Medicare Contact Information
For general information about Medicare, call 1-800-MEDICARE (633-4227) or go to www.medicare.gov. TTY users should call 1-877-486-2048.
For information about eligibility or to apply for Medicare, call the Social Security Administration at (800) 772-1213, visit their website or visit your local Social Security office. TTY users should call 1-800-325-0778. If you are newly eligible for Social Security benefits and you want to apply for both Social Security and Medicare you can do it online.
Social Security and Medicare are important pieces of the retirement planning puzzle for more Americans. But understanding how these systems work can be confusing. Check out WISER’s Social Security and Medicare Benefit Milestones to learn about key milestones for claiming
On July 30th, Medicare turned 47 years old. And while more than 44 million people are now enrolled in Medicare, according to the 2010 Census, many do not fully understand what is and is not covered under Medicare. So we
Medicare and Caregiving for a Friend
What is Medicare?
Medicare is a federal government program that provides health insurance to people age 65 and over. To be eligible, you must be a U.S. Citizens or permanent legal resident with at least five years of continuous residence. Younger people who have received Social Security Disability Insurance (SSDI) benefits for 24 months also qualify. Additionally, people with End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS) are eligible for Medicare benefits as soon as they are eligible for SSDI without having to wait 24 months. 55 million people currently have Medicare coverage.
Part A covers inpatient hospital care, skilled nursing facilities and some home health care. Most people do not have to pay a monthly premium for Part A coverage. Part A does have a deductible and additional co-payment. The Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period.
Part B, the Supplementary Medical Insurance (SMI) program, covers doctor visits (but not routine exams), medically necessary supplies and equipment, physical and occupational therapy, outpatient mental health services and other outpatient hospital services. Part B coverage also includes certain preventive benefits like mammograms and cardiovascular screenings. While Part B is an optional program, most people enroll when first eligible as there are higher premium costs for those enrolling later.
Part B has a monthly premium that is deducted from Social Security, Civil Service, Railroad Retirement benefits or is paid directly each quarter for those eligible for Medicare who are not receiving Social Security benefits. Your premium is based on income.
Higher income seniors pay an even higher premium. The Centers for Medicare & Medicaid Services (CMS) has information on their website about premium rates for those with higher incomes.
If your friend has experienced a “life changing event,” such as death of a spouse, divorce or retirement in the past 2 years and their income has decreased, your friend might be eligible for relief. Read more about what qualifies as a life-changing event in the Social Security Administration’s page Premiums: Rules for Higher-Income Beneficiaries. (Also available in Spanish)
Part C allows Medicare beneficiaries to enroll in private plan, such as a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO). You must be entitled to Part A and enrolled in Part B. In addition to the Part B premium, you usually pay one monthly premium for the service included in a Part C plan. Part C plans receive payments from Medicare to provide all Medicare covered benefits including hospital and physician services and, in most cases, prescription drug benefits.
Part D is an optional program, requiring a separate enrollment if you want to receive coverage for prescription drugs. Part D is offered through private insurance plans that contract with Medicare. Part D plans also have a monthly premium and an annual deductible before the plan will pick up the cost of your prescriptions.
After you meet your deductible, your plan will help pay for your covered prescription drugs. Your plan will pay some of the cost, and you will pay a co-payment or coinsurance. Once both you and your plan have spent the deductible in drug costs, you are responsible for paying no more than 25% of prescription drug costs. Once you have reached your out-of-pocket cap, you will pay no more than 5% of your drug costs for the rest of the year.
Medigap is Medicare Supplement Insurance offered by private companies to fill the “gap” in original Medicare. A Medigap policy can pay some of the cost remaining after Medicare insurance coverage. Visit Medicare’s page on Medigap to read 8 things to know about Medigap policies. (also available in Spanish)
SNPs are a kind of Medicare Advantage Plan. They are available for individuals with dementia. They provide all the care that Medicare Advantage plans are required to provide as well as extra services tailored for people who have dementia so they can stay in their homes longer.
To qualify for an SNP, the individual must:
- Be 65 or older and a U.S. citizen or legal resident for 5 years;
- Have Medicare Parts A (Hospital) and B (Medical Insurance);
- Live in the plan’s service area (SNPs may not be available in all parts of the country);
- Meet the plan’s eligibility requirement for a severe or disabling chronic condition such as Alzheimer’s or other dementias.
Under SNPs, there are potential supplemental benefits covered:
- Modifications for home safety such as bathroom grab bars.
- Non-Medical Home Care such as a professional who helps with bathing, or a homemaker, who prepares meals.
- Adult Day Care that provides a safe environment with counseling, meals, activities, and behavior management.
