The fellow was 65, new to Medicare, and distraught.
Medicare had just deducted $145 for the monthly Part B premium from his Social Security check, and he wanted to know if he could drop Medicare altogether.
His concern, he told a Medicare counselor, was that his income – less than $1,200 a month – already was below what he needed to make ends meet.
For his question he was rewarded with encouraging news: Because of his low income he would qualify to have the state of Oregon pay the $145 each month.
Medicare can be complicated, and it can pay to ask questions. To make an appointment for free Medicare counseling, or to ask a question to be answered here, please see the end of this column.
My husband and I plan to retire in a couple of months and enroll in Medicare. I enrolled in Medicare Part A when I turned 65, but he didn’t. How should we proceed?
Your enrollment in Medicare Part B will be easier because you already have Part A. To enroll in Part B, complete two forms: CMS 40B and CMS L564. One says you want to enroll in Part B; the other certifies that you have had health-care coverage that Medicare defines as creditable.
You husband, meanwhile, must enroll in both Part A and Part B. He may enroll online. Or if he does not have web access, he can call the Salem office of Social Security (866-593-1559) to arrange a callback time to enroll by phone.
He will also need to complete the CMS 564 certification, which can be mailed to the Salem SSA office at 1750 McGilchrist St. S.E., Salem 97302.
The two forms can be found on the Social Security website (ssa.gov), or just Google them. If you lack web access or a printer, the Social Security office will mail the forms to you.
I take an expensive drug. Later this year I’ll fall into the so-called “donut hole.” I asked at the pharmacy, and the drug’s price will be more than I can afford. I don’t qualify for income-based assistance from Medicare. Aside from not taking the drug, what can I do?
You will be going into the coverage gap (also known as the donut hole), which means you will be paying a higher price until the total cost to you and your insurance company equals $6,350 for the calendar year. You may have options, though.
The state negotiates contracts with pharmaceutical manufacturers that permit it to make certain drugs available at lower cost through the Oregon Prescription Drug Program. To obtain a drug discount card, and to ask whether your drug is included, find the program on the Oregon Health Authority website or call the program at 800-913-4284. This program has no income restrictions.
Also available are manufacturers’ patient assistance programs. These programs do have income tests, although they are usually more liberal than Medicare limits. Some will help even if you have prescription drug insurance while others will not. To learn about these, go online to NeedyMeds.org or call 800-503-6897.
If either of these proves helpful, you would use this course instead of your prescription drug insurance.
I’ve recently received a couple of phishing calls saying I had a problem with my Medicare. I knew enough not to respond, but this got me to thinking: What if Medicare really did have reason to contact me?
Medicare will phone you only if you’ve asked for a return call. Medicare will never send e-mail. Likewise, don’t give any personal information to anyone claiming to represent Medicare unless you know the contact is legitimate. For example, you may have a relationship with a Medicare insurance company or with a broker who sold you Medicare insurance.
Likewise, it’s best to keep your Medicare card in a safe place at home. An unscrupulous person who finds a lost Medicare card could use it to defraud Medicare or you. Medicare won’t issue a new number if yours is compromised.
Jim Sellers of Salem is a certified Medicare counselor with the Senior Health Insurance Benefits Assistance (SHIBA) program. To ask a question to be answered in this column, send an e-mail to [email protected]. To schedule a free SHIBA phone appointment with a volunteer Medicare counselor, call 800-722-4134.
