Most people qualify for Medicare when they turn 65. The initial enrollment period is the three months before, the month of and the three months after their 65th birthday. Some people who are on Social Security disability qualify for Medicare in the 25th month of disability.

Enrolling in Medicare is a choice, whether you’re working or not. If you’re still working and have group health insurance coverage through that employer (you or your spouse), you can delay enrolling in Medicare until you no longer have that group health insurance plan (GHIP) without incurring a penalty. However, if you delay enrolling in Medicare and don’t have GHIP you may be assessed a penalty that you’ll pay for as long as you have Medicare.

People who are on Social Security disability qualify for Medicare after receiving disability benefits for 24 months. During the three-month period just prior to your 25th month of disability, you should receive a packet containing your new Medicare card and other information. If you do not, contact Social Security to inquire.

The premiums for Medicare can and do change on an annual basis. Most people on Medicare receive their Medicare Part A premium-free because they or their spouse have been working for at least 10 years paying FICA taxes. Everyone pays a monthly premium for Part B. For the most accurate information about Medicare costs, go to https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/what-does-medicare-cost.

Traditional Medicare Parts A and B will cover approximately 80% of your medical costs. There are plans and programs available that can offset some of the remaining costs. You can contact MAP to learn more about those options.

Medicare beneficiaries have options for how they receive their Medicare benefits. Medicare supplemental plans, Medicare Advantage plans and retirement health plans are just a few of the possibilities. Also, there may be some options that are not available to everyone. Contact MAP to discuss all the options that are available to you.

Your choice of a Part D drug plan should be based on a number of factors, not just the monthly premium. First, do you have other options for drug coverage, such as through your tribe or VA benefits? Second, what medications do you take? The drugs that are covered by each plan can vary significantly. Lastly, you may feel strongly about staying with a specific pharmacy. It’s important to make sure you’ll be able to get your prescription medication from the pharmacy you use at the best possible price. MAP can assist you by comparing the plans available in Oklahoma.

Tricare is the health insurance for active-duty military personnel and their families. When they retire, Tricare becomes Tricare For Life, which acts as a Medicare supplement and pays secondary to Medicare. These individuals will need to enroll in Medicare Part A and B to keep their Tricare For Life (TFL) benefits. Medicare becomes their primary coverage, and TFL will be their secondary coverage. TFL offers prescription drug coverage, as well.

Before retiring, it’s a good idea for individuals to research the options that are available to them for retiree health coverage. Some people have the option of coverage through their employer when they retire. However, that coverage may not be the most cost-effective option for you compared to other options. Find out as much as you can about the options offered by your employer, including dental, vision, hearing, etc. and compare them with what’s available in the individual market. In some cases, it’s possible to get your health benefits through a Medicare supplement plan while keeping your dental coverage through your employer. Explore all your options.

This is a conversation you should have with a representative of your tribal health system to understand what benefits are available to you. An important factor to keep in mind when relying on Indian Health Services (IHS) is that the funds for that coverage can run out before the year is over. By enrolling in Medicare, you increase the network of providers available to you across the country, without having to worry about the annual funds running out. In addition, it allows tribes to use those funds for needed improvements within their healthcare systems.

You can. You would receive all your services, including prescription medications, through the VA system. Some services that can’t be provided through your local VA medical center may be referred out to other providers. VA now allows you to receive your prescription medications through the mail, which makes it more convenient for veterans living in rural areas. Some veterans elect to enroll in Medicare, and they elect which benefits they’re going to use when receiving services. The thing to keep in mind is Medicare doesn’t pay within the VA system and VA doesn’t pay outside the VA system unless they’ve referred you out for services.

Extra Help is a low-income subsidy that helps people who qualify pay for their prescription medications. People on Extra Help receive assistance paying for their monthly Part D premium and reduced copayments at the pharmacy for their medication. To qualify for Extra Help, a person must meet certain income and asset limits that are adjusted annually. To learn more go to https://www.medicare.gov/basics/costs/help/drug-costs.

The Medicare Savings Programs (MSPs) can assist low-income seniors with the premiums and copays associated with Medicare, depending on their income and assets.

1. Qualified Medicare Beneficiary (QMB) pays the Part A and B monthly premiums, deductibles, coinsurance and copayments.
2. Specified Low-Income Medicare Beneficiary (SLMB) Program pays the Part B monthly premium.
3. Qualifying Individual (QI) Program pays the Part B monthly premium,
4. Qualified Disabled and Working Individual (QDWI) Program pays the monthly Part A premiums for individuals who have a disability and return to work.
5. For more information on MSPs go to https://www.medicare.gov/basics/costs/help/medicare-savings-programs.

• If you see a charge on your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) for services or medication you didn’t receive, you have different options:
  • If the bill is coming from a provider you know, contact their office and ask them to explain the charges. Sometimes, it’s an honest mistake they can correct on their end. However, if something still sounds wrong to you, contact MAP and discuss it with one of our counselors.
• If you see any of the following, Contact MAP immediately and discuss it with one of our counselors:

1. 1. Charges for services you never received
   2. Charges for a provider you’ve never seen or did not see on that date
   3. Charges for a service twice that you only received once
   4. Charges for items you received in the mail but did not request

• It’s important that occurrences like this get reported to Medicare to protect your health records and the Medicare Trust Fund.

Unless you have contacted Social Security and requested a new Medicare Card, be highly suspicious of anyone claiming they’re sending you a new card. Never give your Medicare or Social Security number to anyone over the phone or in person unless you know for certain that person has a legitimate need for that information. To learn more go to https://smpresource.org/medicare-fraud/.

• We emphasize three important steps:
• 1. Protect: Protect your personal information, including your Medicare and Social Security numbers. You should treat them like your credit cards. Don’t carry them with you unless you’re going to need them for appointments. Medicare will never call or visit to sell you anything. Don’t give information out over the telephone. If someone calls claiming to be from your doctor’s office, but you aren’t certain, hang up and call your doctor’s office on a phone number you know goes directly to them. You can’t rely on your caller ID to be accurate when someone is calling you.
  2. Detect: Always review your Medicare Summary Notices and other healthcare statements closely. Look for charges for services you didn’t receive, duplicate charges, or charges from a provider you don’t recognize. To make an accurate comparison, it’s a good idea to write down all your appointments, including what services were provided, in a journal. To receive a free healthcare journal in the mail, send a request to MAP@oid.ok.gov.
  3. Report: If you see charges on your statement you don’t understand, call the provider and ask them to explain it. If you still suspect something could be suspicious, give MAP a call to discuss. Frequently, charges are a simple clerical error that can be corrected. However, the number and variety of fraudulent activities impacting Medicare beneficiaries are growing every day. It’s important to report anything you think is suspicious, even if you weren’t charged for it. Having incorrect information on your Medicare Summary Notice can have a negative impact on your future healthcare.
• For more information, go to https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Fraud-Abuse-MLN4649244.pdf.