Medicare Information
What My Office Can Do For You
Similar to Social Security claims submitted by constituents, Medicare is one of the most common and important claims my staff receives every day. Health coverage is very important to our families and I make sure that the best help and assistance is provided through my office. If you are in need of any of the following:
- If you need assistance checking the status of your Medicare claim
- If you are experiencing any difficulties with your Medicare Part D plan
- If you feel Medicare should pay for a bill and are having trouble
- If you have any trouble receiving prescription drugs benefits
Please feel free to contact Philip Stark in my Clarks Summit office with any questions, concerns, or cases that you need assistance with.
Philip Stark
Phil.Stark1@mail.house.gov
(570) 585-9988
You can also begin your casework online by clicking here.
Medicare is the United States' basic health insurance program for people age 65 or older and many people with disabilities. It is not to be confused with Medicaid which is a health care program for individuals with low income and limited resourses.
Medicare has four parts:
- Hospital insurance (Part A) that helps pay for inpatient hospital care and certain follow-up services.
- Medical insurance (Part B) that helps pay for doctors’ services, outpatient hospital care and other medical services.
- Medicare Advantage plans (Part C) formerly known as Medicare + Choice plans, are available in many areas. People with Medicare Parts A and B can choose to receive all of their health care services through one of these provider organizations under Part C.
- Prescription drug coverage (Part D) that helps pay for medications doctors prescribe for medical treatment.
Who is eligible for hospital insurance (Part A)?
- Most people get hospital insurance when they turn 65. You qualify for it automatically if you are eligible for Social Security or Railroad Retirement benefits. You may qualify for it based on a spouse’s (including divorced spouse’s) work. Others qualify because they are government employees not covered by Social Security who paid the Medicare tax.
- If you get Social Security disability benefits for 24 months, you will qualify for hospital insurance.
- Also, people who have permanent kidney failure that require maintenance dialysis or a kidney replacement who have amyotrophic lateral sclerosis (Lou Gehrig’s disease) qualify for hospital insurance if they have worked long enough or it they are the spouse or child of a worker.
Who can get Medical insurance (Part B)?
- Almost anyone who is eligible for hospital insurance can sign up for hospital insurance can sign up for medical insurance. Part B is an option program. It is not free. In 2006, the monthly premium is $88.50 per month. Most people sign up for this part of Medicare.
Who can get Medicare Advantage Plans (Part C)?
- Anyone who has Medicare hospital insurance (Part A) and Medical insurance (Part B) can join a Medicare Advantage (formerly Medicare + Choice) plan.
- Medicare Advantage plans include:
- Medicare managed care plans.
- Medicare preferred provider organization (PPO) plans.
- Medicare private fee-for-service.
- Medicare specialty plans.
- A Medicare Advantage plan takes the place of a Medigap policy, so you might have to pay a monthly premium because of the extra benefits it offers.
Who can get Medicare prescription drug coverage (Part D)?
Anyone who has Medicare hospital insurance (Part A) or medical insurance (Part B) or a Medicare Advantage plan (Part C) is eligible for prescription drug coverage (Part D), Prescription insurance is optional, and you pay an additional monthly premium for the coverage.
Medicare and You
If you would like, my office can provide a very helpful handbook titled “Medicare and You” which is provided free through the Centers of Medicare and Medicaid Services. In this manual, you can find all information regarding your Medicare claim, any issues you may have, and in depth breakdowns of eligibility and plans A through D.
If you would like a copy of this handbook, please contact my office at 570-585-9988.