Medicare

How Your Client Can Get a Medicare Card

The Centers for Medicare & Medicaid Services (CMS) issues Medicare cards if your client is receiving retirement or disability benefits from Social Security. The Railroad Retirement Board (RRB) will issue Medicare cards if your client is receiving retirement or disability benefits from the RRB. CMS or the RRB will mail your client a Medicare card about three months prior to the month he/she will be enrolled in Medicare.

If your client must apply for Medicare benefits, CMS or the RRB will mail his/her Medicare card about four weeks after the application is approved and processed. Your client must provide a mailing address when he/she applies.

The Medicare card will include your client's name, Medicare claim number, the type of coverage he/she has (Part A, Part B, or both), and the date his/her coverage starts.

If your client’s Medicare card has been lost, stolen, destroyed or needs to be replaced, then he/she can request a replacement card by calling Medicare at 1-800-633-4227 or Social Security at 1-800-772-1213. Your client can also request another card by going to the SSA Web site at www.socialsecurity.gov and clicking on Medicare Information.

Your client may need to provide the following documentation when requesting a new Medicare card:

• Social Security number
• Date of birth
• Contact information
• Place of birth or
• Mother’s maiden name

The Centers for Medicare & Medicaid Services or the Railroad Retirement Board will mail your client a replacement card within four weeks of receiving the request.

• If you or your client has questions about the Medicare card, call Medicare at 1-800-633-4227 or Social Security 1-800-772-1213. TTY users should call 1-800-325-0778. If your client wants to visit your local Social Security office, you can find the location by going to the Social Security Web site at www.socialsecurity.gov and clicking on “Find you nearest Social Security office.”

What Your Client Needs to Know to Apply
If Your Client Needs to Renew Enrollment
If Your Client Is Not Eligible for Free Medicare Part A
What Your Client Can Do to Appeal

What Your Client Needs to Know to Apply

If you client is receiving disability or retirement benefits from Social Security or the Railroad Retirement Board, he/she does not have to apply for Medicare.

If your client is 65 years of age:
If your client already receives retirement benefits from Social Security or the Railroad Retirement Board, then he/she is automatically enrolled in Medicare Part B starting the first day of the month he/she turns age 65.

If your client is disabled and under age 65:
If your client is under age 65 and receiving disability benefits from Social Security or the Railroad Retirement Board, then he/she is automatically enrolled in Medicare Part A and Part B after he/she has received benefits for 24 months.

(If you client has Amyotrophic Lateral Sclerosis [also called Lou Gehrig’s disease], the 24-month waiting period is waived. In this case, your client will receive Medicare the first month he/she is entitled to disability benefits).

If your client is close to age 65 and not receiving benefits from Social Security or the Railroad Retirement Board:
If your client is eligible for retirement benefits from Social Security or the Railroad Retirement Board, he/she can sign up for Medicare when applying for these benefits. Your client can also apply for Medicare only.

If your client is close to age 65 and is not receiving benefits from Social Security or the Railroad Retirement Board he/she should apply for Medicare during his/her Initial Enrollment Period (IEP). The IEP begins three months before the month your client turns age 65 and ends three months later.

If your client enrolls during the first three months of his/her IEP, Medicare coverage will start the first day of the month he/she turns 65. If your client’s birthday is on the first day of the month, his/her coverage will start the first day of the prior month.

Example: Mr. Brown’s birthday is February 1. His Medicare coverage would start January 1.

If your client applies for Medicare the month he/she turns 65 or during the last three months of his/her IEP, the Medicare Part B start date will be delayed. Your client can enroll in Medicare Part A at any time. However, if he/she does not enroll in Part B during the IEP, then except in special cases, he/she can only enroll during the General Enrollment Period (GEP) that runs from January 1st through March 31st each year. If he/she enrolls during the GEP, his/her Part B coverage will start on July 1st of the year he/she signs up.

If your client enrolls during the GEP, his/her Medicare Part B premium will go up 10% for each 12-month period that he/she could have had Medicare Part B but did not take it, except in special cases.

If Your Client Needs to Renew Enrollment

There is no renewal process for Medicare. A person can receive a new period of Medicare entitlement if his/her coverage is terminated because:

• He/she is under age 65 and no longer eligible for disability benefits from Social Security or the Railroad Retirement Board or
• He/she stopped regular dialysis treatments for more than 12 months or
• He/she had a kidney transplant more then 3 years ago

Renewal Process for People with a Disability
Periodically, the Social Security Administration reviews the disability claims to determine if your client’s medical condition has improved to the point that he/she is no longer considered disabled by the Administration's definition. The disability determination is a step-by-step process involving five questions:

• Are you working?
• Is your condition “severe?”
• Is your condition found in the list of disabling impairments?
• Can you do the work you did previously?
• Can you do any other type of work?

If your client's medical condition is EXPECTED to improve, his/her case will be reviewed within six to 18 months; if there is a POSSIBILITY that his/her medical condition will improve, the case will be reviewed no sooner than three years; and if his/her medical condition is NOT EXPECTED to improve, the case will normally be reviewed no sooner than seven years.

If your client is receiving Medicare benefits based on a disability and it is determined by the Social Security Administration through its claims review process that he/she is no longer disabled, his/her Medicare benefits will be terminated.

If your client is receiving Medicare benefits based on a disability and he/she returns to work, Medicare coverage may continue for up to eight years after he/she returns to work if your client remains disabled.

Renewal Process for People with End-Stage Renal Disease
If your client is receiving Medicare benefits because of permanent kidney failure, Medicare entitlement will end 12 months after the month he/she no longer requires maintenance dialysis treatment or 36 months after the month of a kidney transplant.

Medicare coverage will continue uninterrupted, if your client resumes dialysis or gets a transplant within the 12-month period after the month he/she stops getting dialysis, or he/she begins or resumes dialysis or gets another transplant within the 36-month period after a transplant.

If your client’s Medicare coverage is terminated and he/she later begins regular dialysis treatments or has a kidney transplant, he/she must file a new application for Medicare based on End-Stage Renal Disease. His/her Medicare coverage will start the first day of the month he/she returned to dialysis or had a kidney transplant.

If Your Client is Not Eligible for Free Medicare Part A

If your client (or his/her spouse) has not worked in Medicare-covered employment for at least 10 years, then he/she is not eligible for free Medicare Part A. Your client can purchase Medicare Part A and/or Part B if he/she is at least age 65 and is a resident of the U.S. and is either:

• A U.S. citizen, or
• A lawfully admitted alien admitted for permanent residence who has lived in the U.S. for the entire five-year period immediately preceding the month he/she files for Medicare.

He/she may purchase Medicare Part B, or Part A and Part B, on a premium paying basis under the Medicare program.

The purchase of Medicare Part A can only be made in combination with the purchase of Part B of Medicare. The Part A premium amount for 2004 is $343.00 a month and the Part B premium amount for 2004 is $66.60 a month.

What Your Client Can Do to Appeal
There is no appeals process with regard to Medicare eligibility or enrollment because your client is automatically enrolled in Medicare if he/she is receiving Social Security or Railroad Retirement benefits, is 65 years of age, has a disability or has End-Stage Renal Disease.