How Do I Use My Benefits?
NOTE: Glossary words are highlighted. Click on any glossary word to see its definition.
What happens once I am approved for Medicare?
When you are approved for Medicare, Medicare will send you an Initial Enrollment Package. The package includes several documents and your red, white, and blue Medicare card:
If you are already getting retirement or disability benefits from Social Security or Railroad Retirement, Medicare will automatically send this package to you three months before your 65th birthday or after your 24th month of disability. If you sign up during the Open Enrollment Period (January 1 through March 31 each year), you will get a package before your coverage begins on July 1.
When you get the Enrollment Package, you will have to make three decisions:
- whether you want to keep Part B Medical Insurance coverage
- if you keep Part B, what health plan you want
- if you want or need Medicare prescription drug coverage you may want to enroll in Part D Prescription Drug Plan.
- whether you need supplemental insurance to pay costs that Medicare doesn't cover
If you need help with these decisions, you may call:
- Social Security at 1-800-772-1213 (TTY: 1-800-325-0778)
- Medicare at 1-800-633-4227 (TTY 1-877-486-2048)
How do I let Medicare know if I want to keep or refuse Part B?
If you decide to keep Part B Medical Insurance, you should cut out your Medicare card, sign it, and keep it with you. You do not have to do anything else. You may use your card starting on the effective date shown on your card. If you get a monthly Social Security, Railroad Retirement, or Office of Personnel Management benefit check, your monthly Part B premiums will be deducted from your check. Otherwise, you will be billed once every three months.
If you do not want Medicare Part B, you must refuse the coverage by signing the form and returning it in the envelope that comes in your enrollment package. Do not remove the Medicare card from the form. Medicare will send you a new card showing that you have only Part A coverage.
Please note that if you refuse Part B now and decide to sign up for it later, you might have to pay a surcharge penalty on your monthly Part B premiums.
What types of health plans are available?
If you have Medicare Part A and Medicare Part B, you will have to make a choice about how to get your benefits. Most people have a choice of several types of Medicare plans, but your choices will vary depending on where you live. Different health plans have different rules about the doctors and hospitals you may use, the costs of services, and the benefits you will get. The types of Medicare plans are:
- the Original Medicare Plan, including Medicare Part A and/or Part B. Additional coverage may include:
- Medicare Prescription Drug Plan and/or
- Medigap (Medicare Supplement Insurance) policy
- the Medicare Advantage Plan. May include:
- Medicare Health Maintenance Organization (HMO) Plan
- Medicare Preferred Provider Organization (PPO) Plan
- Medicare Private Fee-for-Service (PFFS) Plan
- Medicare Special Needs Plan
- Other Medicare Plans which may include:
- Medicare Cost Plans
- Demonstrations/Pilot Programs
- Programs of All-inclusive Care for the Elderly
The Original Medicare Plan is available to everyone eligible for Medicare. Medigap insurance and Medicare Advantage Plans are offered by private companies and may not be available where you live. Regardless of which plan you choose, you are still part of Medicare and, at a minimum, will get all of the services covered by Medicare. Most Medicare Advantage Plans or Other Medicare Plans include prescription drug coverage.
To see which Medicare plans are available where you live, go to the Medicare Options Finder. For more information, see Medicare Health Plans.
How do I get a new Medicare card if my card is lost, stolen, or damaged?
If your card is lost, stolen, or damaged, you can request a replacement Medicare card by phone or online. It will take about 30 days to get your new card.
If you need medical services before then, call Social Security and they will give you proof of Medicare coverage that you can use until you get your new card.
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By phone, call Social Security toll-free at 1-800-772-1213 (TTY: 1-800-325-0778)
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Online, visit Social Security's Replace a Medicare Card.
To get a replacement card, you will need the following information:
- Your name as it appears on your most recent Social Security card
- Your Social Security number
- Your date of birth
- Your mother's maiden name (to help identify you)
- Your phone number (in case Social Security needs to contact you)
- Your last payment amount or the month and year you last received a payment if you have received benefits in the last 12 months.
If I am denied benefits, how do I appeal?
You may appeal any decision about your Medicare benefits. For example, you may appeal if Medicare denies you benefits or if you do not agree with the amount Medicare pays for a claim.
If you are in the Original Medicare Plan, you will get a Medicare Summary Notice (MSN) when Medicare denies you benefits or refuses to pay for your care. The Medicare Summary Notice will tell you how to file an appeal. Be sure to file your appeal by the filing date deadline listed on your notice.
If you have a private Medicare plan (Medicare Advantage), your plan will tell you its procedures for filing an appeal. You have the right to a fast decision (within 72 hours) if your health is at risk. If your plan does not rule in your favor, an agency that works for Medicare (not for your plan) will review your claim.
If you have the Medicare Prescription Drug plan, your drug plan materials will explain how to file an appeal.
You have a good chance of winning an appeal, so always file an appeal if you believe Medicare or your private Medicare plan has made a mistake. Ask your doctor for any information about your condition or bill that might help your case.
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