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Common Questions about Medicare
Contents
These are common questions about Medicare.
Common Questions about Medicare
Medicare is health insurance for people 65 years old or older, and in some cases, people with disabilities.
Medicare is health insurance for people 65 years old or older, and in some cases, people with disabilities. A disability is a mental or physical problem that will last for at least 12 months, or cause death. It must be severe enough to interfere with working.
Medicaid, on the other hand, is health insurance for people with low income. In order to be eligible for Medicaid, you must meet certain requirements. Some requirements have to do with how much income you have. Others have to do with nonfinancial things like your citizenship and Michigan residence. You could also be eligible based on age, disability, or blindness.
To learn more about Medicare, read An Overview of Medicare. To learn more about Medicaid, read An Overview of Medicaid.
There are multiple parts of Medicare that offer insurance coverage for different things. The different parts of Medicare are:
- Part A (hospital insurance)
- Part B (medical insurance)
- Part C – Medicare Advantage Plans
- Part D (prescription drug coverage)
- Medigap (Medicare supplement policies)
- Medicare Savings Programs
To learn more, read The Different Parts of Medicare.
Medicare Advantage Plans are a type of health plan offered by private companies that contract with Medicare. Medicare Advantage plans cover doctor and hospital services and supplies within the U.S. Some plans even cover vision, dental, and hearing. Prescription drug coverage is part of most Medicare Advantage plans.
With Medicare Advantage, you usually need to use doctors who are in the plan’s network for all non-urgent care. In most cases, these plans won’t cover non-urgent care you get outside of their network.
To learn more, read An Overview of Medicare.
You can apply for Medicare online through the Social Security Administration website, or call the toll-free number, 1-800-772-1213 (TTY 1-800-325-0778). You can also visit your local Social Security office to apply in person. If you decide to apply in person, it is best to call ahead to make an appointment to reduce your wait time.
People who are close to turning 65 and are not getting Social Security or Railroad Retirement Board (RRB) benefits should apply for Medicare during the three months before they turn 65. Not applying for Part B during this period could cause a delay in coverage. It could also cause you to pay a penalty every month for as long as you have Part B coverage.
To learn more, read An Overview of Medicare.
If you have Medicare and other insurance, there are rules to decide which one pays first. The insurance that pays first covers costs up to the limits of its coverage. The insurance that pays second may cover some of the costs left over. The insurance that pays second might not cover all the remaining cost.
Medicare will pay first if you:
- Have retiree insurance from your or your spouse’s former job
- Are 65 or older and have insurance from your or your spouse’s current job, and the employer has fewer than 20 employees
- Are under 65, disabled, and have insurance through a family member’s current job, and the employer has fewer than 100 employees
The other insurance will pay first if you are:
- 65 or older and have insurance from your or your spouse’s current job, and the employer has at least 20 employees
- Under 65, disabled, and have insurance through a family member’s current job, and the employer has at least 100 employees
To learn more, read An Overview of Medicare.
If you don’t agree with a decision that Medicare makes, you may be able to appeal it. You can appeal a Medicare denial of your request for a health care service, item, or prescription if:
- You think you should be able to get it
- You already got it and Medicare doesn’t want to cover it
- You want to change the amount you must pay for it, even if Medicare stops paying for it
- You believe it should count towards your deductible, if you have one
There are other decisions you may be able to appeal. To learn more about Medicare appeals and the appeals process, read “How do I file an appeal?” on the Medicare website.
Medicare Savings Programs (MSP), also known as the Medicare Buy-In Programs, help pay for Medicare premiums (monthly costs for coverage), coinsurances, drug costs, and deductibles. A deductible is an amount of your health care costs you are responsible for before your benefits start. For example, if you have a $100 deductible, you are responsible for the first $100 of your health care costs before your benefits start.
The Michigan Department of Health and Human Services (MDHHS) decides if you qualify for most MSPs. Medicare decides if you qualify for the program known as “Extra Help” that helps with drug costs. More information about the different MSPs are in the sections "MSPs through MDHHS" and "Medicare Extra Help Program" in the article Medicare Savings Programs.