Helping Patients Access Care
Beneficiary Resources
Beneficiary Resources
When you turn 65, you will most likely be automatically enrolled in Medicare. At that time, you will have access to preventative services, medical devices, and healthcare.
However, you will not automatically receive coverage of your prescription medications unless you sign up for Medicare Part D. Enrolling and finding the plan that best matches your needs is simple. Below you can find all the necessary information and resources you might need.
Find out if you are eligible for Medicare here.
For more information on open enrollment, you can print out this fact sheet (en Español) and graphic. You can also find helpful information on the Extra Help Program by visiting www.medicare.gov/basics/costs/help/drug-costs.
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• Part A covers inpatient services such as hospital stays, nursing home and hospice care and some home health care.
• Part B covers care you receive in the doctor’s office or other outpatient settings. If you require medications administered by a doctor, such as infusions and chemotherapy, those are covered by Part B as well.
• Part C, also known as Medicare Advantage, is provided by private health plans that contract with the government to provide Part A and B benefits. Plans can also provide additional coverage for prescription medicines, dental, vision or other coverage.
• Part D covers prescription medications. Insurance companies offer these plans, which are selected annually by seniors in an open marketplace. Unlike Parts A and B, you will not be automatically enrolled in Part D and must choose and join a Medicare Prescription Drug Plan for coverage. You can also change your plan each year during the annual open enrollment period.
• Additional information can be found here.
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• Medicare Part D plans are available to those eligible for Medicare.
• If you turn 65 this year, you can enroll during the three months before the month you turn 65.
• If you are under 65 and have been eligible for Social Security disability payments for two years, have permanent kidney failure, or meet a number of other conditions, you may be eligible for Medicare.
• Please Note: While you are automatically enrolled in Parts A and B, Part D is optional and you must choose and join a Prescription Drug Plan during open enrollment for coverage. (See: How do I enroll?)
• If you have questions about your eligibility for Medicare Part A or Part B, or if you want to apply for Medicare, please call Social Security at 1-800-772-1213 or visit or call your local Social Security office. TTY users should call 1-800-325-0778. You can also apply online.
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• To receive Medicare prescription drug coverage, beneficiaries must join a plan run by a private company approved by Medicare. To enroll, call 1-800-MEDICARE. TTY users should call 1-877-486-2048. You can also apply online.
• The annual enrollment period begins October 15th and remains open through December 7th. The open enrollment period is the only time during the year most people with Medicare are allowed to make changes to their health and prescription drug plans. This might mean changing plans to account for new medicines or doctors to meet your health needs. It's also an opportunity for those not yet enrolled in a Part D plan to enroll for the first time.
• The best time to enroll in Medicare Part D is when the senior is first eligible for Medicare. Signing up upon eligibility will save the beneficiary from having to pay a penalty fee.
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Determine Your Eligibility
• To learn more about eligibility (See: Who is Eligible?)
Make Sure Your Medicines are Covered by the Plan You Choose
• Medicare Part D has many different drug plans and each may have a different "formulary," or list of drugs that are covered. It is important you ensure the drugs you need are covered by the plan you select.
Pick a Plan
• Visit the Medicare Prescription Drug Plan Finder to find answers to your questions and compare plans to find one that will fit your needs.
Join a Plan
• You can sign-up for a plan online or over the phone. (See: Where Can I Get Help?)
• You can find much more information on how to enroll and choose a plan by visiting our other website filled with resources for seniors: www.seniorsspeakout.org
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• You can find great information at Medicare.gov or you can call to speak with a real person all day, any day (except federal holidays) at 1-800-633-4227.
State Health Insurance Programs (SHIPs)
• The State Health Insurance Programs (SHIPs) offer free, personalized health insurance counseling. You can look up the number for your state here.
National Association of Health Underwriters (NAHU)
• The National Association of Health Underwriters represents more than 100,000 licensed health insurance agents, brokers, general agents, consultants, and benefit professionals through more than 200 chapters across America. NAHU members service the health insurance needs of large and small employers as well as people seeking individual health insurance coverage.
State Insurance Departments (SIDs)
• The State Insurance Department websites contain information about Medigap (Medicare supplemental insurance) plans sold in the state.
National Association of Area Agencies on Aging (n4a)
• The National Association of Area Agencies on Aging is comprised of a national network of 622 Area Agencies on Aging (AAAs). The organization runs the Eldercare Locator where specialists can answer inquiries via phone, web chat or email to connect seniors with their local Area Agencies on Aging.
The National Alliance for Hispanic Health
• Su Familia offers Hispanic consumers free reliable and confidential health information in Spanish and English and helps navigate callers through the health system.
• 1-866-SU-FAMILIA (1-866-783-2645)
The National Asian Pacific Center on Aging
• Asian seniors nationally can call and get direct bilingual assistance and access to translated information on a variety of pertinent issues, without the need to navigate through intimidating English voicemails, phone menus, or operators. Highly qualified multilingual staff handle callers’ inquiries.
• Chinese: 1-800-582-4218
• Korean: 1-800-582-4259
• Vietnamese: 1-800-582-4336
• English: 1-800-336-2722
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• Plan costs have remained stable for the past five years at slightly above $47.59; however, it’s important to remember that your monthly premium is not the only thing that will determine your costs.
• For information on what to consider when choosing your plan, please visit our sister site www.seniorsspeakout.org.
• If you don’t sign up for Part D upon eligibility but sign up at a later date, you may incur a penalty fee. More information about the late enrollment penalty can be found here.
• Beneficiaries with limited income and resources may qualify for Extra Help, which helps pay for Part D costs. (See: How do I know if I qualify for Extra Help and how do I apply?)
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To qualify for Extra Help:
• You must be enrolled in a Medicare Part D prescription drug plan.
• You must reside in one of the 50 states or the District of Columbia.
• Your annual income must be less than $19,140 for an individual or $25,860 for a married couple living together. Even those individuals or couples with incomes exceeding the threshold may still be eligible for assistance (For example, if you or your spouse support other family members who live with you, have work-related earnings or live in Hawaii or Alaska).
• Your resources cannot exceed $14,610 for an individual or $29,160 for a married couple who live together. (This includes: bank accounts, stocks and bonds. This does not include: your home, car or any life insurance policies.)
To apply for Extra Help, complete the Social Security’s Application for Extra Help with Medicare Prescription Drug Plan Costs (SSA-1020). You can apply in the following ways:
• Apply online at www.socialsecurity.gov/extrahelp
Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778)
Apply at your local Social Security office.