Helping You Make Informed Decisions about Your Coverage
Medicare is a federal government program that provides health care coverage (health insurance) for older Americans who are either 65 or older, less than 65 but receiving Social Security Disability Insurance (SSDI) for a certain amount of time or less than 65 with End Stage Renal Disease (ESRD).
Once you’ve become Medicare-eligible, you can enroll in Original Medicare or choose to enroll in a Medicare Advantage Plan, which is a type of private insurance offered by companies that contract with Medicare.
It is important to understand your Medicare coverage choices and to select your coverage carefully. How you choose your benefits, and whom you get them from, can affect your out-of-pocket costs and which healthcare providers you may use. For instance, Original Medicare is accepted by nearly all doctors and hospitals in the country. But with Medicare Advantage Plans, there are network restrictions that could limit your access to certain doctors and hospitals. Either way, there is a monthly Part B premium, which you must pay.
If you need help making decisions about healthcare coverage, want to learn more about programs to help pay Medicare costs or need assistance with claims and appeals, SHIP offers one-on-one, personalized and unbiased counseling on these issues and more. Our specialized staff can help you understand your benefits and how to make the most of them.
Which of these Situations Applies to You?
Enrolled in Original Medicare and a Prescription Drug Plan – If you’re happy with your current Medicare Prescription Drug Plan, and the plan is offered the following year, you will need to check to see if your current medications are on the formulary, and at what tier levels. Your coverage will automatically continue if no changes are made.
Enrolled in Original Medicare with No Drug Coverage – If you have Original Medicare and you want Medicare Prescription Drug coverage, you can join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (such as an HMO, PPO or private fee-for-service plan). Be aware that if you do not join a Medicare Prescription Drug Plan when you are first eligible, there may be a penalty to join later.
Enrolled in a Medicare Advantage Plan or Other Plan that Covers Drugs – If you’re happy with your current Medicare Advantage Plan with drug coverage and the plan is offered the following year, you will need to check to see if your current medications are on the formulary, and at what tier levels. Your coverage will automatically continue if no changes are made.
Enrolled in a Medigap Plan or Other Plan that Does Not Cover Drugs – If you’re happy with your current Medigap Plan and the plan is offered the following year, you don’t need to do anything. Your coverage will automatically continue. If you want to add or change your Medicare Prescription Drug coverage, call your current plan provider to speak to a representative. Be aware that if you did not add Medicare Drug coverage when you were first eligible, there may be a penalty to add it later.
Receiving a Retiree Drug Subsidy from Former Employer or Union – Call your employer or union benefits administrator to find out how their coverage works with Medicare. You may not be able to have both Medicare Prescription Drug coverage and your employer/retiree drug coverage at the same time. Joining a Medicare Drug Plan may limit or end your employer or union coverage for you and/or any family members covered by your plan.
No Current Prescription Drug Coverage Financial Help – You can apply for extra help paying for Medicare Prescription Drug coverage anytime by filling out and mailing an application to Social Security. There is no cost or obligation to apply. Call Social Security toll free at 1-800-772-1213 (TTY 1-800-325-0778). You can also apply online at socialsecurity.gov. Or you can contact your local SHIP Coordinator for assistance with the application.
Currently Receiving Prescription Drug Coverage Financial Help – You may qualify for extra help paying for Medicare Prescription Drug coverage if you have Medicare and full Medicaid coverage or if you receive help from the State to pay your Medicare premiums or if you receive Supplemental Security Income (SSI).
Frequently Asked Questions
What is SHIP?
SHIP stands for State Health Insurance Assistance Program. It is a statewide service, locally administered by United Way’s Area Agency on Aging, that assists Medicare beneficiaries in understanding how their Medicare benefits work and how they can best take advantage of the benefits they qualify for.
How do I enroll in SHIP?
You do not enroll in SHIP. Contact your local ADRC and complete an assessment, and your information will be referred to the SHIP coordinator.
Is there a cost for using the services of SHIP?
No, there is no cost for SHIP. The service is free of charge and you will receive unbiased information on the many different providers offering Medicare, which types of coverage might be best for you and how to apply.
Is there a best time of year to contact SHIP?
The best time to contact SHIP is during Open Enrollment which is usually October 15th through December 7th of each year. You should also contact SHIP when you first become eligible for Medicare in order to receive a detailed explanation about how your Part A (hospital), Part B (doctors) and Part D (prescription drug coverage) Medicare benefits work. Contact your local SHIP Coordinator at 1-800-AGE-LINE (1-800-243-5463).
You Could Help Others Get the Coverage They’re Entitled To
If you would like to volunteer to become a Certified SHIP Counselor, call 1-800-AGE-LINE (1-800-243-5463). To become certified, you will participate in a class and learn about the different parts of Medicare, A (hospital), B (doctors), and D (prescription drug coverage). And you will need to be available at various times of day during Open Enrollment (between October 15th and December 7th). You will be asked to volunteer as often as possible during Open Enrollment.
For more information on how SHIP can help you, call 1-800-AGE-LINE (1-800-243-5463).