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Frequently Asked Questions

Who is eligible for Medicare?
What are the different parts of Medicare?
When is the Medicare Annual Enrollment Period?
If I missed the Annual Enrollment Period, can I still enroll in or switch Medicare plans?
What is the Initial Enrollment Period?
What is the Special Enrollment Period?
What is the Medicare prescription coverage gap?
I'm not sure if I currently have Medicare coverage. How can I check?

Who is eligible for Medicare?
Original Medicare is a fee-for-service plan that is managed by the federal government. Medicare offers health insurance to people age 65 or older, people under 65 with certain disabilities and anybody with end-stage renal disease. For some medical services, you will pay a deductible before Medicare submits its payment. You pay coinsurance or a copayment when you get a Medicare-covered medical supply or service.

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What are the different parts of Medicare?
The short answer is:

• Medicare Part A covers hospital stays and skilled nursing facilities (provided that certain criteria are met).
• Medicare Part B covers many of the medical necessities that Part A does not, including X-rays, vaccinations, doctors and nurses, and more.
• Medicare Parts A & B combined are generally considered to be the Original Medicare, and only rarely cover prescription costs.
• Medicare Advantage plans (also known as Medicare Part C) are plans offered by private companies that provide comprehensive medical benefits, including doctor visits, hospital coverage, preventive services and more. Medicare Advantage plans often offer additional benefits that Medicare Parts A and B don't include, at a lower cost.
• Medicare Advantage Prescription Drug (MAPD) plans offer an integrated package with the same Medicare benefits as MA plans, plus Part D prescription drug coverage.

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When is the Medicare Annual Enrollment Period?
The Medicare Annual Enrollment Period runs from November 15 to December 31 of each year. People who are newly eligible for Medicare and people who meet other special criteria may enroll outside of this period.

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If I missed the Annual Enrollment Period, can I still enroll in or switch Medicare plans?
Yes, you can, during the Open Enrollment Period, which runs from January 1 to March 31, 2009. The Open Enrollment Period provides Medicare beneficiaries one additional opportunity to enroll in, disenroll from or change a Medicare plan. However, there are some restrictions. If your plan already includes drug coverage, you can only switch to a plan that also has drug coverage. And if you do not have drug coverage, you can only switch to a plan without drug coverage.

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What is the Initial Enrollment Period?
The period when you are first eligible to enroll in Medicare is called the Initial Enrollment Period. This seven-month period starts three months before the month of your 65th birthday and ends three months after the month of your birthday.

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What is the Special Enrollment Period?
The Special Enrollment Period gives you an opportunity to sign up for Medicare Part B if you didn't choose it during the Initial Enrollment Period. The Special Enrollment Period applies to those who didn't enroll in Medicare because they or their spouse was working and had group health coverage through an employer or union. You may take advantage of the Special Enrollment Period at any time during the period you are covered under a group plan. The last eight months of the Special Enrollment Period start the month after the employment ends or the group health coverage ends, whichever comes first.

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What is the Medicare prescription coverage gap?
Sometimes call the "donut hole" or the "gap," the prescription coverage gap is a standard guideline set by Medicare. After your total yearly drug costs—paid by you and your plan—have reached $2,700, you are responsible for paying 100% of your prescription costs until you have paid $4,350 in yearly out-of-pocket costs.

You can protect yourself from having to pay these expenses by selecting a plan that offers coverage through the "gap."

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I'm not sure if I currently have Medicare coverage. How can I check?
Call the Social Security Administration or contact your local Social Security office to verify your Medicare Part A and Part B coverage. If you have a Medicare card, this information can also be found there.

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