Top Twenty Medicare/Medicaid Questions

The following 20 questions and answers are the most frequently asked questions by callers to the Medicare + Choice toll free line. These questions and answers will be updated as needed.

1. How does the Original Medicare Plan work?

The Original Medicare Plan is the traditional fee-for-service system that covers your health care needs. The Original Medicare Plan has two parts, Part A for hospital services and Part B for physician services. But not everybody is eligible for both parts. Medicare pays its share of the bill and you pay the balance. You may choose to go to any doctor, hospital, or other health care provider, like a home health agency, which accepts Medicare payment.

2. How do I know whether or not I'm eligible for both Part A and Part B?

You should contact your local Social Security Office. The staff there can tell you if you are eligible for Part A and Part B.

3. How can I get a replacement Medicare card?

You should contact your local Social Security Office to get a replacement card.

4. I can't afford my Medicare premiums. What can I do?

If your income is limited, your State may help you pay your Medicare costs, such as your premiums and deductibles. Check the Who to Contact section of this web site for the phone number of your State medical assistance office. They can help you determine if you qualify for help.

5. What coverage is available for prescription drugs?

Generally, Original Medicare does not cover prescriptions. There are certain limited exceptions, like some cancer drugs. However, some Medicare health plans do cover drugs. In addition if you are in the Original Medicare plan, Medigap or other supplemental insurance plans may cover prescription drugs.

6. What is Medicaid and who does it cover?

Medicaid is a health insurance program for certain low-income people. It covers children, the aged, blind, disabled, and people who are eligible to receive other federal assistance. In some cases, Medicaid will help pay for Medicare premiums, deductibles, and coinsurance. For more information, you can contact your State medical assistance office.

7. If I have Medicare and Medicaid, who should process my bills first?

Your bill should always be sent to Medicare first. Medicare pays first. The part of the bill that Medicare does not pay will then be sent to your State Medicaid program for additional payment.

8. Will I be responsible for sending my claim to Medicaid?

No, under the Original Medicare Plan your claims are sent to your state Medicaid program for you. Sometimes your provider (hospital or physician) will send the claim to Medicaid after they receive the notification of what Medicare paid. Other times the contractor that pays your Medicare claim will send it to Medicaid.

MANAGED CARE PLANS AND SUPPLEMENTAL INSURANCES

9. What plans are available in my area?

The Original Medicare plan, the traditional fee-for-service system, is available nationally and Medicare managed care plans are available in many parts of the country. You can search for plans in your area using the Medicare Compare database on this web site.

10. If I like the coverage I have under Original Medicare, do I need to make a change?

If you are happy with the Original Medicare plan , you don't need to do anything. You will continue to receive Medicare benefits the same way as you do now.

11. What plan is best for me? Can you recommend a plan?

Medicare can't recommend a plan to you. However, a comparison of plans in your area is available on this site or by calling 1-800-318-2596. Any decision about your health care is an important one. You may want to talk with people you trust about which plan would best meet your needs.

12. What are the plans/choices available under Medicare + Choice?

Medicare + Choice expands your options. The Original Medicare Plan and Medicare HMOs are available now. The Original Medicare Plan, the fee-for-service arrangement, is available to everyone. Also, Medicare HMOs are available in many parts of the country.

Beginning in 1999, Preferred Provider Organizations and Provider Sponsored Organizations, and other insurance options like Private-Fee-For Service Plans and Medicare Medical Savings Accounts, might become available in your area. This site will contain additional information on these options when they become available.

No matter which option you choose, you are still in the Medicare program and will receive all of the Medicare covered services.

13. Does Medicare + Choice replace Original Medicare?

No. Medicare +Choice expands the Medicare health plan options to include a broader range of plans. Currently, the types of Medicare + Choice plans that are available are the Original Medicare Plan and Medicare HMOs. The Original Medicare Plan, the fee-for-service arrangement, is available to all Medicare beneficiaries; and Medicare HMOs are available in many parts of the country. If you choose the Original Medicare Plan, you may want to consider a supplemental insurance plan, or Medigap insurance.

No matter what option you choose, you are still in the Medicare program and will receive all the Medicare covered services.

14. What impact do these new plans have on my Medigap/supplemental insurance?

If you stay in Original Medicare, there is no effect. If you choose to join a managed care plan, you may keep your coverage, but you may not need to. Medicare managed care plans will often cover the same type of services that the Medigap/supplemental policy covers.

If you are trying a managed care plan for the first time, you have a 12-month protection from the time you enroll to change you mind. If you go back to Original Medicare with 12 months, you can get your Medigap plan back as well, as long as it is still being sold.

15. If I don't need Medigap insurance anymore, what should I do to stop it?

To drop your Medigap insurance, contact the insurance company. You should be aware that when you drop your Medigap policy, there is no guarantee that you will be able to pick it back up at the same price if you want it back.

16. Why are HMOs terminating their contracts with Medicare?

Each year, HMOs have to make a choice to continue their contracts, adjust premiums and benefits, or not to renew their contracts. Some HMOs have made business decisions to terminate their Medicare contracts in certain areas.

17. If the HMO I am in now decided not to participate in 1999, what should I do?

You will need to make a decision. Your decision will depend upon what health plan options are available in your area. No matter what you choose, you are still in the Medicare program and will receive all Medicare covered services.

The Original Medicare Plan, the fee-for-service arrangement, is available to all Medicare beneficiaries nationwide; and Medicare managed care plans are available in many parts of the country. Depending upon where you live, a Medicare managed care plan may be available in your area.

In order to enroll in other Medicare + Choice health plan options, you must have Medicare Parts A and B but you must not have End Stage Renal Disease.

18. How do I re-enroll in Original Medicare if I want to leave the plan I have chosen?

You will automatically return to Original Medicare if you leave your plan. You do not need to re-enroll. You may leave your plan by calling the Social Security office, or notifying the plan that you wish to leave and asking to disenroll from your Medicare managed care plan.

19. If I leave my plan, when will my benefits change back to Original Medicare?

It usually takes about a month for this change to occur. Once your plan receives your request to leave, you will automatically return to Original Medicare on the first day of the next month.

Remember, if you change to another managed care plan, that plan will tell you when your new benefits are effective. Usually this will occur on the first day of the next month after your enrollment form is received.

20. What is the State Health Insurance Assistance Program?

The State Health Insurance Assistance Program offers free insurance counseling services to Medicare beneficiaries. Their counselors can help you understand health plan options under Medicare. They can also answer your questions on private insurance to supplement Medicare, and help you with questions on your Medicare bills or statements.