Medicare was established as part of the Social Security Amendments of 1965 to provide health insurance benefits to those 65 and older, or to those who may qualify because of other special needs. Medicare is the largest health insurance program in the country and is administered by the Centers for Medicare and Medicaid Services (CMS). The Social Security Administration works with CMS by enrolling people in Medicare. If you need to apply for Medicare, you can do so online by clicking here.
If you need assistance with the process or help inquiring on the status of your claim, please contact my District Office. You will also need to fill out a Constituent Consent and Information Form in order for my office to assist you.
Medicare Part A – Hospital Insurance
Medicare Part A is hospital insurance. Coverage includes inpatient care in hospitals, critical access hospitals and skilled nursing facilities. It also covers hospice care and some home health care. There are certain conditions that must be met.
Most people do not have to pay a monthly payment, called a premium, for Part A because they or their spouse paid Medicare taxes while employed. If you did not pay a monthly payment while employed and you are age 65 or older, you may still be able to buy Part A. Please contact the Social Security Administration (SSA) at (800) 772-1213 for information about buying Part A.
Enrollment in Medicare. You may apply three months before your 65th birthday through three months after that date. Please note that delaying enrollment past your birthday will delay the effective date of your coverage.
You can enroll in a plan and get more information regarding the General Enrollment and Special Enrollment periods by calling (800) MEDICARE or through Medicare.gov. Medicare's website will allow you to compare different plans based on the prescriptions you use.
Medicare Part B – Medical Insurance
Medicare Part B is medical insurance that helps cover services such as doctor’s visits, outpatient care, home health services, and other medical services. Part B also covers some preventive services such as flu shots, glaucoma tests and screenings for breast, prostate and colon cancer.
Enrollment in Medicare Part B. The General Enrollment Period is from January 1 through March 31 each year. If you did not sign up for Medicare Part B when you first became eligible, you may sign up during this period. You may sign up for Medicare Part B at your local SSA office. However, you may be assessed a 10 percent surcharge for each year you were eligible but did not enroll.
If you did not enroll in Part B when you became eligible because you or your spouse were still employed and had group health coverage through your or your spouse's employer or union, you can sign up for Part B during a special enrollment period.
You may sign up:
- Anytime you are still covered by the employer or union group health plan through your or your spouse's current or active employment;
- During the eight months following the month that the employer or union group plan coverage ends, or when the employment ends (whichever is first).
If you do not enroll during this timeframe, you may be assessed a 10 percent surcharge for each year you were eligible but did not enroll.
Standard Monthly Part B Premium. In 2013, the standard monthly Part B premium is $104.90 for all beneficiaries with a yearly income of less than $85,000.
Medicare Part C – Medicare Advantage Plans
Medicare Advantage Plans or Medicare Part C are insurance plans offered by private companies approved by Medicare.
If you join a Medicare Advantage Plan, the plan will provide all of your Part A (hospital insurance) and Part B (medical insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).
Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for nonemergency or non-urgent care). These rules can change each year.
Medicare Part D
Medicare Part D is prescription drug coverage available to everyone with Medicare, those who are covered by Part A or Part B, or both.
A monthly premium is charged for Medicare Part D coverage. The basic benefit offered pays for 75 percent of prescription costs after a $325 deductible has been met. Once drug costs total $2,970, coverage is suspended until drug costs total $4,750. This coverage gap has been referred to as the “doughnut hole.” Once a beneficiary has spent a total of $4750, Catastrophic Coverage begins. During this time, you will pay $2.65 per month for generics and $6.60 per month for name brand medications or 5% of the medication's retail cost, whichever is higher.
Under the Affordable Care Act, if you reach the coverage gap in 2013, you will receive a 52.5% discount on covered brand-name prescription drugs and a 21% discount on generic drugs at the time of purchase. There will be additional savings during the coverage gap each year through 2020, when the coverage gap will be completely eliminated.
Enrollment in Medicare Part D. As with Part B, individuals may enroll three months prior to their 65th birthday, or the first day of Medicare eligibility, through three months after that date. Additionally, from November 15th to December 31st of each year, an open season will occur. During this time, beneficiaries who did not sign up for the benefit during their initial period may enroll. Additionally, already enrolled individuals can change their plans at this time.
Medicare beneficiaries who do not enroll in Part D when they first become eligible will face a one percent per month premium surcharge and will not be able to enroll until the yearly Annual Coordinated Election Period, between November 15th and December 15th of each year.
If you are interested in which Medicare Part D prescription drug plans are available in Virginia, please visit Medicare.gov.
Creditable Coverage. Individuals with prescription drug coverage through an employer or retiree plan or creditable coverage, i.e. coverage equivalent to or better than the standard Part D benefit, may choose not to enroll. If you have prescription coverage and are Medicare eligible, you should have received a notice from your plan's administrator explaining how current coverage compares to Part D and whether you need to enroll. If your coverage is eliminated you will be able to enroll in Part D during a 63 day special enrollment period, starting the day coverage ends.
Individuals on both Medicaid and Medicare. Individuals receiving both Medicaid and Medicare coverage, also known as dual eligible beneficiaries, were automatically enrolled in a prescription drug plan (Part D). However, you are able to enroll in a different plan if the plan to which you were assigned does not cover your particular prescriptions.
Lost Medicare Card
If you have lost your Medicare card, contact your local Social Security Office at 1-800-Medicare, or visit the Medicare website immediately to get a replacement card.
Updating your address with Medicare
To protect you and ensure receipt of your benefits, please contact Social Security to report your new address. The number for the Social Security Administration is 1-800-772-1213. If you are deaf or hard of hearing, call Social Security's toll-free "TTY" number, 1-800-325-0778.
You can also update your address in person by visiting your local Social Security Office. Click here to find your local Social Security Office.
- Learn how to spot, stop and report Medicare fraud
If you still have questions, please contact my District Office at (757) 380-1000.