UNDERSTANDING MeDICARe

PART D
P R ESC R I P T I O N D RU GS
PREVENTIVE BENEFITS
UNDERSTANDING
MeDICARE
WHAT YOU NEED TO KNOW
Contents
1
3
6
10
11
14
16
Medicare and other health
insurance as you retire
What is Medicare?
Your Medicare choices
Paying for Medicare
Buying Medigap insurance
If you can’t afford Medicare payments
Your Medicare answer guide
This booklet is part of a series of AARP publications that
­provide life answers for people age 50 and over.
MEDIGAP
E X PA N D E D C OV E R AG E
PREVENTIVE BENEFITS
UNDERSTANDING
Medicare: WHAT YOU
NEED TO KNOW
Health insurance is important at any age. But as you near retirement,
it’s especially important to make sure you have insurance to help pay
for medical care once you stop working.
During the working years, most people get
health insurance through their job. Some
people continue to get health coverage
through their former employer’s plan after they
retire. This is called retiree health insurance.
Employers don’t have to provide retiree health
benefits to employees. Even when employers
do offer retiree health benefits, there’s no federal law preventing them from cutting or eliminating those benefits.
Before you retire, find out what health benefits,
if any, are available to you during your retirement years. You can get this information from
your employer or from the person who handles
payroll and benefits.
Another source of health insurance that you’ll
want to get information about is Medicare.
Medicare is a federal health insurance program for people who are 65 and over, for some
younger people with disabilities, and for people
with end-stage kidney disease. Medicare also
offers coverage for prescription drugs.
In addition to offering prescription drug coverage, Medicare has expanded coverage for
preventive benefits. Medicare offers important
preventive benefits and services such as vaccinations, bone mass measurement, glaucoma
screenings, and screenings for certain cancers.
Medicare also covers a Welcome to Medicare
physical exam, an annual wellness visit, personalized prevention planning, and screening tests
for certain cancers, heart disease and diabetes.
Because Medicare doesn’t cover all of your
health care costs, you might want to find out
about Medicare supplemental insurance, sometimes referred to as Medigap. Medigap is pri-
UNDERSTANDING MEDICARE
1
vate health insurance that supplements your
Medicare coverage by helping you pay your
share of health care costs. You have to buy
and pay for Medigap on your own. For some
people with low incomes, the Medicaid program, which is run by your state, can act like a
Medigap plan by covering costs that Medicare
doesn’t.
Before you retire,
find out what health
benefits, if any,
extend to you and
your spouse during
your retirement years.
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To help you become familiar with the
Medicare program and your options, AARP has
prepared this booklet. It also will guide you to
resources that can give you more information
about Medicare, Medigap, and planning for
health care coverage in your retirement years.
PART D
PREMIUMS
PREVENTIVE
BENEFITS
P R ES C R I PT I O N D RU GS
What is Medicare?
Medicare is a federal health insurance program that helps people
age 65 and over. It also helps some younger people with disabilities
and people with end-stage kidney disease pay for their heath care.
The program has several parts. Part A helps
pay for inpatient hospital care and some other
care, such as home health, hospice, and skilled
nursing facility care. Part B helps pay for doctor
visits, some home health care, medical equipment, some preventive services, outpatient
hospital care, rehabilitation therapy, laboratory
tests, X-rays, mental health services, ambulance services, and blood. Medicare Advantage
Plans, also known as Part C, are an alternative
to Original Medicare and are offered by private
companies. Part D helps pay for prescription
drugs.
Most people don’t pay for Part A because they
already paid for it through their payroll taxes
while working. If you do not have premium-free
Part A, you may be able to buy it under certain
conditions. Most people pay a monthly premium for Part B and Part D. Coverage for Part B
and Part D is optional. Some people wait to sign
up for Part B and Part D, but those who wait
may have to pay more in monthly premiums for
coverage later on.
Like most other insurance, Medicare does not
pay for all your health care costs. You’re responsible for paying for the costs that are not covered, such as deductibles, coinsurance, or copayments. Medicare also doesn’t pay for longterm care, such as custodial care or an extended
stay in a nursing home. There are other services
that Medicare does not cover, such as health
care when you travel outside the country, which
is why some people choose to buy additional
coverage.
