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What Are My Medicare Benefits

Medicare Offers Important Choices

Medicare and Your CalPERS Health Benefits

Medicare has two paths that subscribers should consider at the outset. They can choose between Original Medicare and Medicare Advantage. They represent similar coverage, but one consists of private plans, and the other is government-run. Original Medicare is an open arrangement.Users can go to any doctor or medical care provider that accepts Medicare.

Medicare Advantage plans also provide comprehensive coverage but achieves it in different ways. They have management styles that can help patients, for example, some provide a primary care doctor. They offer a network that can have lower pricing than similar benefits on Original Medicare. Advantage plans can cost less than Medicare Part B and add prescription drug benefits for an all-in-one combination.

Users can go to any doctor or medical care provider that accepts Medicare. Medicare Advantage plans also provide comprehensive coverage but achieves it in different ways. They have management styles that can help patients, for example, some provide a primary care doctor. They offer a network that can have lower pricing than similar benefits on Original Medicare. Advantage plans can cost less than Medicare Part B and add prescription drug benefits for an all-in-one combination.

How Do Medicare Spending And Use Of Services Differ For Beneficiaries Under Age 65 With Disabilities And Older Beneficiaries

Medicare per capita spending

Average total Medicare spending is higher for traditional Medicare beneficiaries under age 65, mainly due to higher Part D prescription drug spending.13 Medicare per capita spending for beneficiaries younger than age 65 averaged $13,098 in 2014, nearly one third more than average per capita spending for beneficiaries over age 65 .14 Excluding Part D drug spending, the difference narrows considerably to $9,281 for beneficiaries under age 65 and $8,814 for those over age 65, on average. On average, beneficiaries under age 65 have higher per capita spending for drugs covered under Part D and for inpatient and outpatient services, but lower spending on post-acute and hospice care than beneficiaries over age 65 .

Figure 5: Average Medicare Per Capita Spending for Beneficiaries Under Age 65 With Disabilities and Over Age 65, by Type of Service, 2014

Use of medical services

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Give Back: Its Like Getting A Monthly Rebate

If you pay a Medicare Part B premium, we may pay part of that premium for you. We call this a Part B premium Give Back, or a Part B premium-reduction benefit. Its like getting a raise on your Social Security check. The reduction is administered through the Social Security Administration, and depending on how you pay the Part B premium, the reduction will show as an increase in your Social Security check or a credit on your Part B premium statement.

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If Your Income Has Gone Down

If your income has gone down and the change makes a difference in the income level we consider, contact us to explain that you have new information. We may make a new decision about your income-related monthly adjustment amount for the following reasons:

  • You married, divorced, or became widowed.
  • You or your spouse stopped working or reduced your work hours.
  • You or your spouse lost income-producing property because of a disaster or other event beyond your control.
  • You or your spouse experienced a scheduled cessation, termination, or reorganization of an employers pension plan.
  • You or your spouse received a settlement from an employer or former employer because of the employers closure, bankruptcy, or reorganization.

If any of the above applies to you, we need to see documentation verifying the event and the reduction in your income. The documentation you provide should relate to the event and may include a death certificate, a letter from your employer about your retirement, or something similar. If you filed a federal income tax return for the year in question, you need to show us your signed copy of the return. Use Form Medicare Income-Related Monthly Adjustment Amount Life-Changing Event to report a major life-changing event. If your income has gone down, you may also use Form SSA-44 to request a reduction in your income-related monthly adjustment amount.

Providing Misleading Information Or Medicare Fraud

Medicare Supplement Plan F

When applying for Medicare, you should never lie or attempt to mislead. Doing so can lead to the cancelation of your coverage, or in extreme cases, jail time. This can be something as small as intentionally answering a health question incorrectly on an application or as big as Medicare money laundering. Although these examples are two extremes, they can both lead to the termination of Medicare coverage.

Another example of Medicare fraud is allowing someone else to use your Medicare benefits. The only person eligible for Medicare is the person whose name appears on the red, white, and blue identification card. Committing coverage fraud is a surefire way to lose Medicare benefits.

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Do My Disability Benefits Remain Intact If I Get Married

Some types of Social Security Disability are for unmarried family members of the disabled person , while other types are for married or unmarried people, but have income limits. In that case, a new husband or wifes income can be counted toward these limits and could make a disabled person financially ineligible for benefits.

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What Are Medicare Supplement Insurance Plans

Medicare Supplement insurance, or Medigap coverage, may help pay some healthcare costs that Original Medicare doesnt pay. These may include:

, also called Medicare prescription drug coverage, is optional coverage to help Medicare beneficiaries pay for self-administered prescription drugs. It can cover most prescription drugs. The Medicare Part D plans should cover various prescription drugs that people with Medicare take. You can get Medicare Part D through private insurance as a stand-alone plan or as an add-in through a Medicare Advantage plan.

