Medicare Benefits
Medicare recipients can sign up for or change prescription drug plans during an open enrollment period that begins Saturday and ends Dec. 31.
Villaverde, a medicare benefits specialist with the Centers for Medicare & Medicaid Services, served as host for an online chat on Nov. 13 to discuss prescription drug coverage and other Medicare benefits.
More information: www.medicare.gov
Most Recently Answered Questions
Questions 1 - 13 of 13 (Page 1 of )Submitted by Annonymous from Fort Worth, TX
Q: I appreciate so much Star-Telegram's recent article on Medicare benefits. My wife recently retired so we are currently on TRS-Care level II through Aetna as primary health insurance but I need to know what Medicare plan I currently have and if I need to enroll in Part D. I have MS and need daily injections of Copaxane so I need to know if Part D would help with costs.
Answered 11/13/08 11:16:08 by Vanessa Villaverde
A: Thank you for submitting your Medicare question. Copaxane is a Part D covered drug and included in several Plans in the local area. Enrolling in one of these plans would certainly assist with the costs of Copaxane. You can find more information about individual plans at: http://www.medicare.gov/MPDPF/Public/Include/DataSection/Questions/MPDPFIntro.asp. In order to receive additional information about your Medicare enrollment status and to request a new statement for the lab work on Oct. 16th, please call 1-800-MEDICARE (1-800-633-4223).Submitted by Annonymous from Fort Worth, TX
Q: I will be 65 in 2009. I am covered by Cigna insurance through Ford Motor Co.(my late husbands job) in Michigan. I now live in Texas since the middle of 2008 ( my husband passed away in October of 2006) . I have been reading about Medicare and dates to sign up for coverages. I am comfused.... Do I wait till Sept.of next year to sign up for Part A,B,C,D...............What will the monthly costs be for each part or are their different costs? See how confused I am? Any help would be appreciated.
Answered 11/13/08 11:14:27 by Vanessa Villaverde
A: Thanks for your questions. With regard to the cost of Medicare for Part A and Part B--- Medicare Premiums for 2009: Part A: (Hospital Insurance) Premium Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment. The Part A premium is $244.00 per month for people having 30-39 quarters of Medicare-covered employment. The Part A premium is $443.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment. Part B: (Medical Insurance) Premium $96.40 per month* Medicare Deductible and Coinsurance Amounts for 2009: Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2009 = $1,068) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days. For each benefit period you pay: A total of $1,068 for a hospital stay of 1-60 days. $267 per day for days 61-90 of a hospital stay. $534 per day for days 91-150 of a hospital stay (Lifetime Reserve Days). All costs for each day beyond 150 days Skilled Nursing Facility Coinsurance $133.50 per day for days 21 through 100 each benefit period. Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment) $135.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $135.00 deductible.) Regarding Part C (Medicare Advantage Plan) out-of-pocket costs--- Your out-of-pocket costs can vary depending on the following: -Whether the plan charges a monthly premium in addition to your part B premium. Medicare Advantage Plans charge one combined premium for Part A and Part B health coverage, Medicare prescription drug coverage (Part D) (if offered), and extra coverage (if offered). -Whether the plan pays any of the monthly Part B premium. -Whether the plan has a yearly deductible or any additional deductibles. -How much you pay for each for each visit or service. The type of health care services you need and how often you get them. -Whether you follow the plan's rules, like using network providers. -Whether you need extra coverage and what the plan charges for it. Regarding Part D (Medicare Prescription Drug Coverage) You must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered depending on your selection. Our Medicare & You 2009 handbook is available on-line at the following URL: http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Language=English&Type=Pub&PubID=10050 In addition, you can contact us at 1-800-MEDICARE (800-633-4227) to talk with one of our representatives. In addition, you can also contact the Texas Health Information Counseling and Advocacy Program (HICAP) at 800-252-9240 to get information about Medicare Part A, B, C, and D. We look forward to your joining Medicare next year and hope that the information above is helpful.Submitted by Wanda Carter from Fort Worth, Texas
Q: My husband has end stage renal failure since April. He has been going to Dialysis and my private insurance has been paying, since I am a working wife. He also has heart issues along with diabetes. He has not worked in years. I have been told that he needs to sign up for Medicare but the dialysis center says that I can wait up to 30 months before signing up for Medicare. This is all new to me and I don't understand a bit of it. What is the best thing I need to do for my husband concerning Medicare? Is there a cost involved? He is on a number of prescriptions, does Medicare help with prescriptions. We are both young 40-45.
