Medicare: What you need to know

Medicare is a health insurance program for:

 

  • people age 65 or older,
  • people under age 65 with certain disabilities, and
  • people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

 

Medicare has:

Part A Hospital Insurance - Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

Part B Medical Insurance - Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Prescription Drug Coverage - Most people will pay a monthly premium for this coverage. In January 1, 2006, Medicare prescription drug coverage became available to everyone with Medicare. This coverage is to help you lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.

 

Medicare clients receive a variety of letters, notices, and information that can be confusing.

 

This will help easily identify what type of notice your clients receive by color and topic.  
 
YELLOW: Auto-Enrollment Notice

If you get this YELLOW notice it means they automatically qualify for extra help because you qualify for Medicare and Medicaid (and currently get benefits through Original Medicare).  It can also mean you automatically qualify for extra help with a retroactive effective date. You will be automatically enrolled in a Medicare Prescription Drug Plan unless you decline coverage or join a different plan.

 
ORANGE: Change Extra Help Co-payment Notice

You will get this ORANGE notice if Social Security determines that you still automatically qualify for extra help, but will have different copayment levels next year.

 

 

PURPLE: Deemed Status Notice

If you get this purple notice it means you automatically qualify for extra help, because of any of the following:

 

 
GREEN: Facilitated Enrollment Notice

This green notice lets people with Medicare know that because you qualify for extra help, Medicare will enroll them in a Medicare Prescription Drug Plan if you don’t enroll yourself or decline coverage. People who get this notice qualify for extra help because of one of the following:

 

 
TAN: LIS Choosers Notice

You will get this notice if you get extra help, have joined a Medicare Prescription Drug Plan on your own, and your plan’s premium is changing. This tan notice lets you know you will have to pay a portion of your plan’s premium in the coming year unless they join a new $0 premium plan.

 

 

GREY: Loss of Deemed Status Notice

You will get this grey notice if Social Security determines that you no longer automatically qualify for extra help for the coming year.

 

 

BLUE: Reassignment Notice

You will get this notice if you get extra help and your current Medicare Advantage (MA) Plan or Part D is leaving the Medicare Program. You may also get a blue notice if Medicare reassigns you into a new Medicare drug plan or if the premium is increasing above the amount covered by extra help. This blue notice lets you know that you will be reassigned to new plan for the coming year if you don’t do one of these on your own:

 

    • Join a new Medicare Advantage Plan
    • Join a Medicare drug plan

 

How do I apply for Medicare Savings Programs?

 
QMB income & resource limits in 2022:

Medicare providers aren’t allowed to bill you for services and items Medicare covers, including deductibles, coinsurance, and copayments, except outpatient drugs. Pharmacists may charge you up to a limited amount (no more than $4.00 in 2022) for prescription drugs covered by Medicare Part D.

 

Individual monthly income limit              $1,153

Married couple monthly income limit    $1,546

 

 

SLMB income & resource limits in 2022:

The SLMB Program is a state program that helps pay Part B premiums for people who have Part A and limited income and resources.

 

Individual monthly income limit    $1,379

Married couple monthly income limit   $1,851

 

QI income & resource limits in 2022:

The QI Program is a state program that helps pay Part B premiums for people who have Part A and limited income and resources. You must apply every year for QI benefits

. QI applications are granted on a first-come, first-served basis, with priority given to people who got QI benefits the previous year. (You can't get QI benefits if you qualify for Medicaid).

 

Individual monthly income limit             $1,549

Married couple monthly income limit   $2,080

 

If you answer yes to these 3 questions, call your State Medicaid Program to see if you qualify for a Medicare Savings Program in your state:

 

  1. Do you have, or are you eligible for, Part A?
  2. Is your income for 2022 at, or below, the income limits listed
  3. Do you have limited resources, below the limits above?

It's important to call or fill out an application if you think you could qualify for savings—even if your income or resources are higher than the amounts listed here. To find the contact information for your Medicaid office, 

 

Medicaid eligibility and enrollment Link

 

By contacting the phone number on this website you will be directed to a licensed agent.

 

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