If you are only going to apply for Medicare, call 1‑800‑772‑1213 and a Social Security representative will assist you with making an appointment at your local SSA office. At that time, the SSA representative will let you know what you need to bring with you.

You can also signup here for Medicare only.

Already receiving Social Security Benefits?

If you are already receiving social security benefits or Railroad Retirement Board benefits, you really don’t have to do anything because you are already entitled to Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) starting on the first day of the month you turn age 65.

(If you turn 65 on March 30^th, your Medicare benefits will be effective on March 1. If your birthday falls on the 1^st day of the month, your benefits are effective the first day of the previous month.)

You should receive your Medicare card about 3 months (+/-) before your 65^th Birthday!

Are you under 65 and disabled?

If you are under the age of 65 and disabled and have been entitled to disability benefits under Social Security or Railroad Retirement Board, you are automatically entitled to Medicare Part A and Part B beginning on the 25^th month of your disability. That’s 2 years and 1 month you have to wait before you are entitled to hospital and medical coverage under Medicare.

Your Medicare card should be mailed to you about 3 months prior to your Entitlement date.

If you are enrolled in Medicare Part A and Part B, you can join a Medicare Part C (Advantage Plan) and you are eligible for Part D, the prescription drug coverage plan.

Joining a Medicare prescription drug plan is voluntary, and you pay an additional monthly premium for the coverage. However, unless you have other prescription drug coverage that is as good as Medicare Part D, you will pay a penalty if you wait to join at a later time.

Don’t delay. If you haven’t signed up you have 3 months after your eligible date without a waiting period and up to 7 months to join, without a penalty but with a waiting period for coverage to begin.

Contact Social Security at 1-800-772-1213. You can also visit http://socialsecurity.gov

By Mary Jane Stern

The other day I helped my neighbor, who is turning 65 next month, with options for selecting different Medicare plans (Part A, B, C and D and Medigap).

One of her complaints was there is no place to get the information I presented her. She doesn’t use the computer and the computer she has is in desperate need of repair. So what does a person do to get questions answered and know what choices they have for the different Medicare plans?

Today, it is estimated there are 7,000 Baby Boomers, per day, becoming eligible for Medicare. If you don’t regularly use a computer nor have one, and the material being sent seems a little over-whelming, who can you turn to for assistance?

Medicare employees are very friendly and helpful over the telephone. You might be on hold for a while or have them call you back, but they are able to help you. Here is important information that Medicare has published, for you to pass on to a friend, relative or someone you know that doesn’t have a computer and needs more help with Medicare or just has other questions:

Call the Medicare Helpline

1-800-MEDICARE (1-800-633-4227) (English and Spanish) TTY 1-877-486-2048

• Get general Medicare information.
• Get answers to questions about what Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) covers.
• Ask for information about your Medicare health coverage choices including cost, benefits, quality, and more.
• Get information and ask questions about Medicare Prescription Drug Plans.
• Get information about your Medicare appeal and patients’ rights.
• Get information about nursing homes in your area.
• Ask for Medicare booklets including the “Medicare & You” handbook. May also be available in audiotape (English and Spanish), Braille, Spanish, and large print (English and Spanish).
• Get information about Medicare events and activities in your area. F
• Find the most up-to-date phone numbers (including TTY) for information on Medicare bills and services, fraud and abuse, buying Medigap or long-term care insurance, appeals and complaints, and programs to help pay medical bills for people with limited income.

Hours to call:

24 hours a day, 7 days a week to use the speech-automated system so you can easily get the information you need in English or Spanish. This system will ask you questions that you answer with your voice to direct your call automatically. You can also speak to an English or Spanish speaking operator.

Where to Get Other Medicare Questions Answered – Call Social Security

1-800-772-1213 (English and Spanish) TTY 1-800-325-0778

• Ask for a replacement Medicare card.
• Change your address.
• Sign up for Medicare Part A and Part B.
• Apply for extra help with Medicare prescription drug costs if you have limited income and resources.
• Ask questions about Social Security benefits.
• Ask questions about Medicare Part A and Part B eligibility and enrollment options
• Ask questions to see if you qualify for extra help with Medicare prescription drug costs. Ask Medicare premium questions.
• Find your local Social Security office.
• Report a death.