Getting Medicare
Once you turn 65, you’re automatically signed
up for Medicare Part A and Part B if you are
receiving Social Security or Railroad Retirement
benefits. To qualify for Medicare, you had to
have earned the required quarters of coverage. This generally means paying Medicare
and Social Security payroll taxes for at least 10
years of your work life or meeting other specific
requirements. If you are 65 and have not earned
the required number of quarters of coverage,
you still may able to purchase Medicare on your
own. You must be a citizen or permanent resident of the U.S. If you’re not sure if you’re eligible for Medicare, call your local Social Security
office or the Social Security toll-free telephone
number at 1-800-772-1213.
You should get a package of Medicare information, including your Medicare card, in the mail. If
you don’t get this information by your 65th birthday, contact the Social Security Administration at
1-800-772-1213 and request one.
If you are about to turn 65 but not yet receiving
Social Security or Railroad Retirement benefits,
you need to sign up for Medicare at your local
Social Security office or visit www.socialsecurity.
gov to apply online.
Medicare doesn’t
pay for all of your
health care costs.
You’re responsible
for paying some of
the costs yourself.
There is a 7-month period during which you can
enroll in Medicare:
• During the 3 months before your 65th birthday
• During the month of your 65th birthday
• During the 3 months after your 65th
birthday
The best time to sign up for Medicare is during
the 3 months before your 65th birthday.
If you’re age 65 or over and still covered by a
group health plan from your employer you
might not need Medicare right away. Check with
Medicare to find out how Medicare works with
other insurance coverage that you may have.
Resources
Medicare has a toll-free help line you
phone number of your State Health Insurance
can call to get your questions about
Assistance Program (SHIP) office, which
Medicare answered. Dial 1-800-MEDICARE
offers free health insurance counseling to
(1-800-633-4227) or TTY 1-877-486-2048
people with Medicare; and send you free
(hearing and speech impaired) or visit www.
Medicare booklets.
medicare.gov. Support in Spanish is available. Someone at the help line can answer
your questions about Medicare; give you the
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UNDERSTANDING MEDICARE
PART B
PREMIUMS
PREVENTIVE
BENEFITS
P R E SC R I PT I O N D RU GS
Your Medicare choices
You have a choice of how you get Medicare. You can get Medicare
through the Original Medicare Plan or Medicare Advantage Plans
(like an HMO or PPO). You can also choose a Medicare Part D
plan that helps with prescription drug coverage. Medicare has
several different plan options. Your decisions about which plan
you choose are important because they affect how much you pay
for your health care and what is covered.
Original Medicare
The Original Medicare Plan, also known as
traditional or guaranteed Medicare, is a fee-forservice health plan. This means you can choose
any doctor or hospital under this plan. Medicare
will pay its share of the doctor or hospital bill.
You pay the rest. Original Medicare pays for
many health care services and supplies, but it
doesn’t pay all of your health care costs.
You get Part A and Part B of the Original
Medicare Plan when you’re automatically
signed up for Medicare. To get drug coverage
under Original Medicare, you must choose
and join a Medicare-approved Part D private
drug plan.
Medicare Advantage Plans
Medicare Advantage Plans are alternatives to Original Medicare. They also may be
known as Medicare Health Plans or Medicare
Part C. These Medicare plans are offered by
private insurance companies and pay for
the same health care services as Original
Medicare. But they also might pay for additional health care services that aren’t covered
by Original Medicare. Examples of Medicare
Advantage Plans include Health Maintenance
Organizations (HMOs) and Preferred Provider
Organizations (PPOs).
In Medicare Advantage Plans, you usually pay
a small amount, or a co-payment, when you
visit the doctor. In most Medicare Advantage
Plans, you can only go to doctors, specialists,
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and hospitals on the plan’s list. Otherwise,
you may pay more or you may not be covered for services at all. You choose one doctor to be your primary care doctor, or main
health care provider. Usually, your primary
care doctor will coordinate all of your health
care, send you to a specialist when you
need one, and admit you to the hospital if it
becomes necessary.
