New to Medicare?
SHIIP Can Help You Navigate the System
If you are among the people who will begin receiving Medicare benefits this year, you probably have questions about how to navigate the Medicare system. The following are frequently asked questions from the Department of Insurance’s Seniors’ Health Insurance Information Program or SHIIP.
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How do I enroll in Medicare?
If you are currently receiving Social Security benefits and have paid into the Social Security system for at least 40 quarters, you will be automatically enrolled in Medicare. If you are not receiving Social Security benefits and have paid into the Social Security system for at least 40 quarters, visit your local Social Security Office to apply for Medicare.
What if I don’t meet the 40-quarter requirement?
If you are an American citizen or lawfully admitted non-documented citizen who is not eligible for premium-free Medicare, you may purchase the insurance. If you have worked fewer than 30 quarters, you will pay $393 per month for Medicare Part A (hospital insurance). If you have worked 30-39 quarters, you will pay $216 per month for Medicare Part A. Everyone who receives Medicare pays $88.50 for Medicare Part B (medical insurance).
If I’m not automatically enrolled, when should I apply for Medicare?
You have seven months when you can apply for Medicare — the three months prior to your 65th birthday, your birthday month and three months after your birthday. When you enroll during these seven months determines when your Medicare coverage begins. If you enroll in Medicare during the three months prior to your 65th birthday, your Medicare coverage will begin the first day of your birthday month. If you enroll during the month of your 65th birthday, your coverage begins on the first day of the following month. And if you enroll during the three months after your 65th birthday, your coverage is delayed two months after the month that you signed up; for example, if you turn 65 on Aug. 18, 2008, and enroll in Medicare on Sept. 1, coverage will not be effective until Nov. 1.
Do I need any other insurance besides Medicare?
Medicare’s basic benefit (Original Medicare) has significant gaps in coverage, so supplemental coverage is recommended. Your employer group retiree health plan can act as secondary coverage to Medicare, or you can purchase a Medicare supplement policy to fill the gaps. A Medicare supplement comparison guide is on SHIIP’s web page, www.ncshiip.com., which lists all companies that sell Medicare supplement insurance in North Carolina including premiums.
How do I pay for my prescription medication?
Medicare Part D provides prescription drug coverage for people with Medicare who enroll in a stand-alone prescription drug plan or join a Medicare Advantage plan. These plans vary and are offered by private insurance companies.
What are Medicare Advantage Plans (Part C)?
Medicare Advantage Plans are an alternative health insurance option to original Medicare. These include Medicare managed care plans such as Medicare health maintenance organizations (HMO) and preferred provider organizations (PPO). The newest option in North Carolina is the private fee-for-service (PFFS) plan. People with Medicare may choose among the Medicare Advantage Plan choices available in their area. No matter which Medicare Advantage Plan a person chooses as their Medicare coverage, they will continue to pay the Medicare Part B premium. All three of these Medicare Advantage options are offered in North Carolina; however, all three options may not be available where you live.
The Medicare system has seen many changes in recent years, and SHIIP has trained employees and volunteers who are educated about these changes and who understand that enrolling in Medicare can be a daunting task for some people. If you have questions about your Medicare options, please call SHIIP at 1-800-443-9354 or Council on Aging in Union County at 704-289-5502.
North Carolina Department of Insurance, Seniors’ Health Insurance Information Program (SHIIP)
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