Jeffrey Wade
Medicare is a federal health insurance program for people aged 65 and over. If you are under 65, you may still be eligible if you have a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's Disease). Medicare is made up of several parts, including Part A, which covers hospitalization, home or skilled nursing, and hospice, and Part B, which covers medical insurance. There is also Medicare Part C (Medicare Advantage Plans), a private insurance option that covers hospital and medical costs, and Medicare Part D, which covers prescription medications. To access your Medicare benefits, you will need a Medicare card, which contains a unique Medicare number. This number should only be given to healthcare providers, insurance companies, or licensed agents/brokers.
| Characteristics | Values |
|---|---|
| Medicare Card | Contains a unique Medicare number, displays if you have Medicare Part A, Part B, or both, and the date your coverage begins |
| Medicare Number | Only give to healthcare providers, insurance companies, health plans, or trusted people who work with Medicare |
| Scams | Never share your Medicare Number with anyone who contacts you uninvited via phone, email, or in person |
| Medicare Enrollment | Automatic enrollment in Medicare Part A and Part B at 65 if receiving Social Security retirement benefits between age 62 and up to 4 months before turning 65 |
| Enrollment Period | Initial Enrollment Period begins 3 months before turning 65 and ends 3 months after, for a total of 7 months |
| Social Security Disability Benefits | Automatic enrollment in Medicare Parts A and B after 24 months of receiving benefits |
| Lou Gehrig's Disease (ALS) | Immediate enrollment in Medicare Parts A and B upon enrolling in Social Security disability benefits |
| End-Stage Renal Disease (ESRD) | Learn about Medicare coverage and enrollment |
| Railroad Retirement Board (RRB) | Call 1-877-772-5772 to get a replacement card |
| Medicare Claims | Doctors, providers, or suppliers are required by law to file Medicare claims for covered services |
| Medicare Drug Plans | Pharmacy will file a claim directly with your plan if you have a separate Medicare drug plan (Part D) |
| Medicare Advantage (Part C) Plans | In-network doctors, suppliers, and pharmacies usually submit claims directly to your plan |
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What You'll Learn
Medicare card information
Your Medicare card contains a Medicare number that is unique to you. It also displays whether you have Medicare Part A, Part B, or both, and the date your coverage begins. You should carry your Medicare card with you when you're away from home and show it to your doctor, hospital, or other healthcare provider when you get services. If you have a Medicare drug plan or supplemental coverage, carry that plan card with you too.
If you join a Medicare Advantage Plan or other Medicare health plan, you'll use your plan's card to get services, not your Medicare card. However, you should keep your Medicare card in a safe place in case you switch plans or go back to Original Medicare later. You'll need the information on your Medicare card to join a Medicare health or drug plan or buy Medicare Supplement Insurance (Medigap).
If your Medicare card is lost, stolen, or damaged, you can request a replacement online at Medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227) to order a replacement card to be sent in the mail. If you get Railroad Retirement Board (RRB) benefits, you can call 1-877-772-5772 to get a replacement card. TTY users can call 1-312-751-4701. You can also print an official copy of your card from your online Medicare account.
Your Medicare card shows the name you have on file with Social Security. If you legally change your name, get the details from Social Security. If you think that someone else is using your Medicare Number, call 1-800-MEDICARE (1-800-633-4227). If you suspect identity theft, or feel like you gave your personal information to someone you shouldn't have, contact the Federal Trade Commission.
Remember, only give your Medicare Number and other personal information to healthcare providers, your insurance companies or health plans (and their licensed agents or brokers), or people you trust that work with Medicare, such as your State Health Insurance Assistance Program (SHIP). Do not share your Medicare Number or other personal information with anyone who contacts you by phone, email, or in person, unless you contacted them first and gave them permission to contact you. Medicare will never call you uninvited and ask you to give them personal or private information.
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Medicare scams
Offers of Free Items or Services: Scammers may offer valuable medical equipment, free genetic testing, or other medical supplies for free. They may then persuade individuals to share their Medicare number and use it to file high-cost claims in the beneficiary's name. Be cautious of any unsolicited offers that seem too good to be true, especially when they request personal information.
Pressure to Switch Medicare Plans: Scammers may pose as Medicare representatives and inform you that you are "pre-approved" for a new healthcare plan with better benefits or lower premiums. They may even tell you there is a fee to enroll in this new plan. Remember that Medicare will not call you to sell or promote any plans, and you should never feel pressured to switch without thoroughly researching and initiating the process yourself.
Notices to Renew or Upgrade Your Medicare Card: Scammers may contact you and claim that your Medicare card needs to be activated, renewed, or upgraded. They may request your Social Security number, Medicare ID, or other personal details for verification purposes. However, Medicare will never proactively reach out to you to replace your card unless you specifically requested it.
Claims of Eligibility for a Refund: In this scam, fraudsters will tell older adults that they qualify for a refund due to changes in their plan. They will then ask for personal information, such as your Medicare number or bank account details, to process the fictitious refund. Always be cautious when providing sensitive information, and remember that Medicare will not contact you out of the blue regarding refunds.
Benefits Cancellation Threats: Scammers may try to scare you by claiming that you are at risk of losing your Medicare coverage. They use pressure tactics and create a sense of urgency to rush you into divulging personal information or sending them payments directly. It's important to stay calm and verify the status of your coverage by contacting Medicare directly through their official channels.
