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What you may not know about Medicare (01/09/2008)
What you may not know about Medicare

by: Cherryl Kjos

Winona Social Security District Manager

Almost everyone knows that Medicare is a medical insurance program for retired and disabled people, run by the government. But there are probably some things you don't know about Medicare " and should. Some people are only covered by one type of Medicare; others opt to pay extra for more coverage. Understanding Medicare can save you money. Here are some things you should know about Medicare.

There are four parts to Medicare: Parts A, B, C and D. Part A helps pay for inpatient hospital care, skilled nursing care, hospice care and other services. Part B helps pay for doctors' fees, outpatient hospital visits, and other medical services and supplies that are not covered by Part A. Part C is an optional Medicare program and allows you to choose to receive all of your health care services through a provider organization. These plans may help lower your costs of receiving medical services, or you may get extra benefits for an additional monthly fee. You must have both Parts A and B to enroll in Part C. And Part D is also an optional Medicare program known as the Medicare Prescription Drug Program. Part B is the one we get the most questions about, so here are some things to know about it.

Most people don't pay a premium for Part A because they have worked and paid enough in Medicare taxes on wages over the years. However, there is a monthly premium for Medicare Part B; in 2008 the standard premium is $96.40. Some high-income individuals pay more than the standard premium. Part B is a good value for people who need medical insurance, but you need to enroll during your initial enrollment period, or when you first become eligible, unless you want to pay a penalty in the form of a higher premium. Most people first become eligible for Medicare at age 65.

There are exceptions to this rule. For example, you can delay your Medicare Part B enrollment without having to pay higher premiums if you are covered under a group health plan based on your own current employment or the current employment of any family member. If this situation applies to you, you can sign up for Medicare Part B without paying higher premiums:

Any month you are under a group health plan based on your own current employment or the current employment of any family member; or

Within eight months after your employment or group health plan coverage ends, whichever comes first.

If you are disabled and working (or you have coverage from a working family member), the same rules apply.

Remember: If you don't enroll in Medicare Part B when you first become eligible to apply and you don't fit into one of the above categories, you'll have to wait until the general enrollment period, which is January 1 through March 31 of each year. At that time, you may then have to pay a higher Medicare Part B premium because you could have had Medicare Part B and did not take it.

We also receive many questions about who pays first when you have Medicare and other supplemental health insurance coverage. There is one simple rule of thumb to follow when understanding the "who pays first rule". If you currently have Part A and/or Part B of Medicare and are NOT covered by group health insurance through your own work, or your spouses work, Medicare always pays first on your medical bills. Then if you have supplemental insurance, they will pay second if Medicare hasn't paid for everything. If you currently have Medicare and are covered by other health insurance from your own current employment or your spouses current employment, Medicare will pay second because your group health insurance through work will pay first. Once you or your spouse are no longer working, Medicare pays first.

If you would like to learn more about Medicare Parts A, B, C, and D, visit the Center for Medicare & Medicaid Services (CMS) Medicare website at www.medicare.gov. You may also call Medicare at: 1 800-Medicare (1 800-633-4227) 


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