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May 9--Benefit counselors say the questions about Medicare run the gamut -- everything from how to enroll in the program to how to appeal a claim denial. But some questions turn up more than others. Here are the most common ones and their answers, according to counselors at AARP, Jewish Family Service, Medicare, the Medicare Rights Center and the Senior Source:
QUESTION: Who's eligible for Medicare?
ANSWER: Medicare is for anyone 65 and older, some younger people with disabilities and individuals with kidney failure. Even if you don't qualify for full Social Security benefits until sometime after your 65th birthday, you're still eligible for Medicare at 65.
Medicare has two parts -- Part A helps cover hospital bills, while Part B helps take care of doctor bills. Most people don't pay a premium for Part A, but they do pay $78.20 a month for Part B.
Q: How and when do I enroll?
A: If you're already getting Social Security payments, you're automatically enrolled when you turn 65. Otherwise, you need to contact the Social Security Administration at 1-800-772-1213 for details about signing up.
The best time to enroll is during the three months before your 65th birthday.
When you enroll, you'll get Part A, but signing up for Part B is your choice. If you're still working and have group health insurance from your employer, you may not need Part B right away.
Q: I have good retiree health care coverage through my former employer. Do I need to sign up for Medicare?
A: Yes. Once you become eligible for Medicare, your retiree coverage almost always pays after Medicare does. That means you need to enroll in both Part A and Part B to receive full benefits from your retiree plan. Retiree insurance often offers benefits that fill Medicare's gaps in coverage, such as for prescription drugs.
Q: What's the Medicare discount drug card?
A: Until the end of the year, companies are offering drug discount cards approved by Medicare. A card costs up to $30 and may save you 10 percent to 15 percent on your prescriptions.
Medicare's Web site -- www.medicare.gov -- helps you to compare the discount cards available and to sign up for the one with the best deal. You can then use your card to buy drugs by mail order or at a pharmacy.
Q: How will Medicare's new prescription drug benefit work?
A: On Jan. 1, the discount cards will begin to phase out, and Medicare's coverage for outpatient prescription drugs will get under way.
Medicare is contracting with companies to offer the benefit. The coverage is voluntary, but there will be a financial penalty for beneficiaries who sign up later.
If you do take the insurance, you'll pay a monthly premium (about $35 in 2006) and a share of the cost of your prescriptions. The plans may vary in what drugs are covered, how much you must pay and which pharmacies you can use.
Q: Does Medicare cover long-term care?
A: No, Medicare doesn't pay for custodial care, such as help with bathing, dressing, eating and using the bathroom. It covers only short periods of skilled nursing care after a hospital stay.
Q: I'm retired and on Medicare. If I go back to work, will my earnings affect my health care coverage?
A: No, Medicare eligibility isn't based on your income or other resources. Your eligibility won't be affected by how much you earn after retirement.
Q: I'm thinking about buying supplemental "Medigap" insurance to fill the gaps in Medicare. Can I buy it whenever I want?
A: Medigap policies are sold by insurance companies to cover many of the deductibles and copayments that Medicare doesn't.
The best time to buy a policy is during the six months after you're 65 and enrolled in Part B. During that open-enrollment period, an insurance company can't deny you coverage, place conditions on a policy or change the price of a policy because of past or present health problems.
Q: Will Medicare pay for home health care?
A: Yes, as long as you're homebound and need skilled care. For instance, if you're recovering from hip replacement surgery, can't leave your home and need physical therapy to learn to walk again, you qualify.
But you don't qualify if you require only custodial care, such as if you have Alzheimer's disease and need help to bathe or eat.
Q: Does Medicare cover mental health care?
A: Yes, Medicare pays for inpatient mental health care the same way it covers other hospital stays. But Medicare pays for only a lifetime total of 190 days in a psychiatric hospital.
Medicare also covers half of most outpatient mental health services.
Q: My mother is seriously ill. How long will Medicare cover her hospice care?
A: Your mother can get hospice care as long as her doctor and the doctor of a Medicare-certified hospice agency certify that she is terminally ill and has less than six months to live.
If she lives beyond that time, she can continue receiving care as long as her doctor recertifies that she is terminally ill.
Q: If I have Medicare, can I also be eligible for Medicaid?
A: Yes, if you meet Medicaid's income and asset limits, you can get both. Medicare would be your primary payer, and Medicaid would be your secondary one, meaning it would cover your Medicare out-of-pocket expenses, such as premiums, coinsurance and deductibles.
Q: Does Medicare cover dental services?
A: No, Medicare doesn't pay for routine dental care or most dental procedures, such as cleanings, fillings, tooth extractions or dentures. But Part A will cover certain dental services when you're in the hospital.
GET HELP
Have questions about Medicare? Here's where to find the answers:
AARP: 1-888-687-2277
Dallas Area Agency on Aging: Dial 211 from your home phone.
Jewish Family Service: 972-437-9950
Medicare: 1-800-633-4227 You can also order a copy of Medicare & You, a handbook about Medicare.
The Senior Source: 214-823-5700
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