Medicare doesn’t automatically enroll you
in a Medicare Advantage Plan—you need
to choose a plan and sign up directly. The
Medicare Advantage Plan you choose will
let Medicare know that you have enrolled
in one of their plans. Medicare Advantage
Plans are available in most parts of the
U.S. You must get both Part A and Part B
to participate in a Medicare Advantage
Plan. People with end-stage kidney disease
may not be eligible to enroll in a Medicare
Advantage Plan.
In 2011, there will be changes in how
Medicare Advantage Plans operate. This
could result in changes to your particular
plan. If your plan does change, you will
have ample time to decide on a new plan.
If you have questions, you can call your
Medicare Advantage Plan directly or call
Medicare at 1-800-633-4227 to find out
about your options.
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UNDERSTANDING MEDICARE
Private Fee-for-Service Plans
Private Fee-for-Service (PFFS) Plans are
plans that are like the Original Medicare
fee-for-service plan because you can choose
your own doctors and hospitals. These plans
are offered by private insurance companies.
The insurance company pays its share of
your doctor and hospital bills, and you pay
your share. However, the private insurance
company, not Medicare, decides how much
you pay for your care. This means you might
pay more for your health care under this
plan than under Original Medicare, but you
might get additional benefits.
Call Medicare if you want to know whether
a PFFS plan is available where you live. Like
a Medicare Advantage Plan, you need to
sign up for a PFFS plan. The plan will notify
Medicare when you have changed from the
Original Medicare Plan.
Medicare Prescription Drug
Coverage
Medicare prescription drug coverage (Part
D) is insurance that helps reduce the costs of
prescription drugs. Everyone with Medicare
can elect to enroll in this voluntary drug
coverage, regardless of income. Medicare
Part D is administered by private companies
that have been approved by Medicare to
offer prescription drug coverage.
There are two kinds of Medicare prescription drug plans:
You can switch plans each year during the
open enrollment period. Generally, this is
also the only time you can sign up if you
1. “Stand alone” prescription drug plans that
were eligible to enroll in a Part D plan earoffer only drug coverage. You can add this
lier but didn’t.
type of plan to Original Medicare and some
types of Medicare Advantage Plans that do
You may still be able to enroll in a drug plan
not cover prescription drugs.
outside the open enrollment period, if you:
or
2. Medicare Advantage Plans (which you
may also see referred to as Medicare
Health Plans or Medicare Part C) such
as Health Maintenance Organizations
(HMOs) and Preferred Provider
Organizations (PPOs). You can get both
your Medicare health care and prescription drugs through one of these plans.
You can choose from many drug plans.
Drug plan sponsors can offer more than one
drug plan. The benefits and costs will vary
between sponsors and drug plans.
If you are newly eligible for Medicare, you
can enroll in a Medicare prescription drug
plan up to 3 months before or no later than
3 months after the month you become eligible. A late enrollment penalty may apply if
you decide to enroll after this initial period.
• Lose coverage that is at least as good as
Medicare’s from another source (such as
an employer or union) through no fault
of your own, or your coverage changes so
that it is no longer as good as Medicare’s.
• Move into—or out of—a long-term care
facility such as a nursing home.
• Have been living in another country since
the end of the last open enrollment period
and move back to live permanently in the
U.S.
Like other insurance, there is a monthly
premium for plans offering Medicare drug
coverage. If you have a limited income and
resources, you may be able to get help with
covering the costs of prescription drugs.
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Choosing a Plan
Before you choose a Medicare plan, think
about your options carefully. Read through
information that is available on all the plans.
Talk to your doctor and friends who have
Medicare. Compare the costs, benefits, and
quality of the plans you’re considering. Call
Medicare if you need more information.
And ask yourself the following questions:
• What is most important to you in a
Medicare plan—cost, coverage, or
convenience?
• Will you have your choice of health care
providers?
• Will the plan you choose meet your needs?
• How much will you have to pay for your
health care and prescription drugs?
• Will you have coverage if you travel
frequently or leave your hometown for
long periods of time?
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UNDERSTANDING MEDICARE
Resources
The Centers for Medicare & Medicaid Services
Interactive Tool at www.aarp.org/medicarein-
has a number of publications on Medicare
teractive. Use the Medicare Prescription Drug
choices. Call the Medicare help line at
Plan Finder to compare Part D prescription
1-800-633-4227 to get their latest publica-
drug plans at www.medicare.gov/MPDPF/
tions, or view or order them online at www.
home.asp.
medicare.gov/Publications/home.asp.
