Information from

Department of Health and Human Services/

Elder Care Directory

If you don’t take Part-B when you are first eligible, the cost of your Part-B premiums will go up 10% for each full 12-month period that you could have had Part-B but didn’t sign up for it, except in special cases. You may have to pay this penalty as long as you have Part-B.

If you didn’t sign up for Part-B when you first became eligible, call Social Security at 1-800-772-1213 to see when you can apply. TTY users should call 1-800-325-0778. If you get benefits from the Railroad Retirement Board, call your local RRB office.

Copayments – You have to pay the coinsurance or copayment for each service you receive. In general, Part-B pays 80% of the Medicare-approved amount for each service, and you have to pay the remaining 20% for the service.

If your provider participates in Medicare but does not accept Medicare assignment, then the provider could charge up to 115% of the Medicare-approved amount for the service. In that case, Medicare would still pay only 80% of the approved amount, and you would have to pay 35% of the approved amount to cover the balance. As you can see, your out-of-pocket expense could be substantially higher if you use a provider that does not accept Medicare assignment.

What is Medicare Part-C?

Medicare Part-C allows Medicare beneficiaries to buy government-subsidized health insurance policies from private insurance companies, to replace their coverage under Medicare Part-A and Part-B.

If you are considering participating in Part-C and joining a Medicare Advantage plan, you should read our Guide to the Medicare Advantage Program, before you make any decision, to learn how the program works, its costs and benefits, and what your rights are as a beneficiary.

What is Medicare Part-D Medicare Prescription Drug Coverage?

Medicare offers prescription drug coverage for everyone with Medicare. This is called Part-D. This coverage may help lower prescription drug costs and help protect against higher costs in the future. It can give you greater access to drugs that you can use to prevent complications of diseases and stay well.

Joining a Medicare Drug Plan (Medicare Part-D) is optional. If you decide to join a Medicare drug plan, you usually have to pay a monthly premium. If you decide not to enroll in a Medicare drug plan when you are first eligible, you may pay a penalty if you choose to join later. These plans are run by insurance companies and other private companies approved by Medicare.

There are two different ways to get Medicare prescription drug coverage:

1) You can join a stand-alone Medicare prescription drug plan that simply adds drug coverage to the original Medicare Plan, some Medicare Cost Plans, some Medicare Private Fee-for-Service Plans, and Medicare Medical Savings Account Plans.

2) You can join a Medicare Advantage plan (such as an HMO or PPO) that includes prescription drug coverage as part of the plan. You will get all of your Medicare coverage through these plans, including prescription drugs.

Medicare also offers help to employers and unions to help pay for prescription drug coverage for their employees or members. If you have employer or union drug coverage, joining a Part-D plan could end the retiree health benefits you and your family get, so you should always consult with your benefits administrator before you join a Part-D plan.

What is a Medigap Policy?

A Medigap policy is an insurance policy that you can buy from a private insurance company, which supplements original Medicare Part-A and Part-B coverage and pays the Medicare coinsurance, copayments and deductibles for covered medical services that you would otherwise have to pay for out-of-pocket if you didn’t have a Medigap policy.

You must have Medicare Part-A and Part-B to be eligible to buy a Medigap policy. You have to pay a premium for Medigap insurance and you also must continue to pay your premium for Medicare Part-B. Medigap premiums vary from one insurance company to another and usually increase as you get older.

You can buy a Medigap policy during the six month period that begins on the first day of the month in which you turn 65. If you do not buy a Medigap policy during this enrollment period, your ability to buy one at another time may be restricted and your premiums could be higher.