More on your Medicare Part A or B benefits

GOOD TO KNOW
Patricia Hafermann Benefit Specialist

Part B General Enrollment Period

If you did not sign up for Medicare Part B when you first became eligible, you may sign up during the General Enrollment Period. Below is specific information about the General Enrollment Period:

• The General Enrollment Period runs from Jan. 1 through March 31 of each year.

• Your Medicare Part B coverage will start on July 1 of the year you sign up.

• The cost of Medicare Part B will go up 10 percent for each 12-month period that you could have had Medicare Part B but did not take it, except in special cases. You will have to pay this extra amount as long as you have Medicare Part B.

• During this time, you can sign up for Medicare Part B at your local Social Security office. If you get benefits from the RRB, call your local RRB office www.rrb.gov/accessrrbgov/ ZipLocator/zip_ enter. asp or 1-800-808-0772.

Special Enrollment Period

This period is available if you are eligible for Medicare and waited to enroll in Medicare Part B because you or your spouse were working and had group health plan coverage through an employer or union based on this current employment. If this applies to you, you can sign up for Medicare Part B:

• Any time you are still covered by your employer or union group health plan, through your or your spouse’s current employment, or

• During the eight months following the month that the employer or union group health plan coverage ends or when the employment ends (whichever is first).

If you already get Social Security or Railroad Retirement benefits, you are automatically enrolled in Part B starting the first day of the month you turn 65. If you are under age 65 and disabled, you are automatically enrolled in Part B after you get Social Security or Railroad benefits for 24 months. Your Medicare card will be mailed to you about three months before your 65th birthday or your 25th month of disability benefits. If you do not want Medicare Part B, follow the instructions that came with the Medicare card.

If you sign up for Part B coverage, the premium for 2013 is $104.90 per month. Beginning in 2007, the Part B premium is determined by a means test. This amount is automatically taken out of your Social Security check each month. New premium rates become effective every January. In some cases, this amount may be higher if you did not sign up for Part B when you first became eligible. The cost of Part B may go up 10 percent for each 12-month period that you could have had Part B but did not sign up for it. You will have to pay this extra amount as long as you have Part B, except in special cases.

Starting Jan. 1, 2007, your Part B premium is based on your income.

As required in the federal Medicare Modernization Act of 2003 (MMA), in 2008, single Medicare beneficiaries with annual incomes over $85,000 and married couples with incomes over $170,000 will pay a higher percentage of the cost of Medicare Part B coverage, reducing Medicare’s share. These higher-income beneficiaries will pay a monthly premium equal to 35, 50, 65, or 89 percent of the total cost, depending on their income level, by the end of the three-year transition period.

Part A Hospital Insurance Benefits

Inpatient hospital care

(Semi-private room and meals, general nursing and miscellaneous hospital services) For Each Benefit Period*

You pay:

• The first $1,184 in each benefit period**

• $296 a day coinsurance for days 61 through 90**

• All charges for coverage after 90 days in any benefit period unless you have “lifetime reserve” days available and use them

• $592 a day coinsurance for each lifetime reserve day used**

• All costs after 150th day

Skilled Nursing Facility coverage (SNF)

You pay:

• Nothing to the 21st day

• $148 daily coinsurance for days 21 through 100 in each benefit period**

• All costs for care after 100 days in a benefit period*

• All costs for care that is less than the level of care Medicare covers in an SNF

• All costs if you were not transferred to an SNF in a timely manner after a qualifying hospital stay

• For care in a general nursing home, or in an SNF not approved by Medicare, or just custodial care in a Medicare-approved SNF

• The first 3 pints of blood unless you or someone else donates blood to replace what you use

Hospital stays

Semiprivate room, meals, general nursing, and other hospital services and supplies. This includes inpatient care you get in critical access hospitals and mental health care. This does not include private duty nursing or a television or telephone in your room. It also does not include a private room, unless medically necessary. Inpatient mental health care in a psychiatric facility is limited to 190 days in a lifetime.

Skilled nursing facility care

Semiprivate room, meals, skilled nursing and rehabilitative services, and other services and supplies (only after a related three-day inpatient hospital stay).

Home health care

Limited to reasonable and necessary part-time or intermittent skilled nursing care and home health aide services as well as physical therapy, occupational therapy, and speechlanguage therapy that are ordered by your doctor and provided by a Medicare-certified home health agency. Also includes medical social service, durable medical equipment (such as wheelchairs, hospital beds, oxygen and walkers), medical supplies and other services.

Hospice care

For people with a terminal illness, includes drugs for symptom control and pain relief, medical and support services from a Medicare approved hospice, and other services not otherwise covered by Medicare (grief counseling). Hospice care is usually given in your home (which may include a nursing facility if this is your home). However, Medicare covers some short-term hospital and inpatient respite care (care given to a hospice patient so that the usual caregiver can rest.

*A benefit period begins the first day that you receive inpatient hospital or skilled nursing facility services and ends after you are no longer in the hospital or skilled nursing facility for 60 consecutive days.

*Deductible and coinsurance are for 2013 only.

Blood

Pints of blood you get at a hospital or skilled nursing facility during a covered stay.

Costs for these may vary, depending on the plan you choose.


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