Medicare Options Compare provides detailed
Find out what options are available to you and
information about the Medicare plans avail-
what is covered under the Medicare program
able in your local area. To access this infor-
at www.aarp.org/health/medicare. Maximize
mation, go to the Medicare website at www.
your Medicare choices by using the Medicare
medicare.gov/MPPF/Home.asp.
UNDERSTANDING MEDICARE
UNDERSTANDING MEDICARE
9
9
Paying for M­­edicare
Generally, how much you pay
for Medicare depends on:
• Which Medicare plan you choose
• How often you go to the doctor or hospital
• Whether you have other health insurance
• Whether you qualify for help with
Medicare costs
Medicare does not cover all of your health
care costs. Depending on which plan you
choose, you might have to share in the cost
of your care by paying premiums, deductibles, co-payments, and coinsurance.
The amount of some of these payments
can change. Most people who qualify for
Medicare don’t pay a monthly premium for
Part A, but they do for Part B and Part D
or a Medicare Advantage Plan. You can call
Medicare at 1-800-633-4227 or go to www.
medicare.gov to check current deductibles,
co-payments, and premiums, and what you
will need to pay.
There are options for helping you pay your
share of health costs if you have Medicare.
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UNDERSTANDING MEDICARE
For instance, your out-of-pocket costs might
be lower and more predictable under a
Medicare Advantage Plan, such as an HMO,
but these plans usually limit your choice of
doctors and hospitals.
Retiree health insurance can help pay some
of the costs (when you retire at age 65 or
over, retiree health insurance becomes the
second payer to any Medicare coverage
you have). So can Medicare supplemental
insurance, or Medigap. Also, if you qualify,
you might be able to get help through the
Medicaid program or other public programs. Medicaid is a program funded by the
federal and state governments to help people with low incomes pay for health care.
AARP has more information on what your
costs would be under Original Medicare on
its website. Go to www.aarp.org/health/
medicare. AARP’s Doughnut Hole Calculator
www.aarp.org/doughnuthole helps you find
ways to lower your drug costs. The calculator is available in English and Spanish.
Buying Medigap
­insurance
If you have Original Medicare, you might decide to buy
Medicare supplemental insurance, or Medigap. Medigap
insurance is sold by private companies. It helps you pay for
costs that Medicare doesn’t cover, such as your share of
doctor and hospital services.
Insurance companies in most states can
offer up to 11 standard Medigap plans to
people on Medicare. These standard plans
are labeled Plan A – G and K – N. Each one
offers a different set of benefits, fills different gaps in Medicare coverage, and varies in
price.
Generally, standard Medigap policies cover
some or all of the cost of:
• Hospital coinsurance for Medicare covered
hospital stays
• Medicare coinsurance on your doctor’s
bills and all other Medicare Part B services
• The first three pints of blood you need
each year
• Hospice care coinsurance
There are some things you should consider
when buying a Medigap plan:
Do you have a retiree health policy?
If you have a comprehensive retiree health
plan through your former employer or union
that supplements Original Medicare, you
might not need a Medigap plan. If your retiree
policy provides more generous benefits or
benefits not covered by Medicare or Medigap,
you should think about your options carefully
before dropping the policy for a less expensive
choice. You might not be able to get it back
once you disenroll from your retiree health
plan. Check with your union or your former
employer’s health plan first.
Can you accept some limits on your care?
Medicare Select is a Medigap policy that
limits the providers you can see. Costs can
be lower than standard Medigap policies
because Medicare Select policies cover care
only at certain hospitals and might be limited
to using specific doctors. Your state insurance
UNDERSTANDING MEDICARE
11
department can tell you if there are Medicare
Select plans in your state and give you more information about them.
Remember your rights
If you think you want to buy a Medigap policy,
remember that you have the right to review
your new Medigap policy for 30 days. You must
cancel it during that time for a full refund if you
decide it doesn’t meet your needs. You also
have the right to cancel your Medigap policy at
any time. In most cases, as long as you pay your
premium, your Medigap coverage will continue
year after year.
