Medicare FAQs

What is Medicare?

Medicare is a Federal health insurance program for people 65 years or older, certain people with disabilities, and people with end-stage renal disease (ESRD). Medicare has two parts — Part A, which is hospital insurance, and Part B, which is medical insurance.

Who is eligible for Medicare?

Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Medicare has two parts, Part A (Hospital Insurance) and Part B (Medicare Insurance). You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:

  • You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.
  • You or your spouse had Medicare-covered government employment.
    If you (or your spouse) did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A. If you are under age 65, you can get Part A without having to pay premiums if:
  • You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months. (Note: If you have Lou Gehrig’s disease, your Medicare benefits begin the first month you get disability benefits.)
    You are a kidney dialysis or kidney transplant patient.

While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.

The retirement age for Social Security is increasing until it reaches age 67. Will I still get Medicare at age 65 if I’m not yet eligible for Social Security retirement benefits?

Although the retirement age is rising, 65 remains as the starting date for Medicare eligibility. You will be eligible to apply for Medicare if you have paid into Social Security for at least 10 years or you are eligible to receive Social Security benefits on your spouse’s earnings. If you do not meet these requirements, you can still get Medicare hospital insurance (Part A) by paying a monthly premium if you are a citizen or a lawfully admitted alien who has lived in the U.S. for at least five years.

Also, anyone who is age 65 and a citizen or a lawfully admitted alien with five years of residency in the United States can sign up for Medicare Part B medical insurance and pay a monthly premium.

Be sure to sign up for Medicare about three months before you reach age 65. And remember, you do not have to be retired to enroll in Medicare.
For more information about retirement, visit www.socialsecurity.gov or call 1-800-772-1213 (TTY users should call 1-800-325-0778).

What is “assignment” in the Original Medicare Plan and why is it important?

Assignment is an agreement between Medicare and doctors, other health care providers, and suppliers of health care equipment and supplies (like wheelchairs, oxygen, braces, and ostomy supplies). Doctors and suppliers who agree to accept assignment accept the Medicare-approved amount as payment in full for Part B services and supplies. You pay the coinsurance and deductible amounts. In some cases (such as if you have both Medicare and Medicaid), your health care providers and suppliers must accept assignment. If assignment is not accepted, charges are often higher. This means you may pay more. In addition, you may have to pay the entire charge at the time of service. Medicare will then send you its share of the charge. There is a limit on the amount your doctors and providers can bill you. The highest amount of money you can be charged for a covered service by doctors and other health care providers who don’t accept assignment is called the limiting charge. The limit is 15% over Medicare’s approved amount. The limiting charge only applies to certain services and does not apply to supplies or equipment.

Where can I find a list of all physicians that participate in Medicare?

A list of participating physicians in your area can be found in the Participating Physician Directory section in the www.medicare.gov website. Or, your local Medicare Carrier can assist you with this question. You can find their phone number in the Helpful Contacts section of www.medicare.gov.

Why aren’t all Medicare participating healthcare professionals included in the Participating Physicians Directory?

The healthcare professionals listed in the Participating Physician Directory on www.medicare.gov is derived from the Unique Physicians Identifier Number (UPIN) directory. This directory is limited to practitioners who have the following academic credentials:

  • Medical Doctor (MD)
  • Doctor of Osteopathy (DO)
  • Doctor of Optometry (OD)
  • Doctor of Podiatric Medicine (DPM)
  • Doctor of Dental Medicine (DM)
  • Doctor of Dental Surgery (DDS)
  • Doctor of Chiropractic Medicine (DC)

We acknowledge the fact that there are several other Medicare participating healthcare professionals that have other academic credentials and are not included in the UPIN directory and subsequently are not listed in the Participating Physicians Directory at this time. The healthcare professional classifications that are not included in the UPIN directory include, but are not limited to:

  • Audiologist
  • Certified Clinical Nurse Specialist
  • Certified Nurse Midwife
  • Certified Registered Nurse Anesthetist
  • Clinical Psychologist
  • Licensed Clinical Social Worker
  • Nurse Practitioner
  • Occupational Therapist
  • Physical Therapist
  • Physician Assistant
  • Registered Dietitian

How does Medicare use my personal information?

Medicare uses your personal information to administer our country’s largest health insurance program for the elderly, disabled, and people with end-stage renal disease. Some of the ways Medicare uses your personal information are to:

  • Pay your medical bills for Medicare benefits
  • Make sure you get quality health care
  • Set the Medicare payment rates for doctors hospitals and other health care providers, and
  • Make sure that Medicare does not pay for health care providers or services that you did not get.

How is the privacy of my medical records protected?

You have the right to talk with health care providers in private and to have your personal health care information kept private as protected under federal and state laws.

There is a new patient privacy rule that gives you more access to your own medical records and more control over how your personal health information is used by your health care provider or your health plan. This rule will be fully effective on April 14, 2003.

If you have any questions about this privacy rule, look at the National Standards to Protect the Privacy of Personal Health Information on the web.
If you are in a Medicare managed care plan or a Medicare Private Fee-for-Service plan, you also have the right to timely access to our medical records.

How does Medicare protect my personal information?

The Privacy Act protects the personal information about you that Medicare uses. This law requires that all federal agencies, and their contractors, follow certain rules to protect any personal information which they collect, use, or disclose.
Medicare managed care plans are not required to comply with the Privacy Act, but your personal information is still protected. Medicare managed care plan materials (e.g., Evidence of Coverage) describe your privacy rights. You should contact your managed care plan directly for more information.

Source: www.medicare.gov – The official U.S. site for people with Medicare