Medicare: FAQ

If you have tried to resolve a problem regarding your Medicare benefits, Congressman Ruppersberger’s office may be able to help. Please review the following Frequently Asked Questions before contacting the office, as they may contain the information you need. You can also learn more about the Medicare program, compare plans and enroll online at its website.

What is Medicare?

Medicare is a health insurance program for:

• People age 65 and older
• Some people with disabilities
• People with End Stage Renal Disease (ESRD) and Lou Gehrig’s Disease (ALS)

Medicare is administered by the Centers for Medicare & Medicaid Services (CMS). Medicare enrollment is handled by the Social Security Administration (SSA). It offers the following:

• Part A (Hospital Insurance)
  • Assists with covering inpatient care in hospitals. This includes critical access hospitals and skilled nursing care, hospice, and home health care. Individuals usually do not pay a monthly premium if Medicare taxes were paid while working.
• Part B (Medical Insurance)
  • Helps cover doctor’s visits, outpatient care, durable medical equipment, and home health care. Part B also helps cover some preventive services to help maintain your health and keep certain illnesses from getting worse.
• Part C (Medicare Advantage Plans)
  • Offers health options run by approved private insurance companies. Medicare Advantage plans are a way to get the benefits and services covered under Part A and Part B. Most also include Part D. Some Medicare Advantage plans may include extra benefits for an extra cost. You will need to use Medicare-approved doctors, hospitals, and other providers or you could pay more or all of the costs.
• Part D (Prescription Drug Coverage)
  • Helps pay costs of prescription drugs and is run by approved private insurance companies. The coverage varies and the user will incur out-of-pocket expenses such as co-payments, coinsurance, and deductibles.

How do I know which coverage plan is right for me?

There are two main choices for how you can get your Medicare coverage: Original Medicare or a Medicare Advantage plan. You can use this online tool to help you decide which is right for you.

When am I eligible to enroll?

When you are first eligible for Medicare, you have a 7-month initial enrollment period to sign up for Medicare Part A and/or Part B. For example, if you are eligible when you turn 65, you can sign up during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

You can estimate your Medicare eligibility date here.

If you didn't sign up for Part A and/or Part B when you were first eligible, you can sign up during the general enrollment period between January 1 and March 31 each year. You may have to pay a higher premium for late enrollment.

Click here for information about when you can sign up for Parts C and D.

How do I enroll?

Most people get Medicare Part A and Part B automatically if they are already getting benefits from Social Security or are under 65 and disabled. Click here to determine if you get these benefits automatically. If you are automatically enrolled, you will get your Medicare card in the mail 3 months before your 65th birthday or your 25th month of disability.

If you need to sign up for Medicare Part A or Part B, you can apply online or visit your local Social Security office. You can also call Social Security at 1-800-772-1213.

I am over 65 and still working with insurance benefits from my employer. Do I need to sign up for Medicare Part B?

You should talk to your employer when you become eligible for Medicare to see how your employer insurance will work with Medicare. If you or your spouse are still working and you receive health insurance from that current employer, the insurance is primary if there are 20 or more employees at the company where you or your spouse work. If there are fewer than 20 employees at the company where you or your spouse currently work, Medicare is your primary coverage. Click here for more information.

How do I get a replacement Medicare card?

You may contact your local Social Security Administration office or call the National Hotline at 1-800-772-1213.

How do I appeal a claims decision that I am not satisfied with?

After a decision has been rendered, you will receive a Medicare Summary notice explaining whether your claim was approved or denied. If your claim has been denied, all appeal rights will be explained within the notice. Follow the directions contained within the notice.

How do I report Medicare fraud?

If you believe Medicare has been billed for services you did not receive or Medicare has been over-billed, always contact your provider first to make sure a mistake has not been made. After you contact your provider, if you still believe fraud exists, contact Medicare's fraud hotline at 1-800-447-8477. You can learn more about spotting and reporting Medicare fraud here.

How do I find participating doctors, hospitals, nursing homes and other healthcare providers in my area?

First, find out if your current physicians accept the Medicare-approved amount as full payment. You can also compare health care providers including doctors, hospitals, nursing homes, home health agencies, and dialysis facilities as well as drug and health plans using this online tool. Providers are rated based on the quality of care provided.

I need help paying for my prescription drugs.

Anyone who has Medicare can get Medicare prescription drug coverage. Some people with limited resources and income also may be eligible for the Extra Help program to pay for the monthly premiums, annual deductibles, and prescription co-payments related to a Medicare prescription drug plan. The Extra Help is estimated to be worth about $4,000 per year. Many people qualify for these big savings and don’t even know it. Click here to see if you qualify for the Extra Help program and to apply.

Is there someone from my area who can answer my Medicare questions?

Yes. There are Medicare counselors at your local Senior Health Insurance Program (SHIP) office.

• Anne Arundel County: 410-222-4464
• Baltimore City: 410-396-2273
• Baltimore County: 410-887-2059
• Harford County: 410-638-3025

Still have questions? Contact our office!

If you would like Congressman Ruppersberger’s office to help you with a Medicare issue, please contact our office at 410-628-2701. You will need to submit a Privacy Act Release form, which you can generate here. The Privacy Act of 1974 prohibits any department or agency of the federal government from releasing any personal information about a person without their written permission. This form will enable me to initiate an inquiry on your behalf. For quicker processing, fax your completed form to 410-628-2708. You can also mail your form or submit it in person to 375 West Padonia Road, Suite 200, Timonium, MD, 21093.