Medicare Information

This information is for the “masses”, there are exceptions to every rule. However this is is a great resource for most people

that are trying to understand Medicare.

 

How to enroll into Medicare?

This depends if you are drawing your social security income or if you have deferred it.

If you are drawing your social security income, then you will be automatically enrolled into Medicare Part A and Part B. Your will receive your Medicare Card in the mail approximately 3 months prior to your 65th birthday.

 

If you are not drawing social security, then you will have to register for Medicare Part B. You can do this in three different ways:

1)    You can register online at www.ssa.gov

2)    You can register on the phone at 1-800-772-1213

3)    Or you can go to your local social security office and register in person.

(Click here to find your closest social security office location)

 

If I am still working, do I have to start my Medicare?

No, as long as you or your spouse is still working and you have health insurance through your or your spouse’s employer, then

you can defer your Medicare Part B and you will not be penalized.

However, if/when you lose that coverage, you will have 60 days prior and 63 after that coverage ends to enroll into Medicare

Part B.

When does my Medicare start?

Medicare typically starts the first day of your 65 birth month. Example, if your birthday is 10/10/1948, your Medicare will

start 10/01/2013.

Exception: If your date of birth is 10/01/1948, then your Medicare will start 09/01/2013. (This makes no sense to me either,

but it’s the rule…)

 

What is my Medicare Claim Number?

Your Medicare Claim Number is the number that Medicare uses to file your claims. This is typically your social security

number with a letter after it. This letter is a code that shows why/how you qualify for Medicare.

Examples:

If you Medicare Claim Number is your social security number with an “A” after it, this means that you qualified on your own

by paying your Medicare taxes for 40 quarters.

If you were a housewife (or house husband), then your Medicare Claim Number could be your husband’s (or wife’s) social

security number with a “B” after it. This means that you qualified based on your spouse paying into Medicare.

There are about 35 different codes (letters), to see a full listing Click here.

Is Medicare free?

For most people Medicare Part A has no premium, however for most people Medicare Part B does have a

premium. The Medicare Part B premium is based on your income. What a lot of people do not like is that it is

not based on your current income, the Medicare Part B Premium is typically based on your income from 2

years prior.

Below is a chart illustrating what your Medicare Part B Premium is going to cost you for 2013.

Part B premiums by income

If your yearly income in 2011 was You pay (in 2013)
File individual tax return File joint tax return
$85,000 or less $170,000 or less $104.90
above $85,000 up to $107,000 above $170,000 up to $214,000 $146.90
above $107,000 up to $160,000 above $214,000 up to $320,000 $209.80
above $160,000 up to $214,000 above $320,000 up to $428,000 $272.70
above $214,000 above $428,000 $335.70

Source for chart: www.medicare.gov

 How do I pay for Medicare?

Typically, Medicare will deduct the Medicare Part B premium directly from your Social Security Income

Check. However, if you are not drawing your Social Security Income, Medicare will mail you a quality bill.

 

What is Medicare Part A?

You can go to http://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html , do get a very detailed “long”

definition of what Medicare Part A covers.

MedicareBob™’s cliff notes:

In general, Medicare Part A covers hospital care, Skilled Nursing facility care, nursing home care, hospice, and home

healthcare.

Remember, Medicare Part A is Insurance Coverage. This means that Medicare Part A does not pay for these service in full.

Here is what Medicare Part A “charges you”:

Hospital: When you go to the hospital, Medicare Part A requires you to pay the first $1,186.00 before Medicare will pay for

any of your hospital bills. If you stay longer than 60 days, you will have a copay per day that you will have to pay. Starting day

61 you will be charged $296.00 per day, starting day 91 you will be charged $592.00 per day.

Skilled nursing facility care: Medicare Part A will only pay for the first 20 days. Starting day 21 you will have a copay of

$144.50 per day.

Hospice and home health services: If you meet Medicare’s requirements than Medicare will proved these services at no cost to you.

How much is the Medicare Part A premium?

For most people there is no premium for Medicare Part A.

What is Medicare Part B?

MedicareBob™’s definition: Medicare Part B covers your medical and Doctor’s bills.

Examples:

Doctor visits, outpatient procedures, durable medical equipment, lab work, etc..

Medicare Part B has a small annual deductible of $147.00. This is not a big deal, however, once you pay the $147.00, Medicare

Part B will only pay 80% of your medical and doctor bills. This means you have to pay the other 20% (aka 20% coinsurance).

There is no “max out of pocket”, this means there is no limit to your exposure.

What is a deductible?

A Deductible is an amount of Money that you are require to pay before your insurance plan will pay anything towards your bills.

2 relative examples:

1)    Medicare Part A has a $1,186 deductible when you go to the hospital. This means that you have to pay the first $1,186 before Medicare Part A will step in and pay anything.

2)    Medicare Part B has an annual deductible of $147.00. This means that you have to pay the first $147.00 of your Medical and Doctor Bills before Medicare will step in and pay anything.

What is a Copay?

A copay is a pre-negotiated amount (fixed dollar amount) between a Service Provider or facility and an insurance Plan.

Example: Medicare Part A will charge you a $296.00 copay per day starting day 61 in the hospital.

What is Coinsurance?

Coinsurance is a percentage that you are required to pay. Instead of being a fixed dollar amount, it is a fixed percentage.

Example: Medicare Part B requires you to pay 20% coinsurance. Therefore, Medicare Part B pays 80% of your Doctor and Medical bills, and you are required to pay the other 20%.  

Is physical therapy covered by Medicare?

Yes and no… Yes, Medicare Part B does cover physical therapy, however there are some limitations. The physical therapy has

to be ruled as: medically necessary. Even then, there are limits called, “therapy caps” or “therapy cap limits”. The 2013 limits

for physical therapy this year are $1900.00.

What is not covered by Medicare Part A and Medicare Part B?

Long-term care, Routine dental or eye care, dentures, cosmetic surgery, acupuncture, hearing aids/ exams, routine foot care.