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We Can Help. 914-345-5900 • help@mhawestchester.org |
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MedicareMedicare is a health insurance program for people 65 years of age and older, some disabled people under 65 years of age and people with End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant). Medicare has two parts to its insurance: Part A and Part B.
Is It For Me?You are eligible for Medicare if you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are a younger person with a disability or with chronic kidney disease. If you are disabled due to a psychiatric disability, or you are over 65, Medicare coverage can help you and/or your family pay for psychiatric hospital inpatient stays and for outpatient mental health treatment. You can get Part A (hospital and skilled nursing home insurance) at age 65 without having to pay premiums if:
If you are under 65, you can get Part A without having to pay premiums if:
While you do not have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B (medical insurance) if you want it. The Part B monthly premium in 2008 is $96.40. It is deducted from your Social Security, Railroad Retirement or Civil Service Retirement check. If you are 65 or older and you are not disabled, not eligible for free Part A, or do not have kidney dialysis or do not have a kidney transplant, your monthly premium for Part A Medicare in 2008 will be up to $423 per month. What Is The Benefit?Part A (Hospital and Skilled Nursing Home Insurance) helps pay for:
Part B (Medical Insurance) helps pay for:
Preventive Services, also under Medicare Part B, help pay for:
All people with Medicare who are age 50 and older are covered for Preventive Services. However, there is no age requirement for having a colonoscopy. Other Services Part B helps pay for include:
A Medicare prescription drug plan is effective in 2006. For more information, log on to http://www.medicare.gov. For mental health care given in a hospital, Medicare Part A will help cover your room, meals, nursing and other related services and supplies. If you have Medicare Part B, it will help pay for mental health services generally given outside a hospital. Medicare Part B covers doctors’ services (inpatient and outpatient) and outpatient therapy services given by social workers and psychologists, laboratory tests and partial hospitalization. If you have Adobe Acrobat software installed on your computer, log on to http://www.medicare.gov/publications/pubs/pdf/mental.pdf to learn more about mental health benefits under Medicare. For information regarding Westchester County's Medicare, Medigap and HMO options, go to http://www.westchestergov.com/aging/medicareoptions.htm. Choosing a Medicare provider can be a complex task with many variables going into this important health care decision. Besides checking the above web sites, you can contact the following community based senior centers with your questions: Cortlandt No matter how you get your Medicare benefits, you are still in the Medicare program and still entitled to Part A and Part B coverage. Besides the premiums that you pay for in Medicare Part B, you also will pay significant Medicare co-payments and Medicare deductibles. In Medicare health plans, a co-payment is the amount that you pay for each medical service you get, such as a doctor visit. Usually Medicare sets the your co-payment for each service. A deductible is the amount you must pay for health care before Medicare begins to pay, either each benefit period* for Part A or each year for Part B. These amounts can change every year. *A benefit period is the way Medicare measures your use of hospital and skilled nursing facility services. A benefit period ends when you have not received hospital or skilled nursing care for 60 days in a row. Medicare Supplemental Insurance, also known as Medigap Insurance, is a special kind of health insurance coverage available only to people who are enrolled in Medicare Parts A and B. It was developed to help you pay for the costs (deductibles and co-payments) and medical services and supplies that Medicare does not cover. To compare the costs and coverage of the ten plans offered in Westchester County please link to: http://www.westchestergov.com/aging/MedicareOptions.htm#MEDIGAP INSURANCE COVERAGE. For additional information on Medicare, Medicare Supplement Insurance (Medigap), and Medicare HMOs, contact the Westchester County Office for the Aging at 914-665-5900. For more information regarding disability-related questions, contact your local Social Security office shown below. To determine if you are eligible for other health benefits, log on to http://www.benefitscheckup.org, the online service from the National Council on Aging. What are my rights under Medicare?If you have Medicare, you have certain guaranteed rights. You have them whether you are in the Original Medicare Plan or a Medicare managed care plan. You have the right to:
