What you may not know about Medicare

by Mike Baksa, Social Security Administration
Thursday, January 17, 2008 1:47 PM MST

Almost everyone knows that Medicare is a medical insurance program for retired and disabled people, run by the government.

But there may be some things you don’t know about Medicare — and should. Some people are only covered by one type of Medicare; others opt to pay extra for more coverage.

There are four parts to Medicare: Parts A, B, C and D. Part A helps pay for inpatient hospital care, skilled nursing care, hospice care and other services.

Part B helps pay for doctors' fees, outpatient hospital visits and other medical services and supplies that are not covered by Part A.

Part C allows you to choose to receive all of your health care services through a provider organization. These plans may help lower your costs of receiving medical services, or you may get extra benefits for an additional monthly fee. You must have both Parts A and B to enroll in Part C.

And Part D is the Medicare Prescription Drug Program.

Part B is the one we get the most questions about, so here are some things to know about it.

While most people don’t pay a premium for Part A because they or a spouse have worked and paid enough in Medicare taxes on wages over the years, there is a monthly premium for Medicare Part B. In 2008, the standard Part B premium is $96.40.

Some higher income individuals pay more than the standard premium. Part B is a good value for people who need medical insurance, but you need to enroll during your initial enrollment period, or when you first become eligible, unless you want to pay a penalty in the form of a higher premium. Most people first become eligible for Medicare at age 65.

There are exceptions to this rule. For example, you can delay your Medicare Part B enrollment without having to pay higher premiums if you are covered under a group health plan based on your own current employment or the current employment of any family member. If this situation applies to you, you can sign up for Medicare Part B without paying higher premiums:

* Any month you are under a group health plan based on your own current employment or the current employment of any family member; or

* Within eight months after your employment or group health plan coverage ends, whichever comes first.

If you are disabled and working (or you have coverage from a working family member), the same rules apply. Remember: if you don’t enroll in Medicare Part B when you first become eligible to apply and you don’t fit into one of the above categories, you'll have to wait until the general enrollment period, which is Jan. 1 through March 31 of each year.

At that time, you may then have to pay a higher Medicare Part B premium because you could have had Medicare Part B and did not take it.

For more information about Medicare Parts A, B, C, and D, visit the Center for Medicare & Medicaid Services (CMS) Medicare Web site at www.medicare.gov

(Public Affairs Specialist Mike Baksa may be reached at michael.baksa@ssa.gov)

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