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Medicare Eligibility If You Are Under 65

People younger than 65 may qualify for Medicare if they have certain costly medical conditions or disabilities.

If you are under 65, you can qualify for full Medicare benefits if:

  • You have been receiving Social Security disability benefits for at least 24 months. These do not need to be consecutive months.
  • You have end-stage renal disease requiring dialysis or a kidney transplant. You qualify if you or your spouse has paid Social Security taxes for a specified period of time, based on your age.
  • You have amyotrophic lateral sclerosis, also known as Lou Gehrigs disease. You qualify for Medicare immediately upon diagnosis.
  • You receive a disability pension from the Railroad Retirement Board and meet certain other criteria.

Why Do I Need To Buy A Private Health Plan

Medicare Benefits

Private Medicare health plans like Medicare Advantage or Medicare Cost plans cover everything Original Medicare does, and usually include more coverage for services you might need. Plus, they can include extra perks and benefits.

Find out more in the article, 4 reasons to buy a private health plan.

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Cigna Dental Care Plan

Your plan may include a range of preventive dental services, such as oral exams and cleanings. Some plans may include comprehensive dental coverage, such as fillings, extractions, root canals, dentures, and other services.

How do I find an in-network Cigna Dental dentist?

  • Or, call Cigna Dental Customer Service at

8 am 8 pm, 7 days a week

8 am 8 pm, Monday Friday

A messaging service is used on weekends, after hours, and on federal holidays.

A Cigna Dental Information Guide is included in your Welcome Kit or end-of-the-year renewal mailing. Review this information to know what services are covered under your plan. After youve selected a Cigna Dental network dentist, call them directly to schedule an appointment.

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How To Apply For Medicare

If you qualify for Medicare, there are a number of ways you can apply:

  • Apply online at www.ssa.gov.
  • Visit your local Social Security office.
  • If you already have Part A and want Part B, you must complete an Application for Enrollment in Part B.

You are eligible for free Part A coverage if youve worked a specified number of quarters and file an application for Social Security or RRB benefits. You may not be eligible if you never worked and never paid Medicare taxes, but you can still purchase Part A coverage . If you are not eligible for a free premium for Part A, you must:

  • File an application to enroll by contacting Social Security.
  • Enroll during a valid enrollment period.
  • Enroll in or already have Part B.

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How Do You Enroll In The Medicare Qmb Program

To enroll in the QMB program, you first need to be enrolled in Medicare Part A.

The next step is to review your income and assets to see if you fall below the limits set by Medicare. But remember there are exceptions to those limits, and youre encouraged to apply even if your income or assets exceed them.

To apply for the QMB program, youll need to contact your state Medicaid office. You can check online to find your states office locations, or call Medicare at 800-MEDICARE. The documentation youll need varies by state, but your application process will likely include submissions of identification, proof of Medicare coverage, and financial information.

Once you submit your application, you should receive a confirmation or denial within about 45 days. If youre denied, you can request an appeal. Enrollment in any of the MSPs must be renewed each year.

Even when your QMB is active, you may at times be wrongfully billed for items or services that it covers. Contact Medicare for any billing problems. Be sure to carry documentation of your participation in the QMB program and show it to your providers.

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Other Ways To Get Medicare Coverage At Age 65

Medicare Advantage  Medicare 863

If you dont qualify for premium-free Medicare Part A coverage, you may be eligible to buy coverage. However, you must still be a U.S. citizen or a permanent resident for at least five years to qualify.

Other Medicare Eligibility Options

  • You can pay premiums for Medicare Part A hospital insurance. Premium costs vary based on how long you have worked and paid into Medicare.
  • You can pay monthly premiums for Medicare Part B medical services insurance. Youll pay the same premiums as anyone else enrolled in Part B.
  • You can pay monthly premiums for Medicare Part D prescription drug coverage. Your premium will be the standard rate and would depend upon the plan you choose.

You will not be able to purchase a Medicare Advantage plan or Medigap supplemental insurance unless you are enrolled in Original Medicare Medicare Parts A and B.

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Things To Consider Before Choosing This Type Of Plan

This sounds really enticing especially when youre on a fixed income. But there are some things to consider first before choosing a plan with a Give Back Benefit.

You want to compare all the benefits including:

  • Co-pays for services
  • The annual maximum out of pocket for the plan
  • Your prescription costs
  • Make sure your doctors are in the network

If the costs are much higher than compared to another plan, the monthly Give Back may not be worth it. You may be able to get another plan that will provide a much better value in the long run. You definitely want to compare plans to see what makes the most sense for your situation.

Some people qualify for assistance through the Medicare Savings program, where the government pays for their Part B monthly premium. If the government pays your Part B premium, then youre not eligible for a Give Back benefit since you already get help paying for Part B.

