible for based on your:

How Do I Check Medicaid Eligibility

Checking your Medicaid eligibility will be different in each state as well. Medicaid eligibility is based on your income and ability to pay for your healthcare services, but each states income limits are slightly different due to the cost of living and other factors. Check with your states page, here, to find out if you might be eligible.

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A New Year Means New Plans

Some of your patients may have a new Aetna Medicare Advantage plan for 2022 that has different financial obligations or a new member ID number. Use the Eligibility and Benefits Inquiry transaction to get details on their 2022 plan.

Always use the correct ID number when submitting claims, authorizations/precertifications or referrals.

*Availity is available only to U.S. providers and its territories.

I’m On Disability When Will I Be Eligible For Medicare

Medicare 101

You may be eligible for Medicare before age 65 if you have a qualifying disability. Eligibility usually starts after you’ve received disability benefits for 24 months. You will be automatically enrolled in Medicare Parts A and B. You may make other coverage choices during your IEP. Your 7-month IEP includes the month you receive your 25th disability check plus the 3 months before and the 3 months after.

What Veterans Benefits Am I Eligible For

You can qualify for VA healthcare benefits as long as you served the full period for which you were called to active duty or at least 24 continuous months. If you served prior to September 7, 1980, the time period limit may not apply to you. It also may not apply if you were honorably discharged.

You can qualify for TRICARE if you are a uniformed or retired uniformed Service member or family member, a National Guard/Reserve member or family member, a survivor, a former spouse, a Medal of Honor recipient, or otherwise registered in the Defense Enrollment Eligibility Reporting System .

You may also be able to qualify for disability compensation, memorial benefits, pension, home loans, education, job training, life insurance, and more.

Review Your Medicare Plan Coverage Options

Its a good idea to review your Medicare coverage every year to make sure the benefits of your Medicare plan remain aligned with your health care needs. There are four types of Medicare coverage that are called parts of Medicare, as well as another type of insurance called Medicare Supplement Insurance.

The basics of each type of Medicare plan is as follows:

An annual review of your Medicare coverage can help you determine if your plan combination is right for your needs. For example, if youre spending a considerable amount of money on prescription drugs, a Medicare Part D plan or a Medicare Advantage plan with prescription drug coverage may be something to consider.

Find Medicare Advantage Plans with prescription drug coverage

Or you can visit MyRxPlans.com to compare Part D prescription drug plans and enroll in a plan online in as little as 10 minutes.1

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Understanding Medicare Advantage Coverage

Medicare Advantage plans use many styles of managed care to deliver services and savings to subscribers. Medicare Advantage plans have some High Deductible Health Plans that can work with Medicare Savings Accounts. The accounts receive funds that consumers can use to pay out-of-pocket expenses. The below-listed descriptions show the basic elements.

HMO is the health maintenance organization. It uses a primary care physician to deliver care, and refer the patient to other network resources. The HMO does not use outside resources.

PPO is the preferred provider organization. These Medicare Advantage plans do not require referrals or a primary care doctor. They permit the use of outside resources but cover them at a lower rate of cost sharing than for network resources.

EPO is the exclusive provider organization. This type of Medicare Advantage plan offers low prices and a simple network. The members must use network resources except for emergency care.

HMOPOS is the Point of sale option for health maintenance organization. This type of Medicare Advantage plan uses a primary care physician. The doctor can make referrals to outside resources, and the insurance will cover with a lower rate of cost sharing than if using network resources.

FFFS is the fixed-fee-for-services type of Medicare Advantage plan. This type of managed care offers a wide network and freedom of choice for the consumer. The FFFS can standalone or connect to another network for regional or national coverage.