ENROLLING IN PART A

Medicare Part A  West Virginia

When can you enroll initially?

Any time after you are 64 years and nine months old or otherwise become eligible for Medicare. 


How do you sign up?

Enrollment is automatic if you already get Social Security benefits.  Otherwise, you will enroll at your local Social Security Office.  


ENROLLING IN PART B

Medicare Part B  West Virginia

When can you enroll initially?

Any time from three months before you become eligible for Medicare until three months after your eligibility month.


What if you enroll late?

If you enroll after the initial enrollment period, premiums will be higher unless you qualify for an exception, such as working past 65.


How do you sign up?

If you wish to sign up for Part B and are not receiving Social Security benefits, you can sign up at your local Social Security office.


If you are already receiving Social Security benefits when you turn 65 or otherwise eligible for Medicare, you should automatically be enrolled in Part A and B.


Still Working

If you have employer coverage?

Contact your employer or union benefits administrator to find out how your insurance works with Medicare. It may be to your advantage to delay Medicare Part B (Medical Insurance) enrollment. 


TIP:  

"PART" refers to the sections of the law that created Medicare.  Part A (hospital coverage) and Part B (outpatient, doctor services).  


"PLAN" refers to a Medigap policy identified by letters A-N. A "PLAN" helps fill the coverage 'gaps' like deductibles, copays and co-insurance that Original Medicare Medicare "PART" A and "PART" B do not.

DECIDING ON HOW TO GET YOUR MEDICARE
BEYOND ORIGINAL MEDICARE (PARTS A AND B)

As shown to the right, Original Medicare (Parts A and B) helps you get health care coverage, but you should expect to pay some of those costs while having no limits on your out-of-pocket spending for cost sharing in Part B.  

MAKE A CONFIDENT CHOICE AND LOOK FOR 
PLAN THAT IS THE 
RIGHT FIT FOR YOU

What is important to you? 


Remember, there is no "one size fits all" when it comes to your Medicare options.  


Take your time getting to know the basics of Medicare and how it works with you individually.  


You have some choices to make and we will be glad to answer any question that you may have.

Questions?  Concerns?

Mountain State Senior Insurance Services


103 6th Ave

St Albans, WV  25177

(304) 201-0100--office

(304) 201-5557--fax

MEDICARE BASICS--WHAT YOU NEED TO DECIDE

Most people who are applying for Medicare are learning about the health care coverage options for the first time.  Your biggest decision, and the one to make first, is whether you want Original Medicare (Part A and Part B) or Medicare Advantage (Part C). They cover the same basic services, but they work a little differently.  Your choice depends on what you need.   


Once you decide, you will have other choices to make.  If you choose Original Medicare, you will have more choices.  You will need to choose from several companies and plans if you want to buy a Medicare supplement (Medigap) policy or stand-alone drug plan. If you choose Medicare Advantage, you will have to pick a specific plan from a particular company.   

New to Medicare?  Where to Begin?  West Virginia

MEDICARE PART A (Hospital stays)

MEDICARE PART B (Doctor visits)

Medicare Part A helps with the cost of inpatient hospital stays and skilled nursing after a hospital stay . It also helps with hospice care and some skilled care for the homebound .


What providers can I see?

You can choose any qualified provider in 

the United States who is accepting new 

Medicare patients.


Coverage limits

There are some coverage limits with Part A. For example, if you’re hospitalized or in a skilled nursing facility for a long time (more than 90 days at one time), you may have to pay part of the cost.


What is not covered

Doctor services in the hospital are not covered by Part A. Other services, such as personal in-hospital costs like telephone calls or services related to “custodial care” — help with eating, bathing or dressing — will also not be covered under Part A unless medically necessary.


Most doctor services you receive in the hospital are covered by Part B, and you will have to pay the Part B deductible and 20% co-insurance.


Costs

Premiums. If you or your spouse have made payroll contributions to Social Security for at least 10 years, you will not pay a premium. Most people don’t pay Part A premiums. If you haven’t made contributions, the premium in 2014 is $426 a month. If you enroll late, your monthly premium amount is higher.


Your share of the costs

Deductible. You have to pay a deductible before Part A starts paying a share of your costs. In 2014, it’s $1,216 for each hospital stay, subject to certain limits.


Copay. After staying a certain number of days, you pay a copay . For hospital stays in 2014, you’ll pay $304 per day (days 61 through 90) and $592 per day (days 91 through 150). In a skilled nursing facility, you’ll pay $152 per day (days 21 through 100). In 2014, you’ll also pay a copay of up to $5 for each outpatient prescription drug you receive in hospice care.  

How it works

If you are receiving Social Security benefits when you become eligible for Medicare you will likely be automatically enrolled in Part B. Medicare Part B helps with the cost of medically necessary doctor visits and other medical services, including outpatient care at hospitals and clinics, laboratory tests, some diagnostic screenings, and some skilled nursing care.


What providers can I see?

You can choose any qualified provider who is eligible to participate in Medicare and who is accepting new patients. Coverage limits.

There are limits on a few services — for example, the amount Part B will pay for occupational therapy. And screenings are covered only for specific times.


What is not covered?

Keep in mind that Part B covers vision, dental or hearing only in certain situations . Additionally, it usually does not cover care outside the United States or help with things like bathing or getting dressed.


Costs

Premium. This depends on your yearly income.  Most people pay a monthly premium.  If you receive Social Security, it will be automatically deducted from your Social Security benefits. For 2014, premiums range from $104.90 to $335.70 a month.  For most, the cost is $104.90.


Your share of the costs

Deductible. Before Part B starts paying a share of your costs, you first have to pay a deductible.  In 2014, it’s $147 for the year.


Copay. In 2014, outpatient hospital services have copays for each service you get in an outpatient.  In 2014, outpatient hospital services copays range from a few dollars to $1184.


Coinsurance. After you pay your Part B deductible ($147), Part B generally pays 80% and you pay 20% as coinsurance. 


Limits.  There are no limits on your out-of-pocket spending for cost sharing in Part B. Chronic conditions or serious illness could result in significant cost sharing.


There is no "one size fits all" when it comes to your Medicare options

HOW TO PROTECT AGAINST SIGNIFICANT OUT-OF-POCKET
COSTS AND COSTS NOT PAID BY ORIGINAL MEDICARE (PARTS A AND B)

  1. You can enroll in a Medicare supplement insurance plan to help pay for costs and benefits that are not paid by Original Medicare Parts A and B . You can also enroll in a stand-alone Medicare Part D plan for help with prescription drug costs.

2.  You can also enroll in a Medicare Advantage Part C plan offered by private insurance companies.  
Part C plans generally give you all of the coverage provided by Parts A and B, as well as additional benefits:
• Combines hospital costs and doctor and outpatient care in one plan.
Can include Part D prescription drug coverage.
• May include additional benefits such as dental, vision or hearing services.

Oops! This site has expired.

If you are the site owner, please renew your premium subscription or contact support.