DB101 California - Medicare: Frequently Asked Questions

disability benefits 101: Cómo trabajar con una discapacidad en California

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	DB101 En detalle

	Beneficios a los 18 años

	Calculadoras

	Todas las calculadoras

	De los beneficios al trabajo

	De trabajo a trabajo

	Estudiar y trabajar

	Medi-Cal para trabajadores discapacitados

	PASS

	Situaciones de la vida diaria

	Me acaban de dar el diagnóstico

	Los jóvenes discapacitados

	Volver a trabajar

	Una afección repentina

	Programas de complemento y apoyo económico

	Seguro Estatal de Discapacidad (SDI)

	Programas de discapacidad del Seguro Social

	Seguro de discapacidad a corto plazo

	Seguro de discapacidad a largo plazo

	CAPI

	PASS

	CalWORKs

	Subsidios Pell

	IHSS

	Cobertura médica

	Cobertura médica privada

	Medi-Cal

	Medicare

	Descripción del programa

	Dificultades frecuentes

	Recursos

	Cobertura de Medicamentos Recetados

	Sus derechos

	COBRA y Continuidad de la Cobertura

	Protecciones de HIPAA y California

	En el trabajo

	Política de empleo para discapacitados de California

	Boleto para trabajar

	Asistencia personal en el lugar de trabajo

	Cuentas de Desarrollo Individual (IDA)

	Crédito fiscal de los ingresos provenientes del trabajo (EITC)

	Crédito fiscal por una oportunidad laboral (WOTC)

Medicare: Frequently Asked Questions

2) How many programs does Medicare have?

3) How do I become eligible for Medicare?

4) What is the Medicare waiting period?

5) How do I get help paying for medical costs during the Medicare waiting period?

6) Am I automatically enrolled in Parts A and B if I’m on SSDI?

7) Does Medicare pay for every type of medical service?

8) Will Medicare pay for the entire cost of services that it covers?

10) Can I be on Medicare and another form of health coverage at the same time?

11) What do Medicare Savings Programs pay for?

12) When do I reach my full retirement age according to Social Security?

13) What if I return to work before I retire? How does that affect my Medicare coverage?

14) What happens to my Medicare when I reach retirement age?

15) What does “assignment” mean?

16) What is a Medicare Summary Notice?

17) What if I don’t agree to the charges I see on my Medicare Summary Notice?

1) What is Medicare?

Medicare is a health insurance program run by the federal government. Some Medicare services are provided by private companies, but these companies must follow rules laid out by Medicare.

2) How many programs does Medicare have?

Medicare has three main parts. Each part helps pay for a different aspect of your medical care. In general:

Medicare Part A helps pay for medical care you get while you’re in a hospital.
Medicare Part B helps pay for medical care you get outside of a hospital.
Medicare Part D helps pay for prescription drugs.

Medicare Part C, also known as Medicare Advantage, is a way to get Part A, B, and often Part D coverage through a private company.

3) How do I become eligible for Medicare?

To be eligible for Medicare you must be:

Getting Social Security Retirement Benefits; or
A Social Security Disability Insurance (SSDI) or Childhood Disability Benefits (CDB) beneficiary who has received at least 24 months of SSDI or CDB benefits; or
A person with End-Stage Renal Disease (permanent kidney failure); or
A person with Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease).

4) What is the Medicare waiting period?

Once you start getting Social Security Disability Insurance (SSDI) payments, you generally have to wait two years before getting Medicare. People with Lou Gehrig’s Disease or End Stage Renal Disease don’t have to wait this long for Medicare coverage to start.

5) How do I get help paying for medical costs during the Medicare waiting period?

You may be able to get help paying for medical costs during the waiting period through:

a spouse’s employer sponsored coverage;
COBRA, which allows you to continue employer-sponsored health coverage from a job;
an individual health insurance policy from a private company;
enrolling in Medi-Cal.

6) Am I automatically enrolled in Parts A and B if I’m on SSDI?

Yes. Once you’ve received 24 months of Social Security Disability Insurance (SSDI) payments, you’ll automatically be enrolled in Medicare Part A and Part B.

7) Does Medicare pay for every type of medical service?

No. The general rule is that Medicare will only help pay for care it considers reasonable and necessary.

8) Will Medicare pay for the entire cost of services that it covers?

No. For certain services, you’ll pay a deductible, copayment, or coinsurance before Medicare will begin to help pay for that service. If you need a service that Medicare doesn’t cover, you’ll have to pay for it yourself, unless you have other coverage.

9) What is a Medigap policy?

A Medigap policy (also known as Medicare Supplemental Insurance) is a private health insurance policy that helps pay for services that Original Medicare doesn’t pay for.

10) Can I be on Medicare and another form of health coverage at the same time?

Yes. Other types of coverage that you can have with Medicare include:

Coverage from a current employer;
Coverage from a spouse’s employer;
Continued coverage from a former employer through COBRA;
Medi-Cal
Retiree plans;
Veterans (VA) benefits;
Military (TriCare for Life) benefits; or
Individual health insurance.

11) What do Medicare Savings Programs pay for?

The Qualified Medicare Beneficiary (QMB) program helps pay for Part A and B premiums, deductibles, and coinsurance.
The Qualified Disabled Working Individual (QDWI) program pays for Part A premiums.
The Specified Low-Income Medicare Beneficiary (SLMB) and the Qualified Individual (QI) programs pay for Part B premiums.

12) When do I reach my full retirement age according to Social Security?

Depending on your birth date, your full retirement age can start at age 65, 66, or 67. To verify your full retirement age, check the annual statement that you get from Social Security

13) What if I return to work before I retire? How does that affect my Medicare coverage?

As long as Social Security finds you still have a disability, you can return to work and keep your Medicare coverage for about 8.5 years.

14) What happens to my Medicare when I reach retirement age?

At retirement age, you receive Medicare under your retirement benefits, which will include premium-free Medicare Part A.

15) What does “assignment” mean?

Assignment is an agreement between Medicare and doctors and suppliers of health care equipment and supplies. To accept assignment means the providers or suppliers agree to receive direct payment from the Medicare program and agree to accept the Medicare approved amount as the full amount of the bill.

16) What is a Medicare Summary Notice?

The Medicare Summary Notice (MSN) tells you how much Medicare helped pay for medical costs in a given time period. You’ll get an MSN every three months, or you can view it on the Medicare.gov website

17) What if I don’t agree to the charges I see on my Medicare Summary Notice?

You may think that Medicare should have helped pay for a service that they didn't help with, or that they should have paid more than they did. When you disagree with Medicare, you can file an appeal. For people in Original Medicare, you can file an appeal by following the instructions on your Medicare Summary Notice.

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