So, you have just become a Medicare beneficiary. Nice. Lot’s of mailings? A tremendous amount of paperwork to go through? It’s OK. You’ll get through it. Medicare can become a bit tedious to wrap one’s mind around… even for the most intelligent person on the planet. 🙂 THAT is why I am writing this blog post. This post is here to give you some tips and tricks to working with the Medicare system.

OK! Let us begin. 🙂

Enrollment and Eligibility

There are several ways to become eligible for Medicare:

  1. Turn the age 65 and eligible for benefits from the SSA or from the Railroad Retirement Board.
  2. Under the age 65 years old and on Disability (SSD) for 24 months (2 years).

It can become a bit more complicated, but these are the most common.

Enrollment seems to be a bit more puzzling. Medicare, itself, is NOT responsible for doing the enrollment into Medicare. This is the responsibility of the Social Security Administration. Calling 1-800-MEDICARE will NOT get you enrolled into Medicare. Medicare will simply suggest you contact Social Security to become enrolled. They will apologize for the inconvenience and provide you with their phone number: 1-800-772-1213.

Disability

Some of the most common calls to Medicare are from Medicare beneficiaries who have been on Disability for several years. There lives are in complete upheaval. On the 25th month of them being on Disability from the SSA, Medicare becomes their Primary Insurance… NOT their State Medicaid system that has been paying much of their medical bills over the last 2 years. It’s a bit much for some. These beneficiaries are scared… and rightfully so.

SSD (Social Security Disability) income was not meant to be an end-all process. It is temporary… for 24 months. A person with a Disability has 2 years to get their lives in order to become self-sufficient. A terrible thing for some… yes. Those that can, get a position with employer paid insurance… and end up being OK until they turn the age 65 year old.

Those that are NOT that fortunate… their disability ends up being a life-long struggle. Then, after 24 months, they become enrolled in Medicare. Medicare becomes their Primary Insurance, with their State Medicaid becoming Secondary (pays AFTER Medicare). When this happens, the biggest issue appears to be their inability to get their necessary prescriptions (when Medicare became Primary). This is most certainly because they did not pick a Medicare Prescription Drug plan when they had the opportunity (… or, maybe they DID, and they have not received the necessary documentation from their Medicare Drug Plan in order to GET their Rx. It happens… 🙁

Are YOU on Disability? Cannot get your prescriptions? Contact 1-800-MEDICARE. Their Customer Service Representatives will take a look at your current Medicare situation, and locate your current Medicare Prescription Drug Plan, and get you the appropriate telephone number. You should be OK after that.

Late Enrollment Penalties

Yes. This happens. This can happen on two fronts:

  1. You did not get a Medicare Prescription Drug Plan when you were first eligible.
  2. You did not enroll into Medicare Part B in a timely manner.

First, the Drug Plan. Although you may not take any recurrent prescription drugs, when you are first eligible for a Prescription Drug Plan (when you were eligible for Medicare)… in order to avoid any Late Enrollment Penalties, get a Drug Plan. It will save you a LOT of issues in the future. Just find something inexpensive.

Second, enrolling into Medicare Part B. Issues like this most likely happen when there is a difference between when you retired from your employer, or you lost Medicare Part B eligibility. If the latter, contact Social Security. Medicare will not be able to help in the matter. If the former, contact Medicare. They will provide you with the proper group to assist in this situation. They (Medicare) may not be able to ‘fix’ the issue, but they will help get you in contact with those that can. This may seem odd, but, Medicare does NOT enroll people into Medicare. This is the responsibility of The Social Security Administration.

Claims

There are a few things one needs to keep in mind when talking about any Medicare covered item or service:

Medicare is based upon medical necessity and Medicare requirements. Medicare sets an amount payable, for each item or service that is provided… This is what is called the “Medicare Approved amount” or “Medicare Assignment”, which is based on a fee schedule. Medicare payment is also dependent upon the Provider or Supplier, being enrolled in Medicare.

That’s what you’ll hear when you ask. 🙂 You should be able to look up these services and about how much they’ll cost from the Medicare website. This is a good place to start. Some services will be available once, twice, or even once every 5 years. Make sure you ask your physician. Other services will only be available with consent from your physician. It’s not “Authorization” per-se, but the necessary paperwork will need to be sent to Medicare by your physician. You may have some issues, though:

  1. If your physician is NOT a Medicare provider, you’ll never get that procedure. He may string you along… hoping you’ll get frustrated and pay for itself yourself, because he/she can’t send that necessary paperwork. Medicare won’t accept it. (This happens a LOT) 🙁
  2. You may have had your procedure (once before)… and the allotted time has not passed. This happens often as well… 🙁

You can help prevent many of these issues by simply making sure you ask your physician if they are enrolled in Medicare. If they are (or at least in your Medicare Advantage Plan) you should not run into many issues.

Take care. 🙂