Enrolling in Medigap
You have the right to enroll in a Medigap plan
of your choice during the 6 months following
your initial enrollment in Medicare Part B at
age 65 and over. This is called the open enrollment period. It’s available only once.
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UNDERSTANDING MEDICARE
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UNDERSTANDING MEDICARE
Generally, if you’re on Medicare, have a disability and are under age 65, you aren’t able to
enroll in Medigap as a part of the open enrollment period. You are entitled to get Medigap
as part of open enrollment only when you turn
65. However, some states require insurers to
sell Medigap to people under age 65 with disabilities. Contact your state insurance department for more information.
After your open enrollment period, depending
on the state, insurance companies may be able
to refuse you Medigap coverage.
Other Insurance and Ways to Pay
Health Care Costs
In addition to Medicare, you may be eligible for
other health care coverage such as employer
retiree health care, union health coverage,
veterans’ benefits, military retiree benefits
(TRICARE), Federal Employee Health Benefits
Program (FEHB), and long-term care insurance.
Remember that you
choose your Medicare
plan. Regardless of
which plan you choose,
you’re part of the
Medicare program.
Resources
You can find more information on Medigap
panies that do business in their state and for
insurance on AARP’s website. Go to www.
approving their Medigap policies. They often
aarp.org/health/insurance.
have consumer information and can help
Medicare Options Compare provides detailed
information about Medigap plans available
in your local area. To access this information, go to the Medicare website at www.
with complaints. The National Association of
Insurance Commissioners links you directly to
your state insurance department through its
website at www.naic.org.
medicare.gov/MPPF/Home.asp. The site also
For more information about how other
has Medigap publications from the Centers
kinds of insurance work with Medicare, visit
for Medicare & Medicaid Services that you
www.medicare.gov, call your State Health
can view online at www.medicare.gov/
Insurance Assistance Program (SHIP), or call
Publications/Home.asp. You can also call
1-800-MEDICARE (1-800-633-4227).
1-800-633-4227 to order publications.
State insurance departments are responsible
for licensing and regulating insurance com-
UNDERSTANDING MEDICARE
13
If you can’t afford
Medicare payments
If you can’t afford to pay your share of
Medicare payments there are other programs besides Medicaid that can help you.
They include:
Extra Help with Medicare Prescription Drug
Plan Costs
Medicare Savings Programs
State Prescription Drug Assistance Programs
incomes pay for Medicare coverage. To
qualify, you must meet certain income and
resource guidelines. To find out if you are
eligible for one of these programs, you can
contact your local State Health Insurance
Assistance Program (SHIP) at www.shiptalk.
org. You can also contact the Social Security
Administration at 1-800-772-1213 (TTY
1-877-486-2048) or go to www.socialsecurity.gov/prescriptionhelp/.
The PACE Program (Programs of Allinclusive Care for the Elderly)
These programs help people with limited
Resources
The Centers for Medicare & Medicaid Services
resources about public benefits for which they
has information on programs that can help
might be eligible. The program helps people
you pay for Medicare at www.medicare.gov/
learn about public benefits and encourages
Basics/HelpToPay.asp. You also can call
and helps them apply if they appear to be
1-800-633-4227.
eligible. For more information about this pro-
AARP’s Public Benefits Outreach Program
informs people with limited incomes and
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UNDERSTANDING MEDICARE
gram, contact AARP at 1-888-687-2277.
Your Medicare
answer guide
Your Medicare rights
Everyone enrolled in Medicare has certain
rights. These include the right to:
3. Medicare Part A helps pay for hospital
bills, and Medicare Part B helps pay for
doctor bills. Medicare Advantage Plans,
also known as Part C, are private health
plans, like HMOs or PPOs. Medicare Part
D helps pay for prescription drugs.
• Receive information and assistance
• Receive reasonable and necessary
Medicare services
4. Medicare offers preventive benefits such
• Choose and switch between Original
as screenings for heart disease, diabetes,
Medicare and other Medicare plans offered
and some types of cancer, as well as an
locally by private companies
annual wellness visit and personalized
• Buy Medicare prescription drug coverage
prevention plan.
