All persons 65 or over who qualify for Social Security benefits, and some people under 65 who are disabled, are eligible for Medicare - a health insurance program. To enroll in Medicare, telephone the local Social Security Office three months before 65th birthday. Persons who work past age 65 should apply for Medicare even if they are not applying for Social Security benefits.
Center for Medicare Services (CMS) www.medicare.gov
The Center for Medicare Services will respond to all Medicare related inquiries. CMS has also published “Your Medicare Benefits,” a free guide to what Medicare covers and what an enrollee must pay for covered health care services and supplies. Call CMS and request Publication No. CMS-10116.
1-800 MEDICARE (1-800-633-4227)
Medicare has two parts:
PART A- MEDICAL HOSPITAL INSURANCE
Helps pay for medically necessary inpatient hospital care, and under limited conditions may pay for some nursing home and home health care.
PART B- MEDICARE MEDICAL INSURANCE
Helps pay for medically necessary physicians' services and other medical services. Monthly premium is $78.20 as of January 2005. Empire Medicare Services, the local carrier of Medicare, reimburses 80% of the allowable charge of approved services.
Social Security, Supplemental Security Income and Medicare benefits are subject to frequent changes. Check nearest Social Security office for current information and for details regarding future changes.
HEALTH MAINTENANCE ORGANIZATIONS (HMOS) FOR MEDICARE BENEFICIARIES
HMOs are managed care plans, and are also known as coordinated care plans. A Medicare HMO is an organized, community based network of physicians, health centers, hospitals and other health care providers that is approved by Medicare. HMOs differ from other kinds of health insurance since they combine insurance coverage with provision of care. HMO participants continue to pay the Part B premium, and, in most cases, the HMO charges a premium. HMOs differ, but most provide benefits such as preventive care, dental care, eyeglasses, etc. They also handle Medicare paperwork. HMOs contract with different doctors and hospitals, and charge different premiums.
The Nassau County Department of Senior Citizen Affairs funds Family and Children's Association to provide counseling to seniors who are considering joining an HMO or who have questions of any type regarding health care insurance and coverage. For information, call: 292-1300
MEDICARE RIGHTS CENTER
The Medicare Rights Center (MRC) is the largest independent source of Medicare information in the country. MRC helps older adults and persons with disabilities get good affordable health care by providing free counseling and current and comprehensive information about Medicare options and rights. MRC answers questions about coverage and assists individuals having problems accessing service.
Persons experiencing problems with Medicare bills and services, or who wish to discuss issues of possible fraud and abuse, should contact:
Center for Medicare Services 1-800-MEDICARE
Empire Medicare Services 1-800-MEDICARE
Operation Restore Trust 1-877-678-4697