Medicare Overview

Medicare is the federal health insurance program for people 65 years of age or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure with dialysis or a transplant, sometimes called ESRD). Medicare also covers people who are collecting disability benefits from Social Security Disability Insurance (SSDI). An excellent summary of Medicare benefits can be found at: http://www.medicare.gov/

Medicare is run by the Centers for Medicare & Medicaid Services (CMS), a federal agency. CMS works with each state to run their Medicaid programs and makes sure that participants get access to high-quality health care.

Medicare Parts A, B

Part A - Hospital - Covers hospitalization, skilled nursing facilities and some home health nursing. Depending on eligibility, Part A is automatic.

Part B - Medical - Covers other medical charges, such as physicians, diagnostic testing, some preventive care and other medical charges. Depending on eligibility, Part B is considered voluntary. An amount will be deducted from each monthly Social Security payment to pay for it.

Even with both parts of Medicare, not all medical bills will be covered. There is a yearly hospital deductible. Medical charges under Part B are covered only up to 80% of physician's charges and other covered medical expenses after an annual deductible. Medicare limits or pays only a portion of many other medical bills.

Medicare Part D - Prescription Drug Coverage

Now Medicare also offers coverage for prescription drugs. This is called Part D. Prescription Drug Plans are open to everyone who is eligible for Medicare. Enrolling in a Medicare Prescription Drug Plan can save money and give peace of mind. Everyone with Medicare can choose to enroll in this voluntary drug coverage regardless of their income or health. Even if you do not use a lot of prescription drugs now, you might still want to join. Joining now means that you will pay a lower premium in the future, since you may have to pay a penalty if you choose to join later.

To get Medicare drug coverage, you can:

Join a Medicare Prescription Drug Plan to be used with the traditional Medicare and/or Medicare supplement plan.
Join a Medicare Advantage Plan or other Medicare Health Plan that offers drug coverage.

People who had Medicare prior to May 15, 2006 should have made a decision about prescription drug coverage by May 15, 2006. If an individual was on Medicare prior to May 15, 2006 and did not sign up by May 15, 2006, they may pay a penalty.

Limited Income Subsidy

Help is available for people with lower income and limited savings. If you have limited resources, you may get this coverage for little or no cost through the Limited Income Subsidy program (LIS). Three groups of people fit in the LIS category:

People currently on Medicaid/AHCCCS and eligible for Medicare.
People for whom Medicaid/AHCCCS pays Part B premiums and some co-payments and deductibles.
People whose income is less than 150% of the Federal Poverty Level with limited resources.

To find out more about Limited Income Subsidy and to see if you qualify for extra help, call:

1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7days a week;
The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p. m., Monday through Friday. TTY/TDD users should call, 1-800-325-0778; or
Your State Medicaid Office at: www.ahcccs.state.az.us

Need More Information?

For more information visit www.medicare.gov on the web and view the booklet "Enrolling in Medicare," or call 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048.

Or you may contact Abrazo Advantage Health Plan Member Services at:

602-824-3900 or 1-888-864-1114, 7 days a week, 8:00 A.M. TO 8:00 P.M.
TTY/TDD users should call 602-824-3909 or 1-800-489-1472, Monday-Friday 8:00 A.M. TO 5:00 P.M., after hours, on weekends and holidays call 1-800-842-4681 to access the Arizona Relay System.