-HCFA the Medicare and Medicaid Agency FACT SHEET September 1996 Contact: HCFA Press Office (202) 690-6145 _________________________________________________________________ KNOW YOUR MEDICARE BASICS: TEN TIPS Here's what you need to know to successfully maneuver through Medicare. 1. Apply for Medicare when you turn 65. Don't put it off. If you wait longer than a year to sign up, your premiums will be higher. If you are already getting Social Security, you are automatically enrolled in Part A and Part B. 2. There are two parts to Medicare. You pay only for one. Part A -- Hospital Insurance -- covers most hospitalization and some skilled nursing care when required after hospitalization. It's paid automatically by the government. Part B -- Medical Insurance --covers most doctors' fees and outpatient treatment. You have to pay a small monthly premium for Part B coverage as well as deductibles and copayments just as you do with private insurance. 3. Think about buying Medigap insurance to cover what Medicare does not. There are 10 standard Medigap policies -- each one offers a different combination of benefits. It's important to buy your policy within the first 6 months after you've enrolled in Medicare Part B, or turned 65: you can't be turned down or charged higher premiums because of poor health. After those first six months, you may not be able to buy the policy of your choice and you may have to accept whatever Medigap policy an insurance company is willing to sell you. 4. Consider enrolling in a managed care plan. In a managed care plan, you pay a fixed monthly premium, small copayments for each service and you also must continue to pay the Part B premium to Medicare. However, you may be eligible for additional services that aren't covered by Medicare such as dental care, preventive care, hearing aids, eyeglasses and prescription drugs. These additional benefits may make Medigap insurance unnecessary. 5. If you have limited income and resources, find out if you are eligible for the Qualified Medicare Beneficiary Program (QMB) or Specified Low-Income Medicare Beneficiary Program (SLMB). QMB pays your premiums, deductibles and co-insurance payments. SLMB pays only Medicare Part B premiums. Call your local or state social services or welfare office to determine if you qualify. 6. If you are eligible for Medicaid as well as Medicare, Medicaid will pay your Part B premiums as well as other costs. 7. Ask if your doctor or health care provider accepts Medicare "assignment" or Medicare's "limiting charge" fee schedule before you make an appointment. Medicare has a fee schedule for each medical service. Doctors who agree to the fees "accept Medicare assignment." You are not billed any extra fees. However, some doctors may ask you to pay the balance between what Medicare pays for and what they charge. If this is more than you can pay, consider seeing another doctor. 8. Never let anyone else use your Medicare card and never give your number to anyone but your health care providers. Keep the number as safe as a credit card or checking account number. Take your card with you when you travel and have it handy if you call about a Medicare claim. If you lose your card, contact the Social Security Administration right away. 9. Call the Department of Health and Human Service's Fraud Hotline at 1-800-447-8477 (1-800-HHS-TIPS) if you think you have been overcharged or your Medicare benefits have been abused by a health care provider. 10. Get a free copy of HCFA's booklet, YOUR MEDICARE HANDBOOK. Call 1-800-638-6833 or write: HCFA Publications, 7500 Security Boulevard, Baltimore, MD 21244-1850. For the hearing and speech impaired, call 1-800-820-1202 (TTY). This and other HCFA publications can also be accessed on the Internet at http://www.hcfa.gov. # # # Go to Facts Sheet Go to Fact Sheets (Last Updated: 03/06/97