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:
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 .
How To Apply Online For Just Medicare
Are you within three months of turning age 65 or older and not ready to start your monthly Social Security benefits yet? You can use our online retirement application to sign up just for Medicare and wait to apply for your retirement or spouses benefits later. It takes less than 10 minutes, and there are no forms to sign and usually no documentation is required.
To find out what documents and information you need to apply, go to the .
Write To Insurance Companies
You may write your insurance companies with questions that you have about your coverage. If possible, type up your letter and make sure to keep a copy that indicates the date on which you mailed it.
If you arent able to type up your questions, make sure to write in clear, concise print, leaving plenty of space in between your questions. Be sure to include your contact information in any correspondence that you mail to your healthcare provider.
Before sending mail that contains important documents or your private health information, call ahead and make sure that you have the correct contact information. Mail that is sent to the wrong address is not always forwarded to the right place, especially in places that receive a high volume of mail.
Addresses for major insurance companies that provide Medicare policies:
Aetna Inc.
If your ability to talk on the phone is limited because of a health condition, you can still reach out to Medicare. TTY users can call 1-877-486-2048 to reach a hotline compatible with their devices.
You can also email Medicare at altformatrequest@cms.hhs.gov, or send a letter explaining your need to:
Centers for Medicare & Medicaid ServicesOffices of Hearings and Inquiries 7500 Security Boulevard, Mail Stop S1-13-25Baltimore, MD 21244-1850
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State Health Insurance Assistance Program
If youre a Medicare member, you and your caregivers can get free and unbiased help with the benefit through the program.
SHIP counselors are screened, trained, and certified. They provide one-on-one, confidential Medicare guidance based on your needs.
They can help with Medicare:
- Programs that can lower costs.
The services SHIP provides are free. SHIP counselors dont sell anything and arent paid by a company or plan. The program is funded through a grant from the federal Administration for Community Living.
Aarp Medicare Resource Center
AARPs Medicare Resource Center has stories that can give you an overview about the way Medicare works, news on the latest changes and developments, answers to questions that go more in depth and a link to the Medicare Enrollment Guide, which can introduce you and your friends to the health care benefit that covers nearly 1 in 5 Americans.
Among the other resources youll find:
- Step-by-step tutorials on how to use Medicares Plan Finder, to learn about Medicare Advantage, Medigap and Part D prescription drug plans in your area
- On-demand webinars that teach you about key times and potential problems as you approach Medicare age and deal with this program for the rest of your life
- Videos that give a quick overview on issues, demystifying the complex topic of Medicare. They accompany the relevant articles.
Have additional Medicare questions? AARP can help. Call 877-634-8213 toll free, from 8 a.m. to 8 p.m. eastern time on weekdays, to speak to an AARP Help Center representative. If you prefer to look online, the chat feature in our digital AARP Help Center can help you with questions you type in.
Also, AARP Senior Editor Dena Bunis answers a limited number of questions in each AARP Bulletin. Write to her at .
Courtesy National Association of Insurance Commissioners
Keep in mind
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What Is A Medicare Copay
A Medicare copayment, or copay, is the amount you must pay out of pocket every time you receive services or refill a prescription drug.
Medicare Advantage plans charge different amounts for doctors and specialists visits. Some plans charge higher copayments for out-of-network providers.
Medicare drug plans charge different copayments for drugs based on the plan formulary and tier level of the medications you take. For example, tier 1 drugs are often generic and the least expensive.
Your specific copays will depend on the Advantage or Part D plan you choose.
What Is The Texas Health Information Counseling And Advocacy Program
If you are eligible for Medicare, the Texas’ Health Information, Counseling and Advocacy Program can help you enroll, find information and provide counseling about your options. This partnership between the Texas Health and Human Services system, Texas Legal Services Center and the Area Agencies on Aging trains and oversees certified benefits counselors across the state.
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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.
State Health Insurance Assistance Programs
State Health Insurance Assistance Programs are available in every state plus the District of Columbia, Guam, Puerto Rico and the U.S. Virgin Islands. These programs are a public service that provide personal help from trained counselors on all Medicare issues.
More than 12,500 SHIP counselors provide free one-on-one counseling, seminars and outreach programs, especially during the Oct. 15 to Dec. 7 annual open enrollment period. They can answer questions over the phone, in person or online
Search online for a SHIP in your area or call 877-839-2675.