Hours to call:

7:00 a.m.–7:00 p.m., Monday through Friday to speak to an English or Spanish speaking operator 24 hours a day, 7 days a week to listen to pre-recorded information and services in English or Spanish

Visit Your Local Library

If you don’t have a computer you can always visit your local library and look on the web by visiting:

Medicare: www.medicare.gov get more information on Medicare, find programs that may help with your prescription drug and other health plan costs, download booklets, and compare health plans, prescription drug plans, Medigap policies, hospitals, nursing homes, and more!

Social Security: www.socialsecurity.gov, get more information for a Medicare replacement card, find your local Social Security office, and get important information about Social Security.

If you get benefits from the Railroad Retirement Board, call your local office at 1-800-808-0772 or visit www.rrb.gov on the web.

A few weeks ago I was asked to process a couple of credit cards through a person’s credit card processing service and they were going to pay their friend back in cash. I was given the information and decided not to proceed because somehow it felt like I was participating in a type of credit card fraud. I didn’t know the people nor did I have any written authorization from them to process their credit cards.

Well, this got me thinking to send out a reminder to everyone about Medicare fraud and as I started to write, the U.S. Health and Human Services department put out a press release headlined: “Medicare Fraud Strike Force Charges 111 Individuals for more than $225 Million in False Billing and Expands Operations to Two Additional Cities.”

The 111 arrested were from 9 cities, and according to Assistant Attorney General Lanny Breuer, the medical personnel arrested charged for procedures that were not performed and for unnecessary equipment. The nine cites:

• Miami – 32 arrests
• Detroit – 31 arrests
• Chicago – 11 arrests
• Brooklyn – 10 arrests
• Houston – 9 arrests,
• Dallas – 7 arrests,
• Baton Rouge – 6 arrests
• Los Angeles – 5 arrests

It is so, so important today that you protect your Medicare information. Medicare continues to work diligently in their pursuit of the criminals who steal from Medicare, and that’s stealing from you, because it’s your tax dollars. Here are some things to practice and be aware of:

• Free Offers –  if people approach you in parking lots, shopping centers, or other public areas and offer free services, groceries, transportation, or other items in exchange for your Medicare number – Just Walk Away.
• Health Surveys: If someone calls you claiming to be conducting a health survey and asks for Medicare number. Simply hang up the phone.

• Looking for Payments: Telephone marketers who claim to be from Medicare or Social Security and asks for payment over the phone or Internet may be looking steal your money – Don’t give your information away and just hang up.

If you suspect Medicare fraud, contact the Department of Health & Human Services Office of Inspector General. If you think someone is misusing your personal information, contact the Federal Trade Commission.

TIP: Invest in a paper shredder and invest the time in shredding receipts from your doctor, Medicare, credit card companies, etc. Or start a shredding box. I discovered the other day Office Depot offering shredding services and it’s done while you watch.

Keep Yourself Safe!

Every few years when the federal budget is in trouble, talk begins about privatizing Medicare. Today it’s a hot topic.

Medicare, in my opinion, is one of the best and affordable healthcare programs we have here in the USA.

House Budget Chairman Paul Ryan (R-Wisc.) is proposing a new program to replace today’s Medicare programs with vouchers and seniors would use these vouchers to purchase private health insurance. The Medicare programs as we know them today would end should this proposal pass.

What does this mean?

Government programs like Medicare would end for eligible seniors (also known as the elderly) and they would have to purchase health care insurance from private insurance companies. Private insurance companies are notorious for raising premiums and the Government is generally slow to raise value in entitlement programs. Remember there’s been no COLA (Cost of Living Adjustment) for 2 years, but premiums in various Medicare Programs have increased!