Answered 11/13/08 11:09:30 by Vanessa Villaverde
A: If you have End-Stage Renal Disease (ESRD), you must apply for Medicare Part A at your local social security office. You can schedule an appointment by calling 1-800-772-1213. You can apply for Medicare Part A as soon as you are diagnosed with ESRD. Your Medicare Part A coverage usually starts the fourth month of dialysis treatments or the month you get your kidney transplant To learn more about Medicare for beneficiaries with ESRD, I would suggest you start with the Medicare publication on ESRD at: http://www.medicare.gov/Publications/Pubs/pdf/10128.pdf You can get Medicare Part A no matter how old you are if your kidneys no longer work and you need regular dialysis or have had a kidney transplant, and you have met the following conditions: •You have worked long enough under Social Security, the Railroad Retirement Board, or as a government employee. •You are getting or are eligible for Social Security, Office of Personnel Management, or Railroad Retirement benefits. •You are the spouse or dependent child of a person who has worked the required amount of time under Social Security, the Railroad Retirement Board, or as a government employee or who is getting Social Security, Federal retirement, or Railroad Retirement benefits. However, because your husband is currently insured under your benefits, please see the following information from: http://www.socialsecurity.gov/disabilityresearch/wi/medicare.htm If you are eligible to enroll in Medicare because of End-Stage Renal Disease (permanent kidney failure), your group health plan will pay first on your hospital and medical bills for 30 months, whether or not you are enrolled in Medicare and have a Medicare card. During this time, Medicare is the secondary payer. The group health plan pays first during this period no matter how many employees work for your employer, or whether you or a family member are currently employed. At the end of the 30 months, Medicare becomes the primary payer. This rule applies to all people with ESRD, whether you have your own group health coverage or you are covered as a family member. Please feel free to call 1-800-Medicare for additional information.Submitted by Sheila Cunningham from Burleson, TX
Q: We are new to the Ft. Worth, TX area. My parents have always had medicare with Humanna as their plan D choice. I would like more information about managed care options that are a PPO. I understand that there is one for Tarrent County and surrounding counties that is run bu doctors from the area but I cannot locate information on this PPO or other plans that might help with the extremely high medication expenses my dad occurs each year.
Answered 11/13/08 10:48:38 by Vanessa Villaverde
A: You can input your father's specific medications and find the top Medicare Advantage Plans for him at: www.medicare.gov/mpdpf/ Once you have a list of all options, you can sort by plan type to get the top list of PPO options for him. There are 17 PPO options in Tarrant County.Submitted by Sheila Cunningham from Burleson, TX
Q: Why would medicare not cover dental expenses if a patient has damage from radiation received as a result of treatment for cancer many years ago?
Answered 11/13/08 10:33:41 by Vanessa Villaverde
A: In order to address your specific situation, we would need your personal health information. Please call 1-800-Medicare (1-800-633-4227).Submitted by PATRICIA RILEY from HALTOM CITY TEXAS
Q: I DONT UNDERSTAND ABOUT THIS CHANGE ABOUT MEDACARE PLAN CAN YOU PLEASE EXPLANE THANK YOU
Answered 11/13/08 10:29:55 by Vanessa Villaverde
A: Sure! If you have Original Medicare (your red, white, and blue card) then you get the opportunity to add, change, or consider different benefit choices every year. Between November 15, 2008 - December 31, 2008 you can add a prescription drug coverage insurance to help save money on your prescription drug needs. If you have a prescription drug coverage insurance you should have an additional insurance card. You may still benefit from changing prescription drug insurance coverage. Please call 1-800-MEDICARE (1-800-633-4227) and have your prescription drugs with you to find the best option for you. You can also compare online at: www.medicare.gov/mpdpf/ Additionally, there is "Extra Help" to pay for the prescription drug coverage insurance. To find out if you qualify for this assistance, please visit www.socialsecurity.gov or you can call Social Security at 1-800-772-1213. TTY Users should call 1-800-325-0778.Submitted by Evelyn from Dallas, TX
Q: I have health insurance through my previous employer. Medicare will become my primary provider in March 2009 (when I turn 65), and my Blue-Cross Blue Shield will become secondary. I am currently working part-time for another employer. My question is whether I need to enroll in Medicare Part B. Thank you.
Answered 11/13/08 10:15:45 by Vanessa Villaverde
A: Since your current health care coverage is not based on a connection with your current employer but is based on prior employment with your former employer, you should consider enrolling in Medicare Part B when you turn 65. You should soon expect to receive your welcome to Medicare package which will enroll you in Part A and Part B of Medicare. If you should have additional questions, please contact us at 1-800-MEDICARE (800-633-4227) or online at www.medicare.gov.Submitted by Elva Sanchez from Grand Prairie, TX
Q: Last year I thought I was selecting drug coverage only to add to my original medicare, but I ended up with Wellcare for everything, and there are so few doctors. How do I change back to Medicare, and select a part D drug plan?
Answered 11/13/08 10:11:02 by Vanessa Villaverde
A: If you have questions or concerns about your enrollment into your current plan, please contact 1-800-Medicare to provide more information about your specific situation. Also, open enrollment begins in 2 Days! You can choose to return to Original Medicare and select a part D plan as of November 15, 2008 for an effective date of January 1, 20009. To compare prescription drug plans, please visit: www.medicare.gov/mpdpf/Submitted by Sue from Azle, TX
Q: What Rx plan is best for me, i.e., lowest cost for most coverage; my Rx's are: Etodolac 400 mg. 1 two times a day; bisoprolol/hctz 5/6.25mg. 1 a day; nexium 40mg. 1 a day; nasacort AQ, 2 sprays each nostril once a day; gabapentin, 600mg. 1 a day. I prefer 90 day supply at a time, either mail-in or retail.