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When Am I Eligible For Medicare
Americans age 65 and over are automatically eligible to enroll in Medicare. Some individuals under age 65 who have long-term disabilities are also eligible. Heres how Medicare eligibility works:
- If you are turning 65 years old, you are eligible to enroll in Medicare 3 months before your 65th birthday and up to 3 months afterward.
- If you receive monthly disability benefits through either the Social Security Administration or Railroad Retirement Board, you are eligible for Medicare after 24 months.
- If you have amyotrophic lateral sclerosis and receive monthly disability benefits, you are eligible for Medicare immediately.
- If you have been diagnosed with end stage renal disease and have had a kidney transplant or require dialysis, you are eligible to enroll in Medicare.
There are multiple enrollment periods for Medicare. Once you meet the eligibility requirements, you may enroll during the following periods.
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Each Medicare part that you enroll in has costs associated with it, including premiums, deductibles, copayments, and coinsurance.
Provider Requests And Questions Regarding Claims Payment
MACs, intermediaries, and carriers will continue to process claims submitted for primary or secondary payment. Claims processing is not a function of the BCRC. Questions concerning how to bill for payment should continue to be directed to your local Medicare claims paying office. In addition, continue to return inappropriate Medicare payments to the local Medicare claims office checks should not be sent to the BCRC. Questions regarding Medicare claim or service denials and adjustments should continue to be directed to your local Medicare claims office. If a provider submits a claim on behalf of a beneficiary and there is an indication of MSP, but not sufficient information to disprove the existence of MSP, the claim will be investigated by the BCRC. This investigation will be performed with the provider or supplier that submitted the claim. The goal of MSP information gathering and investigation is to identify MSP situations quickly and accurately, thus ensuring correct primary and secondary payments by the responsible party.
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What Is A Medicare Out
A Medicare out-of-pocket maximum is the limit on how much you will pay out of pocket for all your Medicare costs in a single year. Theres no limit on out-of-pocket costs in original Medicare.
All Medicare Advantage plans have a yearly out-of-pocket maximum amount, which varies depending on the plan you are enrolled in. Enrolling in a Medigap plan can also help lower yearly out-of-pocket costs.
Using Tricare For Life With Other Health Insurancehealth Insurance You Have In Addition To Tricare Such As Medicare Or An Employer
If you have other health insurance, such as a Medicare supplement or an employer-sponsored health plan, you can use TRICARE For Life as long as you have both Medicare Parts A and B.
- If you have employer-sponsored insurance based on current employment, the other health insurance pays first, Medicare pays second and TRICARE pays last.
- In this case, your provider will file your health care claims.
Your claim must be filed within one year from the date of care. For more information, visit the WPS website.
Can I suspend my FEHB coverage to use TRICARE For Life? Yes. Call the Office of Personnel Managements Retirement Information line at 1-888-767-6738 to get a suspension form.
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The Parts Of Medicare
Social Security enrolls you in Original Medicare .
- Medicare Part A helps pay for inpatient care in a hospital or limited time at a skilled nursing facility . Part A also pays for some home health care and hospice care.
- Medicare Part B helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.
Other parts of Medicare are run by private insurance companies that follow rules set by Medicare.
- Supplemental policies help pay Medicare out-of-pocket copayments, coinsurance, and deductible expenses.
- Medicare Advantage Plan includes all benefits and services covered under Part A and Part B prescription drugs and additional benefits such as vision, hearing, and dental bundled together in one plan.
- Medicare Part D helps cover the cost of prescription drugs.
Most people age 65 or older are eligible for free Medicare hospital insurance if they have worked and paid Medicare taxes long enough. You can sign up for Medicare medical insurance by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. To learn more, read .
Ask A Friend Or Family Member To Listen In
Remember that you can always request to have information sent to you in writing at the end of your call. If you have someone available who can help you, it may be wise to listen to the call on speakerphone. The other person should remain silent on the phone, but can take notes for you and prompt you with questions you wanted to ask.
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Can I Use Medicare When Im Outside My State
Original Medicare offers nationwide coverage to all beneficiaries. This means youre covered for out-of-state medical care.
Medicare Advantage plans, on the other hand, offer coverage only for the state you live in, though some may also offer in-network services out out-of-state.
