What you need to know about Medicare

Фото: Depositphotos

If you have ever considered how you will pay for healthcare services after you retire and which insurance plan to buy, this article is for you. ForumDaily partnered with Fidelis Care, New York State’s leading insurance company, in order to straighten out the subject of Medicare program: who is eligible, how to apply for it, and what healthcare services it covers.

What is Medicare?

Medicare is the U.S. program of health insurance for people aged 65+. Those under 65 might enroll if they have disabilities, or suffer chronic renal disease or amyotrophic lateral sclerosis (Charcot’s disease).

The program helps to pay for your healthcare but does not cover all healthcare-related expenses.

Medicare program is financed from payroll taxes paid by both employees and employers. Another part of it is financed with monthly payments deducted from social security benefit payments.

When should you apply for Medicare?

“Under the U.S. law, all permanent residents of the country who have been working for at least 10 years (40 quarters) and have been paying insurance tax during all this period have the right to receive Medicare federal healthcare insurance after they reach the age of 65. It is worth visiting a Social Security Administration office or Medicare provider in New York, Fidelis Care, about three months prior to turning 65 in order to subscribe for Medicare even if you’re not planning to retire,” says Leonid Kopeykin from Fidelis Care.

Fidelis Care offers free or inexpensive complex healthcare insurance, including Medicaid Managed Care, Medicare Advantage, Child Health Plus, as well as products available through NY State of Health program: The Official Health Plan Marketplace.

In addition, Fidelis Care also offers products of managed long-term care for adults who require nursing home care but can also safely stay home with necessary support and care. Fidelis Care has partnered with numerous healthcare service providers in order to offer high quality and affordable healthcare insurance to local residents. Above all else, Fidelis Care is the only organization in New York with a Russian-speaking team in place.

This means immigrants from former CIS countries are able to receive all necessary information about healthcare insurance in popular form and in their mother tongue.

Фото: Depositphotos

What’s included in Medicare program?

Medicare Part A (hospital insurance) covers inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, and home health care.

Most of U.S. permanent residents or citizens aged 65 and older are entitled for free insurance in case of hospitalization under Medicare Part A program.

After turning 65, a person has the right to receive allowances under the program if:

• He/she receives or is entitled to receive benefit payments from the Social Security Administration; or
• He /she (or a spouse) receives or is entitled to receive pension benefits for railway employees; or
• His/her spouse (dead or alive, ex-spouses) worked long enough at as a public servant and Medicare taxes were deducted from spouse’s salary; or
• He/she was financially dependent on an insured child who is now dead.

If you do not meet the eligibility criteria, you still can receive hospital insurance under Medicare program by making monthly payments.

Medicare Part B (medical insurance) covers, including doctor and other health care providers’ services, outpatient care, durable medical equipment, home health care, and some preventive services to support one’s health. All those eligible for free hospital insurance under Medicare Part A can also receive insurance under Medicare Part B by making monthly premium payments. Persons with higher income will have to pay more. If you turned 65 but are not eligible for free insurance under Part A, you can buy Part B insurance without having hospital plan (Part A) if you are a U.S. citizen or have lived legally in the United States for at least five years.

Medicare Part C (Medicare Advantage plans). These are various plans offered by private healthcare companies approved by Medicare that include benefits and services covered by Medicare A and Medicare B. Most of Medicare Advantage plans pay for prescription drugs under Medicare D. If you are enrolled in Medicare Parts A and B, you are eligible to enroll in Medicare Advantage plan. Medicare Advantage plans are offered by private healthcare companies and are approved by Medicare. When enrolling in one of the plans, you will not need additional Medigap plan.

Medicare Part D (Medicare Prescription Drug Coverage) helps cover cost of prescription drugs, may lower your costs, and protect against higher costs. This plan is carried by private insurance companies approved by Medicare. If you already have a hospital insurance plan (Part A), medical insurance (Part B) or Advantage plan (Part C), you are eligible to enroll in a plan covering prescription drugs costs (Part D). The subscription to this part is voluntary and requires additional monthly costs.

Health Insurance Claim Form

How to apply for Medicare?

“As long as Medicare is a national insurance, you can apply for it and receive it through offices of the Social Security Administration. They will ask you for your social security card, passport, green card, etc. As a rule, people are given a list of documents to receive Medicare. Fidelis does not participate in this part of the process. We step forward during the next part that can be called ‘Choosing your provider.’ The competition in the New York service market is extremely high, and the winner is the one who’s able to offer their clients the most attractive combination of the list of services, their accessibility (offices that accept this insurance and provide for receiving the services), and prices. At this stage, you will need your Medicare cards and income statements,” says Leonid Kopeykin of Fidelis Care.

Documents that need to be presented to the Social Security Administration

• The original birth certificate or any two documents that confirm your age: a school record, a vaccination record, an insurance policy, a hospital admission record, a state census record. You can show a copy of your birth certificate if it’s verified by a certified agency.
• A document proving that you’re a U.S. citizen, or any other official document confirming your legal migration status if you were not born in the U.S.
• A copy of a document stating that you served in the U.S. Army (for those who served before 1968).
• A copy of W2 and/or self-employment tax return if you are self-employed.

If you had submitted the documents that prove your legal status and age when filing out a form for Medicate or Social Security subsidies, you don’t have to present them again.

All original documents will be returned to you.

And don’t forget to have personal information ready for the application.

Personal Information

• Date and place of birth
• Social security number
• Name, social security number, and date of birth or age for your current spouse and all ex partners, as well as the dates and places for marriages, divorces, or deaths
• Names of all unmarried children under 18, aged 18-19, and incapacitated children under the age of 22
• Bank information for a transfer
• Immigration status
• Whether anyone applied for receiving state subsidies on behalf of you (Social Security, Medicare, or Supplemental Security Income)
• Whether you used a different social security number
• Define a starting date for the program
• If you are three months shy of being 65, define when you want to enroll in Medicare (Plan B)

Employment Information

• Names and addresses of employers for current and previous years
• Annual income for current and previous years
• A copy of document indicating your income
• Starting and ending date of army service (for those who served before 1968)
• Period of time when you were incapacitated over a disease or any other reasons over the past 14 months
• Whether you or your spouse worked as a railway employee
• Whether you received subsidies from other countries
• Whether you receive or are approved to receive pension payments

After enrolling in Medicare program, you will receive a red and white and blue card indicating the type of your insurance: Part A, Part B, or both parts. To choose a plan that will suit you the best, ask for help from experts.

“For people who reach retirement age we offer different plans with the best combination of the list of services and their price. The price for the services is a very important issue. It might be either zero ($0.00) or relatively small. At first place, of course, we tell people about available plans and help them choose the most suitable one. For New York, where prices are high, it’s not that easy,” the representative of Fidelis Care says.

How to choose a plan?

First, you need to decide which coverage you prefer — Original Medicare (Parts A & B) or Medicare Advantage (Part C – A+B+D).

If you choose Original, then answer the question whether you need Part D. After that, decide whether you want additional coverage.

In the case of Medicare Advantage, you need to understand whether to add Part D. With Medicare Advantage, you don’t need to buy (and you should not even when offered) additional insurance Medigap.

“Medicare clients will need to involve an insurance company representative when choosing a provider. These services are not bought but finalized, and this process cannot be computerized completely so far,” Fidelis Care representative says.

By the way, Fidelis Care holds regular sessions for all those who want to learn more about any subsidized insurance.

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Все о медстраховании в штате Нью-Йорк: специалисты Fidelis Care ответили на вопросы наших читателей

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