Nebraska Department of Insurance
THE NEBRASKA HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE (NICA) PROGRAM
MARCH 2004 NICA NEWS
QUESTIONS AND ANSWERS
Q. I'm turning 65 in March 2004. A representative from Social Security told me I would be eligible for full Social Security benefits in July (4 months after I turn 65). Is that when I become eligible for Medicare too?
A. Although the age at which you can receive full Social Security benefits is rising, the Medicare-eligibility age remains 65. You can enroll in Medicare at anytime during your Initial Enrollment Period, a seven-month period which includes the three months before, the month of, and the three months following your 65th birthday. You will be billed quarterly for the Medicare Part B premium ($66.60/month in 2004) for the months you are enrolled in Medicare and are not receiving a Social Security check. Once you get your Social Security benefits, the Medicare premium will be deducted from your Social Security check. If you have insurance through your or your spouse's current job, you may want to check with Social Security and consider delaying enrollment in Medicare, and enrolling later during a Special Enrollment Period. If you wait until you become eligible for full Social Security benefits in July 2004, and are not eligible for a SEP, you will not be able to enroll in Medicare this year and will have to wait until January 2005 to sign up, with your Medicare coverage effective only in July 2005.
Q. What are the lock-in dates now for Medicare Advantage plans?
A. To coordinate with implementation of the Part D Prescription Drug Benefit, the Medicare Modernization Act of 2003 delays the implementation of the Medicare Advantage (previously known as Medicare + Choice) plans lock-in one year. The new lock-in will begin January 1, 2006. Currently a person can enroll, disenroll, or change Medicare Advantage plans at any time, and the effective date of the change of coverage will be the first day of the month following the change. After January 1, 2006, the enrollment and disenrollment timelines may be more restrictive. (See Manual pages N9 - N12)
Q. How long can I keep my rented wheelchair?
A. Medicare allows you to keep rental items (called "capped rental items") for as long as you need them. Medicare will pay 80 percent of the Medicare-approved amount for the first 10 months. After you have rented a capped item for 10 months in a row, the supplier of your item is required to give you the option of purchasing or continuing to rent.
- If you choose to rent the equipment: Medicare will pay 80 percent for five more months, up to a total of 15 months (you pay the 20 percent coinsurance plus any extra allowable charges). Even though neither you nor Medicare will continue to pay the monthly rental fee, you may continue to use the equipment for as long as you need it. The item still belongs to the supplier and all maintenance and repair of the equipment will be the supplier's responsibility. Every six months after that, for as long as you have the equipment, the supplier can bill Medicare a maintenance and service fee equal to one month's rent. You will need to pay the 20 percent coinsurance plus any allowable excess charges. When the equipment is no longer needed, the supplier will pick it up.
- If you choose to buy the equipment: Medicare will pay 80 percent for three more months of rental, up to a total of 13 months (you pay the 20 percent coinsurance plus any extra allowable charges). You will own the equipment, after you pay any allowable charges you still owe the supplier. All responsibility to maintain and repair the equipment will be yours. Medicare will pay 80 percent of the Medicare-approved amount for repairs only, and how much you pay depends on which type of supplier you choose to perform the repair. To keep your costs down, use providers who accept Medicare assignment.