You may want to know if theres an option for a Give Back Benefit in your area. So give us a call at 783-5901 and well be happy to show you whats available and compare your options.

Things To Do Before Signing Up For Medicare

  • Ask the employer or benefits administrator how its retiree coverage works with Medicare. Youll want to know if your current benefits will change, if they offer retirement coverage or other supplemental coverage that works with Medicare, and if any drug coverage they offer is . Get questions to ask.
  • Check when your current coverage ends and sign up for Medicare about a month earlier. Signing up for Medicare before your current coverage ends can help you avoid a gap in coverage.
  • Ask the employer to fill out the employment form. Youll need this extra form to qualify for a Special Enrollment Period to sign up without penalty.
  • Find Medicare plans in your area, if you dont have retiree coverage or if the employer doesnt offer . If you join a Medicare Advantage Plan or Medicare drug plan, coverage starts the first day of the next month.
  • To avoid a tax penalty, you and your employer should stop contributing to your Health Savings Account 6 months before you retire or apply for benefits from Social Security . Why should I stop contributions before I retire?
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    Do You Have To Report Inheritance To Medicaid

    medicaidplanner Staff answered 2 years ago. If you inherit money, you are legally obligated to report it to Medicaid. Depending on the amount of the inheritance and your current level of income and assets, an inheritance can cause you to lose your Medicaid coverage. On the other hand, if you inherit money and do not report it,

    What If Ive Worked But Not Long Enough

    Medicare & You: Medicare’s Preventive Benefits

    You can still get Medicare Part A coverage, even if you dont fully meet the work requirement of 40 credits. Heres what youll pay in 2022:

    • If you have 30 to 39 credits, your Part A premium will cost $274 per month.
    • If you have fewer than 30 credits, your Part A premium will cost $499 per month.
    • If youre able to continue working and you accumulate 40 work credits, you wont have to pay the monthly premium for Part A coverage.

    Part A is the only part of Medicare that requires a specific amount of work history. You can enroll in Medicare parts B, C, and D without a work history.

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    When Does Medicare Coverage Start

    Medicare coverage is dependent on when you have signed up and your sign-up period. Coverage always starts on the first of the month.

    If you meet the criteria for Premium-free Part A, your coverage starts the month you turn 65-years old or the month before if your birthday is the first of the month.

    Part B and Premium-Part A plans are dependent on sign-up:

    You can also sign up for Premium-free Part A after your 65th birthday. Coverage starts 6 months back from sign-up or when you apply for benefits from Social Security or the Railroad Retirement Board.

    After your IEP is over, you can only sign up for Part B and Premium-Part A during the other periods of General Enrollment or Special Enrollment.

    For Original Medicare, the General Enrollment Period is Jan. 1 March 31, with coverage beginning on July 1. You may have to pay a monthly late enrollment penalty if you do not qualify for Special Situations.

    Under Special Situations or the SEP, you can sign up for Part B and Premium-Part A without paying a late enrollment penalty. Your coverage will start next month. Access your situation and

    More About How Va Health Care Works With Medicare And Other Insurance

    This is your decision. You can save money if you drop your private health insurance, but there are risks. We encourage you to keep your insurance because:

    • We dont normally provide care for Veterans family members. So, if you drop your private insurance plan, your family may not have health coverage.
    • We dont know if Congress will provide enough funding in future years for us to care for all Veterans who are signed up for VA health care. If youre in one of the lower priority groups, you could lose your VA health care benefits in the future. If you dont keep your private insurance, this would leave you without health coverage.
    • If you have Medicare Part B and you cancel it, you wont be able to get it back until January of the following year. You may also have to pay a penalty to get your coverage back .

    Yes. We encourage you to sign up for Medicare as soon as you can. This is because:

    Youll need to choose which benefits to use each time you receive care.

    To use VA benefits, youll need to get care at a VA medical center or other VA location. Well also cover your care if we pre-authorize you to get services in a non-VA hospital or other care setting. Keep in mind that you may need to pay a VA copayment for non-service-connected care.

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    Do Medicare Plans Offer Prescription Drug Coverage

    There are 2 ways to get Medicare prescription drug coverage:

    • You can choose a Medicare Advantage plan that includes prescription drug coverage .
    • You can purchase a called Part Dto add to your Original Medicare.

    Your out-of-pocket costs for prescription drug deductibles, copays and coinsurance vary from plan to plan. Check each plans Drug List to see what prescription drugs are covered.

    What Is Medicare Part B Medical Insurance

    Medicare 2021 Benefits Comparison Chart

    Medicare Part B provides outpatient/medical coverage. The list below provides a summary of Part B-covered services and coverage rules:

    This list includes commonly covered services and items, but it is not a complete list. Keep in mind that Medicare does not usually pay the full cost of your care, and you will likely be responsible for some portion of the cost-sharing for Medicare-covered services.

    The 2022 Part-B premium is $170.10 per month

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