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Frequently Asked Questions

What are the most common Medicare scams, and how can I protect myself from them?

The most common Medicare scams involve criminals posing as Medicare representatives to obtain personal information or money from beneficiaries. Here are a few examples:

  1. Medicare Card Scam: A scammer will call and tell you that you need a new Medicare card and ask for your personal information, such as your Social Security number or bank account number. Medicare will never call you to ask for personal information.
  2. Medical Equipment Scam: A scammer may offer to provide you with free or low-cost medical equipment, such as a back brace or wheelchair, but then bill Medicare for the equipment at an inflated price.
  3. Fake Prescription Drug Plans: Scammers may offer you a fake prescription drug plan that seems too good to be true, but will then bill Medicare for the medications at a high price.

To protect yourself from Medicare scams, it is important to be vigilant and take the following steps:

  1. Protect your personal information and never give it out to anyone who calls or emails you claiming to be a Medicare representative.
  2. Be suspicious of unsolicited offers for free or low-cost medical equipment or prescription drugs.
  3. Verify all information and claims made by anyone offering you a service or product related to Medicare by calling Medicare directly at 1-800-MEDICARE.
  4. Review your Medicare statements regularly to ensure that all charges are accurate and that you did receive the services or equipment billed for.
  5. Report any suspicious activity to Medicare by calling 1-800-MEDICARE or the Senior Medicare Patrol (SMP) at 1-877-808-2468.

 

How do I appeal a Medicare coverage decision if I disagree with it?

If you disagree with a Medicare coverage decision, you have the right to appeal. There are five levels of appeal, starting with a redetermination request to the company that handles claims for Medicare. If your appeal is denied at one level, you can move on to the next level until you reach the Administrative Law Judge level.

How does Medicare coverage work if I travel outside of the United States?

Original Medicare typically does not provide coverage for medical services received outside of the United States, with a few exceptions. However, some Medicare Advantage plans may provide coverage for emergency care received outside of the United States.

What is the Medicare Part D prescription drug benefit, and how does it work?

Medicare Part D is the prescription drug benefit that helps pay for prescription medications. It is offered through private insurance companies, and beneficiaries can choose from a variety of plans with different premiums, deductibles, and drug formularies. Beneficiaries pay a monthly premium for Part D coverage and also pay a portion of the cost of their prescription drugs.

What are the differences between Medicare Advantage and Original Medicare?

Original Medicare consists of Parts A and B, which are administered by the federal government. Medicare Advantage plans, also known as Part C, are offered by private insurance companies and provide the same coverage as Original Medicare, but may also offer additional benefits like dental, vision, and hearing. Medicare Advantage plans often have different cost-sharing requirements and provider networks than Original Medicare.

Can I keep my current doctor if I enroll in Medicare?

It depends on whether your doctor accepts Medicare. Most doctors do accept Medicare, but it’s important to check with your doctor before enrolling to make sure.

How much does Medicare cost, and how are premiums calculated?

The cost of Medicare varies depending on which parts you enroll in and your income. Most people do not have to pay a premium for Part A, but there are premiums for Parts B, C, and D. Part B premiums are based on your income and can range from $164.90 to $560.50 per month in 2023. Part C and D premiums also vary depending on the plan you choose.

Who is eligible for Medicare, and how do I enroll?

People who are 65 or older, or who have certain disabilities or ESRD, are eligible for Medicare. To enroll, you can sign up during your Initial Enrollment Period, which starts three months before your 65th birthday and ends three months after. You can also enroll during the Annual Enrollment Period, which is from October 15 to December 7 each year, or during a Special Enrollment Period if you have a qualifying life event.

What are the different parts of Medicare, and what do they cover?

There are four parts of Medicare:

  • Part A: Hospital insurance that covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
  • Part B: Medical insurance that covers doctor visits, outpatient care, preventive services, and medical equipment.
  • Part C: Medicare Advantage plans that are offered by private insurance companies and provide coverage for both Parts A and B, often with additional benefits like vision, dental, and hearing.
  • Part D: Prescription drug coverage that helps pay for prescription medications.
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