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Marci’s Medicare Answers, information from the Medicare Rights Center Dear Marci, Every year my Medicare Part B premium is higher. What will it be this year? -Scott Dear Scott, In 2007, most people’s Medicare Part B premium will be $93.50. For the first time ever, the Part B premium is based on income. If your annual income is above $80,000 ($160,000 for couples) your Part B premium will be higher than $93.50. To find out what you will pay, call Social Security at 1-800-772-1213 or check http://www.medicarerights.org/newmedicarecosts.html. -Marci
Dear
Marci, Mary Dear Mary, It depends on which Medicare health plan you have. If you have Original Medicare, you will be covered to go to any doctor or hospital in any state or U.S. territory. If you are enrolled in a Medicare private health plan, like an HMO or PPO, you have to follow your plan’s rules. These private plans generally restrict you to seeing doctors and hospitals in your plan’s network. You will pay more—sometimes the full cost—for non-emergency care received outside of your private plan’s network. Call your plan and ask what the rules are for out-of-network care. If you want to switch to Original Medicare, you can do so from November 15 to December 31 every year. You can also change your choice of health coverage between January 1 and March 31 (but you can not choose to add or drop Medicare drug coverage—Part D—during this period). -Marci Dear Marci, I signed up for a new Medicare drug plan this year. Last year some friends had trouble filling their prescriptions, and I am worried about what I will do if this happens to me. -Eddy Dear Eddy, Medicare drug plans are required to offer their new members a “transition policy.” You can use this to immediately fill at least one 30-day supply of every prescription you were taking before your new drug coverage began. You can tell your pharmacist to fill the prescription using your drug plan’s “transition” or “temporary” first-fill policy, regardless of whether the drug plan covers the prescription or has placed restrictions on it. While you are getting this supply, ask your doctor to either switch you to a covered drug or to ask your plan for an “exception” to cover the drug you need. You can only use your drug plan’s transition policy during the first 90 days after joining. If you have trouble getting your prescriptions filled, call the Medicare Rights Center’s Medicare Drug Appeals hotline at 888-466-9050. Marci Dear Marci, I'll turn 65 in August, but my Social Security benefits do not begin until December. When and how do I sign up for Medicare? —Paul Dear Paul, You can sign up for Medicare during the three months before, the three months after, and the month that you turn 65. To enroll in Medicare, either go to your local Social Security office or mail Social Security a dated letter that includes your name, signature, Social Security number and the date you want to be enrolled in Medicare. Be sure to note who you spoke with and keep copies of any letters, so you can prove that you tried to enroll in Medicare when you were first eligible. You will be charged a premium penalty if you delay enrolling in Medicare Part B, unless you have employer health insurance through your or your spouse's job at a company that employs at least 20 people. Call 800-772-1213 to locate your local Social Security office, or 800-MEDICARE if you have questions about your Medicare coverage. Marci Dear Marci, My mother broke her hip and was in the hospital for four days. Now her doctor recommends that she enter a skilled nursing facility. Will Medicare cover this? —Mary Dear Mary, Medicare will cover your mother's care in a Medicare-certified skilled nursing facility (SNF) if she was in the hospital for at least three days during the 30 before being admitted in to the SNF, needs either skilled nursing care seven days a week (like injections) or skilled therapy (like physical or speech therapy) at least five days a week, and became eligible for Medicare before she was discharged from the hospital. If your mother meets these requirements, Medicare will pay the full cost of her first 20 days in a Medicare-certified SNF, and part of the next 80 days each benefit period. A benefit period begins the day she enters the SNF and ends when she no longer receives SNF care for 60 days in a row. To learn more about SNFs, or to find a Medicare-certified one for your mother, speak with her doctor and the hospital discharge planner, or call the Eldercare Locator at 800-677-1116. Marci Dear Marci, I've been in the same Medicare HMO for years, but now my doctor has left the plan's network. Can I drop the HMO? Eddy Dear Eddy, You have until March 31 to drop your Medicare HMO and switch to Original Medicare or another Medicare private health plan (such as an HMO or PPO). Every year, everyone with Medicare can drop or change their health plan one time between January 1 and March 31 during the Open Enrollment Period, with coverage effective the next month. You can also change your choice of Medicare health coverage between November 15 and December 31, with new coverage effective on January 1. You cannot decide to add or drop Medicare drug coverage (Part D) during the Open Enrollment Period. Marci
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