Answered 11/13/08 10:03:36 by Vanessa Villaverde
A: We ran your drugs through the Medicare Plan Finder at www.medicare.gov/mpdpf/ and these plans came up as the lowest cost for your drugs. We highly encourage you to either visit the plan finder yourself or call (817) 390-7177 till noon today or 1-800-MEDICARE so you can get even more personalized results based on your Medicare record in addition to the drugs you are taking. According to planfinder, at www.medicare.gov/mpdpf/ the top 5 lowest cost plans available for your drugs in Azle are: CIGNA Medicare Rx Plan One (S5617-108) (800) 735-1459 (800) 322-1210(TTY/TDD) CIGNA Medicare Rx Plan Two (S5617-110) (800) 735-1459 (800) 322-1210(TTY/TDD) First Health Part D-Secure (S5768-104) (800) 588-3322 (888) 788-4010(TTY/TDD) Community CCRx Basic (S5803-091) (866) 423-5040 (866) 684-5351(TTY/TDD) MedicareRx Rewards Standard (S5960-128) (866) 892-5334 (800) 297-1538(TTY/TDD)Submitted by Jeff Effland from Fort Worth
Q: I am in the election period to select an insurance carrier for the supplemental insurance coverage for medicare. I have been inundated with information from numerous companies to the point of frustration. None of the plans are reasonably priced and on the face, appear to be fairly equitable. My HMO is through Generations Health Care and I have enrolled in Medicare A & B. My question(s) then would be: How much of the additional coverage do I need? and, Is there a particular carrier whose track record is more stellar than others?
Answered 11/13/08 09:44:58 by Vanessa Villaverde
A: I believe that you are in a Medicare Advantage Plan with Generations Health Care. If you have coverage through them that includes prescription drug coverage AND you are satisfied, then you do not need to purchase any additional supplemental plans. If you are not satisfied, you can compare plans by calling our phone bank this morning at (817) 390-7177. After this morning, you can also call 1-800-MEDICARE. Finally, you have the option of comparing online at: www.medicare.gov/mpdpf/Submitted by Isabel Martinez from Burleson,Tx
Q: I have medicare and AARP supplemental ins. Just got word that I could get my prescrition from AARP free. Do I stay with them both. I am very pleased with them although AARP is very expensive for supplemental?
Answered 11/13/08 09:36:12 by Vanessa Villaverde
A: Before you make any changes to your coverage, be sure to check that the prescription drug coverage will cover your specific prescriptions and that your preferred pharmacies accept the insurance. If you would like to compare your costs for supplmental insurance to Medicare Advantage plans with prescription drug coverage, please use the planfinder tool: www.medicare.gov/mpdpf/Submitted by Doug from Dallas, TX
Q: If you don't retire at 65, when do you sign up for Medicare?
Answered 11/13/08 09:29:41 by Vanessa Villaverde
A: Great Question! Be sure to sign up for Medicare about three months before you reach age 65. You do not have to be retired to enroll in Medicare Part A Your Initial Enrollment Period starts 3 months before you turn age 65 and lasts for 7 months. In certain cases, you can delay your Medicare Part B enrollment without having to pay higher premiums. If you didn’t take Medicare Part B when you were first eligible because you or your spouse were working and had group health plan coverage through your or your spouse’s employer or union, you can sign up for Medicare Part B during a Special Enrollment Period. You can sign up: -Anytime you are still covered by the employer or union group health plan through your or your spouse’s current or active employment, or -During the 8 months following the month the employer or union group health plan coverage ends, or when the employment ends (whichever is first). -If you are disabled and working (or you have coverage from a working family member), the Special Enrollment Period rules also apply. Please note that there is also a Medicare Eligibility Tool to assess your personal situation at: http://www.medicare.gov/MedicareEligibility/home.asp?version=default&browser=IE%7C7%7CWinXP&language=EnglishSubmitted by Jerry Smith from Pipe Creek, Texas
Q: Is dental sugical work, such as root canal covered? Also, what about false teeth or bridge work? Extractions?
Answered 11/13/08 08:58:24 by Vanessa Villaverde
A: Currently, Medicare will pay for dental services that are an integral part either of a covered procedure (e.g., reconstruction of the jaw following accidental injury), or for extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw. Medicare will also make payment for oral examinations, but not treatment, preceding kidney transplantation or heart valve replacement, under certain circumstances. Such examination would be covered under Part A if performed by a dentist on the hospital's staff or under Part B if performed by a physician. For more information, please see: http://www.cms.hhs.gov/MedicareDentalCoverage/