For an independent source of information regarding your rights under Medicare, please log on to http://www.medicarerights.org. The Medicare Rights Center (MRC) is the largest independent source of health care information and assistance in the United States for people with Medicare. If you feel your rights were violated, there are two agencies you can contact. You can call the Health Care Financing Administration Regional Office (HCFA) at 212-264-4488, or call the State Health Insurance Assistance Program at 800-701-0501. When Do the Benefits Apply?In some circumstances, you will be enrolled automatically in Part A and Part B of Medicare as you become eligible. If you have a Social Security number, about three months prior to your 65th birthday you will be sent an Initial Enrollment Package that will contain information about Medicare, a questionnaire and your red, white and blue Medicare card. If you are disabled and have been receiving disability benefits under Social Security or Railroad Retirement Board for 24 months, you will be enrolled automatically in Part A and Part B beginning the 25th month of benefits. If you are not receiving Social Security or Railroad Retirement Board benefits you must apply for Medicare Part A and Part B. If you enroll in Part B or Part A (if you don't get Part A automatically without paying a premium), your General Enrollment Period (GEP) for Original Medicare is January 1 through March 31 of each year. The coverage then begins July 1 after you enroll. If you plan to join an HMO plan, rather than Original Medicare, you can enroll in November, and your coverage begins January 1 of the next year. Most HMOs will accept new members at other times of the year. For Medicare Supplemental Insurance, do not delay. When you first enroll in Part B at age 65 or older, you have a six-month Medigap open enrollment period. During that time your health status cannot be used as a reason either to refuse you a policy or to charge you more than all other open enrollment applicants. (The insurer may make you wait up to six months for coverage of a pre-existing condition.) If you try to enroll later, you may be denied a policy or charged a higher rate. How Do I Apply For The Benefit?If you are receiving Social Security or Railroad Retirement or disability benefits, you will be enrolled automatically in
Medicare Part A and Part B. If you (or your spouse) did not pay Medicare taxes while you worked and you are age 65 or older,
you still may be able to buy Part A. If you are not sure if you have Part A, look on your red, white and blue Medicare card.
It will show “Hospital Part A” on the lower left corner of the card. If you do not want Part B, follow the instructions that come with the card.
You can also call the Social Security Administration toll-free at 800-772-1213 or call your local Social Security
office for more information about applying for Part A and Part B Medicare coverage. Below is a list of your local
Social Security offices in Westchester County:
85 Harrison Street
One Park Place, Third Floor
297 Knollwood Road
20 South Broadway, 10th floor
If you get benefits from the Railroad Retirement Board (RRB), call your local RRB office or 800-808-0772.
For Medicare managed care (HMO) you can call the plan and ask for an enrollment form. For a listing of HMOs
and their phone numbers log on to
http://www.westchestergov.com/aging/MedicareProviderPlans.htm.
To enroll in Medigap you can get a listing of Medigap providers and their phone numbers by logging on
to
http://www.westchestergov.com/aging/MedicareOptions.htm#Medigap Provider Company Phone List
Should you lose your Medicare card, please call the Social Security Administration (SSA) 800-772-1213. A representative can
request that HCFA send you a replacement Medicare card. The best time to call is Tuesday through Friday between 7:00 AM and 7:00 PM.
Make sure you have your Medicare number handy. You should receive the replacement card in four weeks.
Assuming you meet the eligibility criteria, there is no cost for Medicare Part A, though there are significant deductibles and
co-payments associated with the coverage. Part A - Hospital Insurance 2008 Rates:
In a Skilled Nursing Home for each benefit period you pay: In 2008, for Medicare Part B, you pay a monthly premium of $93.50 and
a $135 deductible annually. There is also generally
a 20% co-pay (50% for outpatient mental health care) for most Medicare Part B services.
If you have Adobe Acrobat software installed on your computer, you may get a more detailed list
of Part B costs in the traditional Medicare plan, by logging on to
http://www.medicare.gov/publications/pubs/pdf/02118.pdf.
For costs of other Medicare plans, link to
http://www.westchestergov.com/aging/MedicareProviderPlans.htm#TABLE%204.
You can also call 800-MEDICARE (800-633-4227) to find out more information regarding deductibles and co-payments for Part B.
The costs and coverage for a psychiatric inpatient stay is similar to a stay at a general medical hospital. For outpatient
mental health treatment, there are differences in how much you will have to pay for mental health professional and facility charges
compared to general medical outpatient services. You will have to pay 50% of the doctor and professional charges, after your
yearly $135 Medicare Part B deductible. Medicare pays the other 50% of most of these services. Medicare will send you a
notice showing what you owe.
Most of your health care costs are covered if you have Medicare and you qualify for Medicaid. Medicaid is a joint federal and
state program that helps pay medical costs for some people with low incomes and limited resources. People on Medicaid may also
get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. Please click here
for more information about Medicaid.
Medicare is provided by the U.S. Federal Government.
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