Is Medicare Different In Each State?

Is Medicare Different In Each State?

Yes. Medicare is regulated by the federal government, which is the reason you have a Medicare card that is good in all 50 states. But each state determines its own coverage and which health care providers can be paid under the program.

What is the Medicare Advantage program?

The Medicare Advantage program is a type of health plan that is approved under Medicare and is offered by private insurance companies. Medicare Advantage plans may include prescription drug and/or dental benefits, and are sold by private insurance companies as an alternative to traditional Medicare.

What is the prescription drug benefit?

The Medicare prescription drug benefit was designed to help Medicare beneficiaries pay for the cost of their prescription drugs and to reduce the number of people spending a large portion of their income on prescription drugs. Under the Medicare prescription drug benefit, beneficiaries can choose between coverage by the traditional Medicare program or a Medicare Advantage plan that provides prescription drug coverage. Traditional Medicare does not cover prescription drugs.

If I don't have prescription drug coverage, can I get it through Medicare?

Yes, you can. The Medicare prescription drug benefit is optional and you can choose to enroll in a plan that provides drug coverage if you wish.

What is the Medicare Cost Plan?

The Medicare Cost Plan is a type of Medicare health plan that offers Medicare-covered benefits at a lower cost in exchange for accepting some cost-sharing for items and services covered by Medicare, such as deductibles and coinsurance. Medicare Cost Plans are not available in every state and are not available to every Medicare beneficiary.

What is the Medicare Prescription Drug Coverage (Part D) program?

Medicare Prescription Drug Coverage is Part D of the Medicare program. It's a voluntary prescription drug benefit that begins on January 1, 2006, for beneficiaries who are:

Age 65 or older

Under age 65 with ESRD

Enrolled in Medicare Part A and enrolled in Medicare Part B

How does Medicare determine the cost of Medicare Part D drugs?

The government has negotiated with the pharmaceutical industry to hold down the cost of drugs provided to Medicare beneficiaries. For coverage starting January 1, 2006, Medicare beneficiaries can expect to pay the following:

In 2006 and 2007, a Medicare beneficiary will pay a $250 deductible for Part D drugs.

For 2008 and beyond, the beneficiary will pay a $415 deductible, which will go up $10 each year until it reaches $415 in 2011.

Medicare beneficiaries who obtain a Medicare Advantage plan that offers prescription drug coverage will pay a separate monthly premium for Part D.

Medicare beneficiaries will pay a portion of the cost of each prescription, or co-payment. For 2006 and 2007, beneficiaries will pay $10 for generic drugs, $45 for brand-name drugs and $100 for non-preferred brand-name drugs.

For 2008 and beyond, co-payments will range between $12 and $70, depending upon the formulary tier.

How does the Medicare Part D coverage compare with other insurance plans?

Medicare's offer of coverage for prescription drugs compares favorably with other private plans:

No deductible for the first 60 days of coverage.

No co-payments for drugs in the first two formulary tiers.

No co-payments for generic drugs in any tier.

Lower co-payments for brand-name drugs in the upper tiers than those offered by most other private insurance plans.

Most other private insurance plans don't cover drugs in the first formulary tier -- which includes some of the most commonly used drugs. With Medicare drug coverage, you pay no cost-sharing for these drugs.

Who is eligible for Medicare?

To be eligible for Medicare, you must:

Be 65 or older.

Be a U.S. citizen or be a permanent resident.

Not be "medically determined" to be disabled based on an Approved Disability Determination.

Have been a permanent resident for five continuous years.

How long do I have to wait before I can enroll in Medicare?

In most cases, you have to wait six months after you turn 65 before you can enroll in Medicare. A few exceptions apply. In general, you can enroll in Medicare three months before the month you turn 65 or earlier if you have a Medicare-approved disability.

Can married couples and people in common-law relationships get benefits?

Yes. Married people or people in common-law relationships can get benefits, but they must have been together for at least one year. If a spouse has been entitled to Social Security or Railroad Retirement Board disability or retirement benefits for at least 24 months, the spouse can get Medicare.

Does Medicare cover long-term care?

Medicare does not cover most long-term care services.

Will my Medicare be affected if I leave the U.S. for an extended period of time?

You will not lose your Medicare coverage if you leave the U.S. for an extended period of time. You do have to pay your Medicare Part B monthly premium while you are outside the U.S.

Can I sign up for Medicare if I have coverage from my or my spouse's employer?

If you have employer coverage that is equal to or better than Medicare, you might consider keeping your employer coverage instead of joining Medicare. However, you should check with your employer, your union, or your spouse's employer to make sure you understand what your employer coverage covers.

What are the charges for Medicare services?

Medicare will not charge you for any covered services. You will also not be charged a premium.

Can I still get Medicare if I work?

Yes, but you must pay a premium for Medicare Part A.

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