Medicare

Medicare can be confusing. It’s important to know where to go when you have questions. This chapter will cover:

Basic information about the Parts of Medicare;
How to get help signing up for Medicare;
What to do if you disagree with a Medicare decision;
Where to go for help with your prescription coverage (Part D); and,
What health care reform means for seniors.

What Is Medicare And How Do I Get It?

Medicare is a health insurance program run by the federal government. People who are at least 65 years old, younger people who have specific disabilities and anyone with End-Stage Renal Disease, permanent kidney failure requiring dialysis, or a kidney transplant are eligible for Medicare. This section will explain what Medicare is and how to get it.

Parts of Medicare

There are four major parts of Medicare.

Usually, people get their Medicare one of two ways:

1. Original Medicare (Parts A and B). Original Medicare includes hospital insurance and medical insurance.

Or,

2. Medicare Advantage Plan (Part C). Under Medicare Part C, you choose to get your Medicare hospital and medical benefits from a Medicare-approved private insurance provider instead of the federal government.

Depending on your situation, you might also want to add prescription coverage (Part D). You can get more information about Medicare Part D by visiting the official Medicare website by clicking here [1].

Sometimes, people with Original Medicare buy “Medigap Insurance.” Medigap insurance helps you pay for things that Medicare does not cover.

You can get more information about the different parts of Medicare at the official Medicare website by clicking here. [2]

Call your local Area Agency on Aging at 1-877-353-3771 to get help choosing the right plan for you. Or, visit the Medicare Plan Finder online by clicking here. [3]

For information on how to get help with your Medicare costs, visit the Maine Equal Justice Partners website on the topic, by clicking here. [4]

Signing up for Medicare

You need to sign up for Medicare during a specific time period, called your “initial enrollment period.” This period is seven months long and starts three months before your 65^th birthday month, includes your birthday month, and then ends three months after your birthday month. If you do not sign up during this seven month period, you have to wait for the next “open enrollment” period and your premium might be more expensive.

If you want help signing up for Medicare, call your local Area Agency on Aging at 1-877-353-3771.

You can get more information about signing up for Medicare at the official Medicare website by clicking here. [2]

What Is A “Medicare Summary Notice?"

If you are signed up for Medicare Parts A and B and you are getting health care services, you will get a “Medicare Summary Notice” (MSN) every 3 months. The MSN is not a bill. The MSN will tell you what health care services Medicare covered over the past three months. If you did not get any health care services over the past three months, you will not get an MSN for that time period.

Read your MSN carefully. Sometimes the MSN will have mistakes that you could end up paying for. Call the Maine Senior Medicare Patrol program at 1-877-353-3771 to get help understanding Medicare billing and your MSN.

You can appeal any Medicare decision. To find out how to appeal a Medicare decision, see “What if I disagree with a Medicare decision?” below.

What if I Disagree with a Medicare Decision?

If you have been denied Medicare coverage and you disagree with the denial, you have the right to appeal.

If you decide to appeal a Medicare decision, you need to do so within 120 days of receiving the Medicare Summary Notice containing the disputed decision. The Medicare website has a step-by-step guide on how to appeal a Medicare decision. You can get this guide by clicking here. [5]

If you are getting services in a hospital, skilled nursing facility, home health agency, comprehensive outpatient rehabilitation facility or hospice, and you think your Medicare-covered services are ending too soon, you have the right to a “fast appeal.” Your provider will give you a notice that tells you when your Medicare-covered services are ending. This notice will tell you how to ask for a fast appeal.

You might want help with your Medicare appeal. Call the Legal Services for the Elderly Helpline at 1-800-750-5353 to talk to an attorney for free.

What If I Have Questions About Part D (Prescription Drug Coverage)?

Medicare Part D can be very confusing. Many people have a hard time understanding what their options are or even what their Part D covers. Legal Services for the Elderly has a special Medicare Part D Unit to help Maine seniors and disabled Maine residents with Medicare Part D. There is no cost for this help.

Call the Medicare Part D Unit at Legal Services for the Elderly, toll-free, at: 1-877-774-7772 Monday through Friday, 9 a.m. to Noon, and 1 p.m. to 4 p.m. The Medicare Part D Unit will help you by phone.

You can get more information about Medicare Part D by visiting the LSE Medicare Part D Unit’s website available by clicking here. [6] Or, visit the official Medicare website on Part D by clicking here. [1]

What Does Health Care Reform Mean for Seniors?

It is very important that you get all the facts about the new health care reform law.
Visit the Legal Services for the Elderly website on health care reform by clicking here. [7]

Resources

Legal Services for the Elderly
If you are a Maine resident who is 60 or older and you have been denied Medicare coverage, call the Legal Services for the Elderly Helpline at 1-800-750-5353 to talk to an attorney for free.

Legal Services for the Elderly Medicare Part D Unit
If you have questions about Medicare Part D, or if you want help with a Medicare Part D appeal, call the Legal Services for the Elderly Medicare Part D Unit at 1-877-774-7772.

You also may be able to find answers to some of your questions by visiting the LSE Medicare Part D Unit’s website available by clicking here. [6]

Legal Services for the Elderly Medicare Rights Advocate
If you have concerns about your Medicare coverage or need help with a Medicare appeal, call the Legal Services for the Elderly Helpline at 1-800-750-5353 and ask to speak with the Medicare Rights Advocate.

Area Agency on Aging
If you have any questions about Medicare or about any type of insurance, call your local Area Agency on Aging at 1-877-353-3771. Trained health insurance counselors are available to answer your questions for free.

Maine Senior Medicare Patrol
If you have any questions about your Medicare Summary Notice or suspect that you are a victim of healthcare fraud or abuse, call the Maine Senior Medicare Patrol at 1-877-353-3771.

Maine Equal Justice Partners
For information on how to get help with your Medicare costs, visit the Maine Equal Justice Partner website on the topic, available by clicking here. [4]

The Official U.S. Government Site for Medicare
For general information about Medicare, visit the official Medicare website available by clicking here. [8]

Centers for Medicare and Medicaid Services
A Guide to Health Insurance for People with Medicare: Buying a Medigap Policy
Get the guide by clicking here. [9]