Medicare Part A covers inpatient care in hospitals, critical access hospitals and skilled nursing facilities. It also covers hospice care and some home health care. There are certain conditions that must be met.

Most people do not have to pay a monthly payment, called a premium, for Part A because they or their spouse paid Medicare taxes while employed. If you did not pay a monthly payment while employed and are age 65 or older, you may still be able to buy Part A. Please contact the Social Security Administration (SSA) at 1-800-772-1213 for information about buying Part A.

Enrollment in Medicare: You may apply three months before or after your 65^th birthday. Please note that delaying enrollment past your birthday will delay the effective date of your coverage.

You can enroll in a plan and get more information regarding the General Enrollment and Special Enrollment periods by calling 1-800-MEDICARE (1-800-633-4227) or through Medicare.gov.

Medicare Part B covers doctor’s visits, outpatient care, home health services, and other medical services. Part B also covers some preventive services such as flu shots, glaucoma tests and screenings for breast, prostate and colon cancer.

Enrollment in Medicare Part B: The General Enrollment Period is from January 1 through March 31 each year. If you did not sign up for Medicare Part B when you first became eligible, you may sign up during this period. You may sign up for Medicare Part B at your local SSA office.

If you did not enroll in Part B when you became eligible because you or your spouse were still employed and had group health coverage through your or your spouse’s employer or union, you can sign up for Part B during a special enrollment period.

You may 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 that the employer or union group plan coverage ends or when the employment ends (whichever is first).

If you do not enroll during this timeframe, you may be assessed a 10 percent surcharge for each year you were eligible but did not enroll.

Medicare Advantage Plans, or Medicare Part C, are insurance plans offered by private companies approved by Medicare.

If you join a Medicare Advantage Plan, the plan will provide all of your Part A (hospital insurance) and Part B (medical insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).

Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you obtain services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care). These rules can change each year.

For more information, you may contact the Health Information Counseling & Advocacy Program of Texas (HICAP) at 1-800-252-3439.

Medicare Part D is prescription drug coverage available to everyone with Medicare, including those who are covered by Part A and/or Part B.

Enrollment in Medicare Part D: As with Part B, individuals may enroll three months before or after their 65^th birthday or on their first day of Medicare eligibility. Additionally, open season is from November 15^th to December 31^st of each year. During this time, beneficiaries who did not sign up for the benefit during their initial period may enroll and already enrolled individuals can change their plans.

Medicare beneficiaries who do not enroll in Part D when they first become eligible will face a one percent per month premium surcharge and will not be able to enroll until the yearly Annual Coordinated Election Period, between November 15^th and December 15^th of each year.

If you are interested in which Medicare Part D prescription drug plans are available in Texas, please visit Medicare.gov. 

Creditable Coverage: Individuals with prescription drug coverage through an employer or retiree plan or creditable coverage, i.e. coverage equivalent to or better than the standard Part D benefit, may choose not to enroll. If you have prescription coverage and are Medicare eligible, you should have received a notice from your plan’s administrator explaining how current coverage compares to Part D and whether you need to enroll. If your coverage is eliminated, you will be able to enroll in Part D during a 63-day special enrollment period, starting the day coverage ends.

Individuals on both Medicaid and Medicare: Individuals receiving both Medicaid and Medicare coverage, also known as dual eligible beneficiaries, were automatically enrolled in a prescription drug plan (Part D). However, you are able to enroll in a different plan if the plan you were assigned does not cover your particular prescriptions.

Lost or Stolen Medicare Card: If your Medicare card is lost or stolen, call the Social Security Administration at 1-800-772-1213, or apply through the Social Security website. When using the website, select “Medicare” from the tabs across the top and then click on “Replace Your Lost, Stolen or Damaged Medicare Card” and you will be directed on how to apply for a new Medicare card.

Railroad Retirees: If you are a railroad retiree and are trying to obtain Medicare benefits, you will need to contact the Railroad Retirement Board Helpline at 1-800-808-0772, or visit the Railroad Retirement Board website.

Information on Medicare.gov:

• Apply online for Medicare
• Learn about the free “Welcome to Medicare” physical exam appointment
• Sign up for MyMedicare.gov
• Get a copy of Medicare and You Handbook
• Review and compare plans during open enrollment season
• Choose and join a Medicare Drug Plan (Part D)
• Speak with a Medicare representative 24 hours a day including weekends in both English and Spanish at 1-800-MEDICARE or 1-800-633-4227.

