Medical Services Medicare Medicare is a federal health insurance


program for U.S. citizens and legal residents. Medicare is for persons 65 and older as well as those under 65 with a qualifying disability (after a 24 month waiting period). Medicare typically pays 80% for health care, but does not cover all medical expenses (dental, for example, is an excluded service), nor does it cover the cost of long-term care. You apply for Medicare at Social Security, but questions about coverage should be directed to 1-800-MEDICARE or SHIP, State Health Insurance and Assistance Program, at the Area Agency on Aging, 205-333-2990 or 1-800-AGELINE.


Medicare Has Four Parts:


1. Part A: Hospital insurance that helps pay for inpatient care in a hospital or skilled nursing facility for rehab (following a hospital stay), some home health care and hospice. Typically premium is free if you have enough credits paid into Social Security, if not, one can purchase Part A.


2. Part B: Medical insurance that helps pay for doctors’ services, other medical services and supplies that are not covered by hospital insurance. There is a monthly premium for all who enroll. **Together Medicare A and B pay for 80% of health care costs


3. Part C (Medicare Advantage): An optional way to get your healthcare through a provider organization based on plans available that serve the area in which you live. One must have Medicare A and B to enroll in Medicare Advantage. Plans are available in PPO (Preferred Provider Organization), HMO (Health Maintenance Organization) and SNP (Special Needs Plans). Additional premiums may apply.


4. Part D: Prescription drug coverage that helps pay for medications that doctors prescribe


edical Services


When Can You First Enroll In Medicare?


You can sign up for Medicare during


designated enrollment periods. Each has a specifi c purpose.


*Initial Enrollment Period (IEP) This is when you are fi rst eligible to enroll


in Medicare. Your age eligibility for Medicare and the timing of your IEP are based on the date of your 65th birthday. If you become eligible due to disability, then your IEP timing is based on your disability date.


*General Enrollment Period (GEP) This is a set period of time for people who did not enroll during their IEP. It runs from January 1-March 31 of every year. If you enroll during the GEP, your Medicare will be effective July 1 of that year.


*Special Enrollment Period (SEP) You must meet certain requirements to


qualify for a SEP; the timing is based on the specifi c situation. This is for people who are unable to enroll during their IEP or who choose not to. A common reason for delaying enrolling in Medicare Part B is for those who have been continuously covered by a group health plan based on full time employment. This situation would open a Special Enrollment Period for Medicare.


Under Medicare law, a Special Enrollment Period (SEP) allows you to enroll in Medicare Part B outside of your Initial Enrollment Period (IEP) and the General Enrollment Period (GEP). You may be automatically enrolled in


Original Medicare Parts A and B when you turn 65. This happens if you are already getting benefi ts from Social Security or the Railroad Retirement Board (RRB). If you are automatically enrolled, you will receive your Medicare card three months before your 65th birthday. If you


205-333-2990 • www.westalabamaaging.org


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for treatment. There is a monthly premium for all who enroll plus co-insurance costs.


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