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FAQ 3: What about eligibility, etc., for Medicare?

Some Medicare FAQ's of Interest

1) Q. How and where can I apply for Medicare when I turn 65?

Automatic Enrollment When You Turn 65:

If you are already getting Social Security or Railroad Retirement benefit payments when you turn 65, you will automatically get a Medicare card in the mail about three months before your 65th birthday as part of an enrollment information package.

The card will usually show that you are entitled to both Part A (Hospital Insurance) and Part B (Supplementary Medical Services) and indicates the beginning dates of your entitlement to each. If you do not want Part B, follow the instructions that come in the package.

When an Application for Medicare is Required:

If you are not receiving Social Security or Railroad Retirement benefits when you turn 65, you have to apply for Medicare coverage with the Social Security Administration (call 1-800-772-1213 or visit your local Social security office.) If you must file an application for Medicare, you should do so during your initial 7-month enrollment period. That period starts three months before turn 65 and ends three months after. For Medicare to begin at age 65, enrollment must occur prior to the month you turn 65. For each month after, enrollment is delayed. You may also enroll in the "General Enrollment
Period (GEP)", which is January, February, and March, of every year but your entitlement to Medicare begins July, of that same year. You may also enroll under the "Special Enrollment Period (SEP)", which is Medicare entitlement for individuals age 65 and older who are covered by an employer group health plan under their own or spouse's employment.

2) Q. How do I get a replacement Medicare card? Where do I call to change my address?

Please call the Social Security Administration (SSA) at 1-800-772-1213. A representative can request that HCFA send you a replacement Medicare card. The best time to call is Tuesday through Friday between 7 a.m. and 7 p.m. Make sure you have your Medicare number handy. You should receive the replacement card in four weeks.

3) Q. I am 65 years old. Am I eligible for Medicare?

A. Almost everyone who is 65 is eligible for Medicare Part B. For information concerning eligibility and enrollment, please contact the Social Security Administration at 1-800-772-1213.

4) Q. Why are Medicare notices such as EOMBs so confusing?

Medicare is a complicated program and HCFA's notices try to give you complete
information about your claim. HCFA wants to make such notices more user-friendly and understandable and has begun to pilot a new EOMB notice that you may receive in the future.

5) Q.Does everyone pay the Part B premium? Does everyone pay the same amount?

There is always a premium payment for the Medicare Part B premium. It is usually paid by the individual either through deductions from Social Security checks or direct billing. However, if your income and resources are low enough, the State you reside in may pay Medicare premiums.

Most people pay the same premium amount. Some beneficiaries pay premium surcharges because of delayed enrollment into Medicare.

6) Q. Who do I talk to about my premium payment notice?

For premium payment questions, begin by contacting a service representative at the Social Security Administration -- 1-800-772-1213. The best time to call is Tuesday through Friday between 7 a.m. and 7 p.m. when you can speak to a service representative, if necessary. Make sure you have your Medicare number handy. It is a Social Security number with a letter after it.

7) Q. Do I need Medicare if I'm ready to retire but my employer is going to provide me with benefits? I'm age 65 and ready to retire.

Yes. Medicare pays first in all situations unless you (or your spouse) are currently employed and coverd by an employer group health plan. In this situation, there will be no surcharge if Medicare is refused until employment ceases. If you are not working, whether your employer provides benefits or not, Medicare is primary and you should enroll. If you refuse Medicare at age 65 and again don't accept Medicare when you retire you will risk a premium surcharge and possibly a delay in receiving Medicare benefits.


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