How it Would Work

In simple terms, the government would send you a voucher for a certain dollar amount and you would have to go out and find the best plan you could for the amount of money the government gives you.  That could really empty your wallet. Look at what the private insurance companies have done with the Part D premiums and copayments over the last few years. They keep on going up every year!

As you read this today and you are a senior enrolled in a Medicare program or becoming eligible, you won’t be affected.  In an article in the Huffington Post, Ryan’s proposal states:

“Current Medicare recipients would get to stay in the program. People within 10 years of eligibility – ages 55 to 64 – would also go into Medicare. But those now 54 and under would get a fixed payment from the government when they become eligible at age 65. They would be able to use the voucher to buy a Medicare-approved private plan from a menu of coverage levels and options.”

Does this mean if the voucher program is eventually passed, Medicare will actually end and
Social Security is privatized?

Young or old in the USA, health care is a major issue and concern to many people. Many cannot afford the expense and many States are finding the Affordable Care Act unconstitutional.  What happens to the “pre-existing” condition clause? Will we lose that too?

Where do you shop for your $4 generic medications? Do you shop at the same pharmacy and run the charges through your Medicare Part D plan? Or do you shop at a different pharmacy and just pay cash for them?

Why would I ask you these questions?  A few years ago we ran all of our prescriptions through one pharmacy using our Medicare Part D plan.  Then one day we realized that in many instances $4 is not what is being charged against the Total Drug Cost. Instead, it’s a retail price on the generic drug being charged against the Total Drug Costs.

You take a prescription drug and it is in the pharmacy’s list of $4 generic drugs and your co-payment is $4.  When you get your Medicare Part D Explanation of Benefits you might see a charge of $15-$20 or more for that medication. That $15-$20 is applied to your Total Drug Cost and can put you into the Coverage Gap perhaps a few months sooner.

What Can You Do?

As much as it is an inconvenience, shop at two different pharmacies.  Don’t use your Part D plan for the $4 generic drugs.

The reason I recommend two different pharmacies is because once the pharmacy has your insurance information, it’s almost impossible to get them to stop running the $4 generic charges through your plan.

Just go to another pharmacy offering $4 generics and pay cash and these charges are never applied against your Total Drug Cost in your Medicare Part D plan.

It’s really worth the inconvenience of shopping at two pharmacies. One for $4 generics and one for brand name medications.  It won’t be until 2020 that the coverage gap is closed.  In the meantime, we need to look at ways to stay out of the Coverage Gap.

Check around and find out what some of the pharmacies in your area are offering.  One pharmacy in our area has a “no cost” antibiotic prescription program and they offer certain diabetes medications at no cost.

Let us know if you have any strategies for staying out of the Coverage Gap and let us know if pharmacies in your area have any prescription programs.  We would love to hear about them and share with our readers.

During 2011 2.8 million baby boomers will turn 65 and become eligible for Medicare and with the different plans available this can become overwhelming when trying to make a decision.

Do you just enroll in Original Medicare Part A, Part B and the Prescription Drug Plan (Part D)? Or do you enroll in a Medicare Advantage Plan (Part C)?

The Medicare Rights Center, http://medicarerights.org, suggests you consider a few key points when enrolling in a Medicare Advantage plan:

Key Points

• Choice of doctor
• Ease of access to specialists without unexpected bills
• Coverage away from home
• Prescription drug coverage
• Does the plan works with Medicaid if enrolling in a Medicare Advantage Plan

You are also encouraged to speak with your healthcare provider, their staff, friends, family or others to help you with your decision.  Here are some other important questions the Medicare Rights Center suggest you receive answers to before enrolling:

