Evaluating Tools for Clients: Medicare Eligibility Test

Week 3



Date of Birth: 8/7/1944

Marital Status: Married

Tax Filing Status: Separate

Type of Medicare Coverage: Part A & B

Do you have Medicaid: No

Are you living outside of the U.S.: No

Household Income Range: $85,000 or less

Are you receiving health benefits from employer: No

Retirement type: Uniformed Service Retiree



There are two parts to Medicare: Part A and Part B. Medicare Part A helps cover your inpatient care in hospitals, critical access hospitals and skilled nursing facilities. It also covers hospice care and some home health care. Medicare Part B helps cover your doctors’ services, outpatient hospital care, and some other medical services that Medicare Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home health care. Medicare Part B helps pay for these covered services and supplies when they are medically necessary. For more coverage information, please visit the Your Medicare Coverage section of our website.

If you qualify for Medicaid, you may be eligible for help in paying for medical expenses under your state Medicaid program. Medicaid may help pay out of pocket Medicare expenses such as premiums, deductibles and coinsurance. For more information please call 1-800-Medicare (1-800-633-4227).

Based on your answers, the amount you will pay each month for your Medicare Part B premium is $110.50* in 2010. This amount is based on your income. For more information see our FAQ: Medicare Part B Monthly Premiums in 2010. Most people who choose to enroll in Medicare Part B don't get a premium billing notice because their premiums are deducted from their monthly social security, railroad retirement or Office of Personnel Management annuity check. If you don't get any of these payments, Medicare will send you a bill for your Part B premium every 3 months Generally, if you have supplemental insurance through your former employer or union, it is considered a secondary payer and pays after Medicare. Your retiree benefits often covers the deductible and/or co-payments required by Medicare. Retiree coverage (not a Medigap policy) might not fill the gaps in Medicare coverage, but might offer other benefits such as prescription drug coverage and routine dental care. Retiree coverage might not pay your medical costs during any period in which you were eligible for Medicare but didn't sign up for it. If you are not sure how your plan works with Medicare, get a copy of your plan’s benefits booklet or look at the summary plan description provided by your former employer or union. You can also call your benefits administrator and ask how the plan pays when you have Medicare. Note: When you have retiree coverage from an employer or union, they have control over this insurance. They may change the benefits or the premiums and can also cancel the insurance if they choose.

Uniformed services Medicare eligible retirees, spouses, and survivors enrolled in Medicare Parts A and B are also eligible to use TRICARE for Life coverage for physician, hospital, surgical, and pharmaceutical services. Your TRICARE for Life plan pays after Medicare and often covers the deductible and/or co-payments required by Medicare. For more information on TRICARE for Life, www.tricare.osd.mil.

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