DB101 California - Medicare: Frequently Asked Questions

Disability Benefits 101: working with a disability in California

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1) What is Medicare?

2) How many programs does Medicare have?

3) How do I become eligible for Medicare?

4) What is the Medicare waiting period?

5) How do I get help paying for medical costs during the Medicare waiting period?

6) Am I automatically enrolled in Parts A and B if I’m on SSDI?

7) Does Medicare pay for every type of medical service?

8) Will Medicare pay for the entire cost of services that it covers?

9) What is a Medicare supplement policy?

10) Can I be on Medicare and another form of health coverage at the same time?

11) What do Medicare Savings Programs pay for?

12) When do I reach my full retirement age according to Social Security?

13) What if I return to work before I retire? How does that affect my Medicare coverage?

14) What happens to my Medicare when I reach retirement age?

15) What does “assignment” mean?

16) What is a Medicare Summary Notice?

17) What if I don’t agree to the charges I see on my Medicare Summary Notice?

1) What is Medicare?
Medicare is a health insurance program run by the federal government. Some Medicare services are provided by private companies, but these companies must follow rules laid out by Medicare.

2) How many programs does Medicare have?

Medicare has three main parts. Each part helps pay for a different aspect of your medical care. In general:

Medicare Part A helps pay for medical care you get while you’re in a hospital.
Medicare Part B helps pay for medical care you get outside of a hospital.
Medicare Part D helps pay for prescription drugs.

Medicare Part C, also known as Medicare Advantage, is a way to get Part A, B, and often Part D coverage through a private company.

3) How do I become eligible for Medicare?
To be eligible for Medicare you must be: Getting Social Security Retirement Benefits; or A Social Security Disability Insurance (SSDI) or Childhood Disability Benefits (CDB) beneficiary who has received at least 24 months of SSDI or CDB benefits; or A person with End-Stage Renal Disease (permanent kidney failure); or A person with Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease).

4) What is the Medicare waiting period?
Once you start getting Social Security Disability Insurance (SSDI) payments, you generally have to wait two years before getting Medicare. People with Lou Gehrig’s Disease or End Stage Renal Disease don’t have to wait this long for Medicare coverage to start.

5) How do I get help paying for medical costs during the Medicare waiting period?
You may be able to get help paying for medical costs during the waiting period through: Employer sponsored health coverage through a current, former, or spouse’s employer; A private health insurance policy; A guaranteed issue policy from the Minnesota Comprehensive Health Association (MCHA); Medical Assistance (MA) or another Minnesota health care program.

6) Am I automatically enrolled in Parts A and B if I’m on SSDI?
Yes. Once you’ve received 24 months of Social Security Disability Insurance (SSDI) payments, you’ll automatically be enrolled in Medicare Part A and Part B.

7) Does Medicare pay for every type of medical service?
No. The general rule is that Medicare will only help pay for care it considers reasonable and necessary.

8) Will Medicare pay for the entire cost of services that it covers?
No. For certain services, you’ll pay a deductible, copayment, or coinsurance before Medicare will begin to help pay for that service. If you need a service that Medicare doesn’t cover, you’ll have to pay for it yourself, unless you have other coverage.

9) What is a Medicare supplement policy?
A Medicare supplement (also known as "Medigap") is a private health insurance policy that helps pay for services that Original Medicare doesn’t pay for.

10) Can I be on Medicare and another form of health coverage at the same time?
Yes. Other types of coverage that you can have with Medicare include: Coverage from a current employer; Coverage from a spouse’s employer; Continued coverage from a former employer through COBRA; Retiree plans; Veterans (VA) benefits; Military (TriCare for Life) benefits; or Individual health insurance.

11) What do Medicare Savings Programs pay for?

If your countable monthly income is less than 135% of the Federal Poverty Guidelines plus $20, and you meet other eligibility criteria, you’ll qualify for one of the following Medicare Savings Programs:

The Qualified Medicare Beneficiary (QMB) program helps pay for Part A and B premiums, deductibles, and coinsurance.
The Service Limited Medicare Beneficiary (SLMB) and the Qualified Individual (QI) programs pay for Part B costs.

12) When do I reach my full retirement age according to Social Security?
Depending on your birth date, your full retirement age can start at age 65, 66, or 67. To verify your full retirement age, check the annual statement that you get from Social Security.

13) What if I return to work before I retire? How does that affect my Medicare coverage?
As long as Social Security finds you still have a disability, you can return to work and maintain your Medicare coverage for about 8.5 years.

14) What happens to my Medicare when I reach retirement age?
At retirement age, you receive Medicare under your retirement benefits, which will include premium-free Medicare Part A.

15) What does “assignment” mean?

Assignment is an agreement between Medicare and doctors and suppliers of health care equipment and supplies. To accept assignment means the providers or suppliers agree to receive direct payment from the Medicare program and agree to accept the Medicare approved amount as the full amount of the bill. In Minnesota, all providers, including those that do not accept assignment, can only bill for the Medicare approved amount. The only exception is ambulance providers.

16) What is a Medicare Summary Notice?
The Medicare Summary Notice (MSN) tells you how much Medicare helped pay for medical costs in a given time period. You’ll get an MSN every three months, or you can view it on the Medicare.gov website.

17) What if I don’t agree to the charges I see on my Medicare Summary Notice?
You may think that Medicare should have helped pay for a service that they didn't help with, or that they should have paid more than they did. When you disagree with Medicare, you can file an appeal. For people in Original Medicare, you can file an appeal by following the instructions on your Medicare Summary Notice.

. Disclaimers. Privacy.