To protect yourself from Medicare scams:
- Never give out your Medicare number, Social Security number, or other personal information to unsolicited callers or individuals claiming to be from Medicare.
- Be cautious of direct contact from "Medicare representatives" unless you initiated the communication.
- Regularly review your Medicare statements and receipts for any discrepancies or incorrect charges.
- Report any suspected fraud or scams to the appropriate authorities, such as the Medicare Fraud hotline or the Federal Bureau of Investigation (FBI).
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Medicare coverage
Medicare is the federal health insurance program for people aged 65 and over in the US. If you are under 65, you may still be eligible if you have a disability, permanent kidney failure, End-Stage Renal Disease (ESRD), ALS (Lou Gehrig's Disease), or receive Disability benefits.
There are several parts to Medicare, each covering different services:
- Medicare Part A covers hospitalisation, inpatient hospital care, home or skilled nursing, and hospice.
- Medicare Part B is medical insurance, covering doctors' services and tests, and preventive services.
- Medicare Part C (Medicare Advantage Plans) is a private insurance option that covers hospital and medical costs.
- Medicare Part D covers prescription medications.
There are several ways to enrol in Medicare, depending on your circumstances. If you are already receiving Social Security retirement benefits, you will be automatically enrolled in Medicare Parts A and B when you turn 65. If you are still working at 65 and do not wish to receive Social Security benefits yet, you can apply online for Medicare only.
To check if a service is covered by Medicare, talk to your doctor. You can also check coverage information on the item, service, or supply, as well as national and local coverage decisions made by Medicare.
Your Medicare card will contain your unique Medicare number, indicate whether you have Part A, Part B, or both, and display the date your coverage begins. Only give your Medicare number to healthcare providers, insurance companies, or licensed agents/brokers. Do not share your Medicare number with anyone who contacts you uninvited—Medicare will never ask you for personal information over the phone, via email, or in person unless you have given them permission to contact you.
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Medicare claims
Medicare is the federal health insurance program for people aged 65 and over in the US. If you are under 65, you may still be eligible for Medicare if you have a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's Disease). Medicare is split into several parts, each covering different aspects of healthcare:
Medicare Part A
Medicare Part A is insurance for hospitalisation, home or skilled nursing, and hospice. Claims for Part A are submitted directly to Medicare by your providers (doctors, hospitals, labs, suppliers, etc.). Medicare takes approximately 30 days to process each claim. For Part A claims, you are responsible for deductibles, copayments, and non-covered services.
Medicare Part B
Medicare Part B is medical insurance for doctors' services, outpatient hospital care, outpatient physical and speech therapy, certain home healthcare, ambulance services, medical supplies, and equipment. If your provider accepts assignment (agrees to accept Medicare's approved amount as full reimbursement), Medicare pays the Part B claim directly to them for 80% of the approved amount. You are responsible for the remaining 20% (this is your coinsurance). If your provider does not accept assignment, they are required to submit your claim to Medicare, which then pays the Part B claim directly to you. You are responsible for paying the provider the full Medicare-approved amount, plus any excess charge.
Medicare Part C
Medicare Part C, also known as Medicare Advantage Plans, is a private insurance option that covers hospital and medical costs. If you have Medicare Advantage (Part C) with or without drug coverage, in-network doctors, suppliers, and pharmacies will usually submit a claim directly to your plan.
Medicare Part D
Medicare Part D covers prescription medications. If you have a separate Medicare drug plan (Part D), the pharmacy will file a claim directly with your plan.
Filing a Claim
If your doctor, provider, or supplier hasn't filed your claim, you can call 1-800-MEDICARE to ask for the exact time limit for filing a Medicare claim for the service or supply you received. If it's close to the end of that time limit, you should file the claim yourself. You will need to fill out a claim form provided by your insurance company and attach copies of the bills and Medicare Summary Notice (MSN) related to those bills. Make copies of everything for your personal records. Mail your claim packet to the Medigap company or retiree plan.
It's important to note that you should only give your Medicare Number to healthcare providers, your insurance companies or health plans, or people you trust that work with Medicare. Be cautious of scams and never share your Medicare Number or other personal information with anyone who contacts you unsolicited.
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Cancelling Medicare
If you decide to cancel, you can enroll in new Medicare coverage during the next enrollment period. However, you might face late enrollment penalties, and there may be a gap in your coverage. If you cancel without enrolling in another plan, you will be responsible for all health costs.
To cancel Part A, you need to complete Form CMS-1763, which can be downloaded or obtained from your local Social Security office. You must provide your full name, Medicare number, and a brief explanation for cancelling, as well as setting a termination date and getting two witnesses to fill in their details. The form then needs to be mailed or faxed to your local Social Security office. Your coverage will end on the last day of the month after submitting the form.
Part B can be cancelled by following a similar process, marking "medical insurance" on the form. If you were automatically enrolled in Original Medicare, you'll need to follow the cancellation instructions in your welcome packet, which includes returning your Medicare card.
It's important to note that Medicare may request a personal interview to discuss your cancellation and alternative coverage options. Cancelling Medicare plans can have financial implications, so it's advisable to understand the potential risks and costs before proceeding.
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