MyMedicare.gov:

MyMedicare.gov is a free, secure online service where you can access your personal Medicare information 24/7.

• Review your claim information
• View plan enrollment information
• Create an “On the Go” report with information you can share with your healthcare providers

Health Information Counseling & Advocacy Program of Texas:

• Provides information about Medicare and Medicaid eligibility, program benefits, and appeal rights and assistance with completing Medicare and supplementary claim forms.
• Explains Medicare supplement insurance policy benefits, exclusions and coverage language, the pros and cons of health maintenance organization (HMO) memberships, and long-term care options.

Social Security Administration: 1-800-772-1213

• Call for information about buying Part A insurance
• Replace your lost, stolen or damaged Medicare card
• Apply for Extra Help with Medicare prescription plan costs

StopMedicareFraud.gov

Learn how to spot, stop and report Medicare fraud

Report Medicare Fraud to the Office of the Inspector General at 1-800-447-8477 / TTY: 1-800-377-4950 or to the Centers for Medicare and Medicaid Services a 1-800-633-4227 / TTY: 1-877-486-2048.

Social Security Administration: 1-800-772-1213

• Obtain or replace your Social Security card
• Apply online for Social Security benefits
• Check on the status of your application
• Request a Social Security statement
• Estimate your retirement benefits
• Apply for Medicare
• Get extra help with Medicare prescription drug costs
• Appeal a disability decision

Use the Social Security Office Locator to find the local office nearest you.

Original Social Security Card: To apply for an ORIGINAL Social Security card if you have never been assigned a Social Security number before, the Social Security Administration needs at least two documents as proof of:

• Age
• Identity
• U.S. citizenship or lawful alien status

ACCEPTABLE IDENTITY DOCUMENTS: Driver's license, employer ID card, passport, marriage/divorce record, adoption record, health insurance card (not a Medicare or Medicaid card), military record, life insurance policy, and school ID card.

Duplicate Social Security Card: To apply for a DUPLICATE card (same name and same number), the SSA needs proof of identity.

Corrected Social Security Card: To apply for a CORRECTED card (same number, different/new last name), SSA needs proof of identity. One or more documents that identify you by the old name on SSA records and your new name, e.g. a marriage certificate, divorce decree, a court order that changes your name, is also required. The SSA will also accept two identity documents – one in your old name and one in your new name.

Lost or Stolen Social Security Card: You can apply for a replacement card by filling out Form SS-5. The new card will have the same number as the one lost.

Child’s Social Security Card: Identification for INFANTS and YOUNG CHILDREN that Social Security Administration accepts include recently issued doctor or clinic records, hospital records, daycare center records, school records, or religious records e.g. baptismal records. The name on these documents must match the name you want on the card. A document with a photograph is preferred, however, they generally accept a non-photo identification document only if it has enough information to identify the child by either the child’s name, age, date of birth or parents’ names.

If you have reached age 62 or over and are planning to retire, the Social Security website is the best place to learn about the services and benefits that are offered. You may:

Apply by phone: 1-800-772-1213 / TTY 1-800-325-0778

Apply online: Social Security Benefit Application

Apply in person: Enter your zip code into the Social Security Office Locator to find the Social Security office nearest you. The offices are open Monday through Friday. Please call and confirm the office hours of the location you plan to visit.

Social Security benefits are distributed based on the recipient’s date of birth. Everyone enrolled since May 1, 1997 receives his or her check on the following payment schedule ordered by birth date:

• 1^st - 10^th - Payment day is the second Wednesday of every month
• 11^th - 20^th - Payment day is the third Wednesday of every month
• 21^st - 31^st - Payment day is the fourth Wednesday of every month

Beneficiaries receiving benefits prior to May 1997 or receiving both Social Security benefits and SSI payments receive their benefits on the 3^rd of the month if it is a business day. If not, the benefits are paid on the 2^nd or the 1^st of the month.

The Social Security Administration is currently experiencing an extreme backlog of claims, impacting its processing times. The SSA has provisions in place to expedite claims for individuals facing severe financial and medical hardships. These situations include impending foreclosure, eviction or terminal illness. I cannot guarantee that any case will be expedited or granted a favorable decision.