Whether you have original Medicare or Medicare Advantage, you should always make sure that the provider youre visiting accepts Medicare assignment.
Medicare Coverage Helpline Scam: How It Works
Watch out for the Medicare Coverage Helpline Scam happening this month. Many people are getting Medicare scam calls claiming to be from local medical centers. The topic of the discussion is anything related to the pandemic. How does it work? Crooks call using automated services and ask the recipient to confirm the continuation of the annual coverage.
Then they ask them to make a payment that didnt go through the previous time. Alternatively, the callers let the victims know about a new mandatory prescription that they need to get. Lets take an in-depth look.
In all cases, criminals exploit the health concerns of the victims and ask for confirmation of their Medicare number and their credit card details. As expected, most of the people who fall for the Medicare scams are the elderly. They are scared about their well-being, especially since the COVID-19 is deadly amongst people over 70 if not treated immediately.
The World Health Organization recently released a video explaining what people need to do to protect themselves from getting the Coronavirus. Watch it below:
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Where Can I Get Free Medicare Advice
If you have questions beyond the scope of the above, were here for you as a Medicare resource. Our services are completely free. If youre considering a Medigap plan, our team of licensed agents will educate you on each option and ensure you choose the coverage thats best for your health and budget.
If youre not ready to call, we have a library of resources on our website to answer all the most frequently asked Medicare questions. From coverage to enrollment periods, browsing our site will help eliminate your confusion. If you have more questions, call the number above, and one of our Medicare experts will find the answer for you.
Medicare Part Bmedical Insurance
Medicare Part B helps cover your doctors’ services and outpatient surgery. It also helps cover some medical services that Medicare Part A doesn’t cover, such as physical and occupational therapies, and preventive services like mammography and prostate screenings.
Enrollment in Medicare Part B is optional. However, to be eligible for a Medicare supplement or Medicare Advantage plan, you must continue to pay your Part B premium if not otherwise paid for under Medicaid or by another third party.
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Coordination Of Benefits Overview
The Benefits Coordination & Recovery Center consolidates the activities that support the collection, management, and reporting of other insurance coverage for Medicare beneficiaries. The purpose of the COB program is to identify the health benefits available to a Medicare beneficiary and to coordinate the payment process to prevent mistaken Medicare payment. The BCRC does not process claims or claim-specific inquiries. The Medicare Administrative Contractors, , intermediaries, and carriers are responsible for processing claims submitted for primary or secondary payment and resolving situations where a provider receives a mistaken payment of Medicare benefits.
All Medicare Secondary Payer claims investigations are initiated from and researched by the BCRC, and is not a function of the local Medicare claims paying office. This single-source development approach greatly reduces the number of duplicate MSP investigations. This also offers a centralized, one-stop customer service approach for all MSP-related inquiries, including those seeking general MSP information. The BCRC provides customer service to all callers from any source, including, but not limited to, beneficiaries, attorneys/other beneficiary representatives, employers, insurers, providers, and suppliers.
Medicare Benefits & Questions Line Commercial Review
The Medicare Benefits & Questions Line commercials are not from Medicare or any government organization. This commercial is paid to advertise Medicare Advantage plans for seniors.
PART C BENEFITS CLAIM: There are additional benefits from the Medicare Advantage Plan or Medicare Part C, including expanded dental coverage.
- THE TRUTH: You need to enroll in Medicare Advantage Plan to get these benefits.
- THE TRUTH: These plans are not available in all 50 states, so the availability of the benefits depends on your location.
ZERO DOLLAR MONTHLY PREMIUM CLAIM: You can qualify for zero dollar monthly premium.
- THE TRUTH: Plans with no premium will require you to qualify for low-income subsidies.
- THE TRUTH: You often have to live below the poverty line to qualify for this benefit.
ADDITIONAL BENEFITS CLAIM: Additional benefits may include dental, vision, and hearing.
- THE TRUTH: You may not necessarily qualify for this benefit.
- THE TRUTH: Their fine print says, Plan and benefit availability varies by carrier and location.
DENTAL WORK COVERAGE CLAIM: You can get dental benefits that cover dental exams, teeth cleanings, dental x-rays, fillings, gum disease treatment, and dentures.
- THE TRUTH: Their fine print says, Plan and benefit availability varies by carrier and location.
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