Get Answers to These Questions

• Can you use your current doctors?
• Are your doctors in the plan’s network and are they taking new patients?
• Do your doctors recommend joining this plan?
• What will happen if your doctors leave the plan?
• Which specialists, hospitals, home health agencies and skilled nursing facilities are in the plan’s network?
• If you have or develop a complex illness, what disease-related services are covered?
• What extra benefits does the plan offer? (Physical exams, dental services, vision care) and what rules do you have to follow to get them?
• Are your prescription drugs on the plan’s formulary (list of covered drugs)?
• Are there limits or caps on prescription drug coverage?
• Do you have to pay a monthly premium? If so, how much is it?
• How much is your co-payment for a visit with your Primary Care Physician or a visit with a specialist?
• How much will you pay for brand-name drugs? How much for generic drugs?
• How much will you pay for a hospital stay?
• How much will you pay if you use a non-network doctor or hospital?
• Are there higher co-pays for certain types of care, such as hospital stays or cancer treatment?
• What service area does the plan cover?
• What kind of coverage do you have if you travel outside of the service area?
• What type of disenrollment from the plan and how many members leave?
• How do members rate the health care they get from the Plan?

The questions are really good questions to consider.  If you decide to enroll in a Medicare Advantage Plan, the questions can be used to compare one plan against another plan.  Remember the Medicare Advantage Plans are run by private insurance companies.

The Medicare Rights Center has been helping people with Medicare since 1989 and is the largest independent, non-profit source of Medicare information and assistance.  You can contact them at 1-800-333-4114.

When I started writing this blog it was to remind you about some of the new things that were happening in 2011 for Medicare Part D, like the 50% co-payment by the pharmaceutical manufacturers for brand name drugs when you hit the coverage gap.

But as I started writing, I stumbled upon something interesting that could ultimately cost you more while in the coverage gap if you use generic drugs.

We know Part D providers encourage you to use a generic drug whenever possible.  And, where I live in the State of Florida, a pharmacy dispenses a generic drug unless it is written on your prescription that the “brand” is medically necessary.

Until you hit the coverage gap and you are using the generic drug, your monthly co-payment is generally less expensive than it would be if you were receiving a brand name drug.

What’s New

In 2011 when you hit the coverage gap (donut hole) you will receive a 50% discount on the total cost of your “brand” name drug(s) as long as the pharmaceutical manufacturer has an agreement with Medicare.

You will have a 93% cost share on your generic drugs during the coverage gap in 2011. This is the beginning of reducing the beneficiary co-insurance rate in the gap from 100% to 25% by 2020 for generic drugs.

Generics Could be More Expensive – A Catch 22

But, in some instances your costs for generics during the coverage gap in 2011 could be more expensive than a “brand” name drug.  This is somewhat of a “Catch 22.” You are sort of “damned if you do, and damned if you don’t.”

The Example:

You are prescribed “Brand X” which is a brand name drug and has a retail price of $170 and there is “Generic D” available.  Your Part D provider offers you a co-payment of $10 per month for using the generic versus $50 per month for using “Brand X.”  The generic has a retail price of $130 for a 30 day supply.  Along with your other drugs you hit the coverage gap. (As a note, these costs are based on an actual brand versus generic.)

The Catch

During the coverage gap, “Brand X” will cost you $85 per month, but “Generic D” will cost you $120 per month.  In this instance you are actually paying more for the generic than the brand during the coverage gap.

The Solution

There is no correct solution to this dilemma. You can ask your physician to write a prescription that is “medically necessary” for the brand name drug. What happens here is that you reach the coverage gap quicker because of the higher retail price.

But on the other hand, if you reach the coverage gap and use the generic drug, your out-of-pocket costs are much higher.

Let us know if you have a solution for this situation as I’m sure there will be many beneficiaries who will fall victim to this issue.

1. Reducing Drug Costs
2. Tools to Use during Medicare Open Enrollment
3. What is the Medicare Therapeutic Shoe Program
4. No Pre-existing Condition Clause with Medicare
5. Silver Sneakers for Older Adults Not On Medicare
6. How To Report Medicare Fraud
7. Another Part D Provider Sanctioned by Medicare
8. Medicare Preventive Services
9. Medicare Requirements for a Skilled Nursing Facility
10. Keep Your Medicare Card Safe