• Buy Medigap insurance
• Choose and switch doctors
5. Most people who are 65 and over are
• Appeal denials of care and coverage
entitled to get Medicare. Some younger
people with disabilities can also get
Your Medicare rights can vary, depending
Medicare.
on whether you have Original Medicare, a
Medicare Advantage Plan (like an HMO), or 6. Most people get Medicare Part A autoanother option.
matically. Other people have to sign up.
There are many things to learn about the
7. You need to tell Medicare if you don’t
Medicare program. Fortunately, there are also
want Part B. You need to sign up if you
many resources to turn to for information and
want Part D (prescription drug coverhelp. Listed “in a nutshell” below are 12 basic
age).
facts you should know about Medicare.
8. You can sign up for Medicare Part B and
Part D even after you turn 65, but you
Medicare in a nutshell
might pay more for your monthly pre1. Medicare is a federal health insurance
mium and be limited in the times of year
program.
in which you can enroll.
2. Medicare helps pay for your hospital and
9. Depending on where you live, you might
doctor bills. If you purchase Medicare
have a choice about how you get your
prescription drug coverage, it also helps
health care under Medicare.
pay for your prescription drug costs.
UNDERSTANDING MEDICARE
15
10. You can change your Medicare health care
plan and your Medicare drug plan each year.
11. Medicare does not pay for all your health
care costs. You can get other kinds of insurance to help pay for some of your health
care costs.
12. Assistance is available for people with limited incomes and resources to help pay for
health care and prescription drug costs.
Medicare Tips
The following consumer tips can help you get
the most out of Medicare:
• If you have Medicare and you’re satisfied with
your coverage, you don’t need to make any
changes.
• If you’re thinking about changing from one
Medicare plan to another, don’t rely only on
information from the plan. Get additional
information from people and organizations
you trust, such as your doctor, your friends,
the State Health Insurance Assistance
Program (SHIP), and the Medicare Program.
• You can switch from Original Medicare to
another Medicare plan. But if you drop your
Medigap insurance or retiree health insurance, you might not be able to get it back.
Check with your former employer or union
before you make any changes. There are laws
that limit your opportunity to get Medigap
coverage.
• If you don’t enroll in Medicare Part B or Part D
when you’re first eligible and don’t qualify for
an exemption or special enrollment period,
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UNDERSTANDING MEDICARE
you will pay a penalty if you decide to enroll
later. You might also be limited in terms of
which time of the year you can later enroll.
• Some doctors “opt out” of Medicare. They can
charge you whatever they want for their services, but only if you sign a contract with them
before they provide the services. Medicare
won’t pay for any of the care you get from
these doctors.
• Regardless of the plan you choose, everyone
enrolled in Medicare has a right to receive
reasonable and necessary services covered by
Medicare. Everyone has a right to appeal denials of care and coverage.
• You may be able to buy Medicare insurance
if you don’t qualify for it. You’ll have to pay
premiums for both Part A and Part B, as well
as for Part D.
• The Medicare-approved amount is the
amount Medicare says is a reasonable payment for a medical service.
• You must have Medicare Part A and Part B if
you want to join a Medicare Advantage Plan,
like an HMO or a PPO.
• If you’re age 65 or over, you have a 6-month
period in which to buy any Medigap policy
you choose once you sign up for Medicare
Part B. During this enrollment period, you
can’t be turned down or charged more
because of past or present health problems.
• By law, Medigap providers aren’t allowed
to sell more than one Medigap plan to the
same beneficiary.
Resources
For more information about your Medicare
rights, call Medicare at 1-800-633-4227
and ask for the publication, Your Medicare
Rights and Protections. You can also order
or view it online at it www.medicare.gov/
Publications/Home.asp.
Your State Health Insurance Assistance
Program (SHIP) offers free one-on-one
health insurance counseling to people with
Medicare. Go to www.shiptalk.org. You can
find the number for your state SHIP office
by calling Medicare at 1-800-633-4227,
searching the “Helpful Contacts” section
of the Medicare website at www.medicare.
gov/Contacts, or looking in the back of the
Medicare Handbook, Medicare and You.
Before you call
for help, be sure
to write down
any other questions that come to
mind. Be ready to
take notes when
you get answers to
your questions.
UNDERSTANDING MEDICARE
17
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Puerto Rico, and the U.S. Virgin Islands.
D19327 (510)
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