- Memory Care/Assisted Living an assisted living community that emphasizes helping persons with advanced Alzheimer’s or dementia.
Younger individuals may qualify for coverage if they receive Social Security Disability benefits or have end stage renal disease. Also, individuals without the required 40 quarters of covered employment may buy into Medicare Part A and pay a monthly premium, and have the option of enrolling in Part B.
Resources about Medicare Eligibility and Applications
Low-income individuals enrolled in a Medicare Part D plan may also be eligible for Extra Help with Medicare Part Prescription Drug Plan Costs. The Social Security Administration (SSA) administers the Extra Help Program. Applications may be made online or by calling Social Security toll –free at 1-800-772-1213 (TTY 1-800-325-0778). (also available in Spanish).
Free consumer counseling is available in every state through state programs that are funded by the federal government. These programs, called SHIP programs (Senior Health Insurance Assistance Program) give neutral advice to Medicare beneficiaries and their families about Medicare, Medicaid, private Medigap insurance and Medicare Advantage plans. SHIP counselors may also assist with applying for Medicare Savings Programs and for filing the Extra Help application with SSA. A listing of SHIP programs by state is available online.
Medicare Rights Center, a non-profit organization that operates a national telephone helpline to help callers understand Medicare benefits, find the right coverage, and understand how any existing coverage works with Medicare. Callers living on low or fixed incomes are also screened for additional programs that they may be eligible for that can help pay costs of Medicare. Helpline: 1-800-333-4114.
My Medicare Matters is a resource of the National Council on Aging (NCOA) in partnership with Aon Retiree Health Exchange™. This educational service is designed to make it easier for people with Medicare (and those turning 65) to make informed and confident choices about their health coverage and to make the most of that coverage. The service offers: Education and unique decision-support tools provided by NCOA to help people make good decisions and save money; and for those who choose it, one-on-one assistance – at no cost – in selecting and enrolling in healthcare coverage that best fits that individual from a licensed Benefits Advisor at Aon Retiree Health Exchange.
Frequently Asked Questions
Medicare does not cover most long-term care and covers only limited home health care and nursing home costs, usually following a hospital stay. It also does not cover routine dental, eye care or hearing aids.
If your friend has Alzheimer’s Disease, Medicare will help pay for their care. Learn more about what is and isn’t covered for Alzheimer’s Disease by reading NCOA’s summary.
Preventive care can help maintain health and identify medical problems early. Medicare offers several important preventive services. Read the Alliance for Aging Research’s summary of preventive and screening services covered by Medicare.
Medicare Part B does not pay for routine vision screening, glasses, and contact lenses. However, in some circumstances, Medicare does pay for testing and treatment. And several charities and professional societies offer financial assistance with these expenses for older adults. Read NCOA’s article on Medicare and vision coverage.
Generally, individuals are automatically entitled to Medicare if:
- They are 65 years old and have 40 quarters of work credit in Social Security covered employment, or
Their spouse is eligible for Medicare.
- Individuals may also be eligible if:
- They are 65, and
- They or their spouse worked in Medicare-covered employment.
If you are not 65 yet, but are already receiving Social Security retirement or disability benefits, you will be automatically enrolled in Part A and will have the opportunity to enroll in Part B in the month you turn 65 or after 24 months of receiving disability benefits. You will receive a Medicare Initial Enrollment Period package three months before your 65th birthday.
If you are approaching age 65 and not receiving Social Security benefits, you must contact Social Security to apply for Medicare benefits. You will not get Medicare information sent to you automatically.
The open period to apply for Medicare is 3 months prior to your 65th birthday, the month of your 65th birthday and 3 months after your 65th birthday. For example if your birthday is on June 1, you will have from March 1-September 1 to apply. Social Security recommends applying 3 months before you turn 65.
There is a penalty for delaying enrollment in Part B. Your monthly premium for Part B may go up 10% for each full 12-month period that you were eligible and could have enrolled in Part B but didn’t. However, the penalty does not apply if you delayed enrollment because you were actively employed and covered in a workplace plan or covered by an employed spouse’s workplace plan. If you are working past age 65 and have health coverage from an employer, you should consult with your employers’ benefit administrator about your health coverage options.
Medicare Savings Programs (MSPs), also called Medicare buy-in programs, provide financial assistance to Medicare eligible individuals with limited finances to help pay for premiums, co-payments, or deductibles. The three main programs are: the Qualified Medicare Beneficiary (QMB), the Specified Low-income Medicare Beneficiary (SLMB), and the Qualifying Individual (QI) Program.
Contact your state agency that administers Medicaid for specific information on each program. States may use different rules to count income and assets when determining eligibility.