If you sign up during the General Enrollment Period, your Medicare coverage will begin July 1 of the year you enroll. Your premiums will be higher than they would have been if you had enrolled during your special enrollment period. If your household income exceeds $85,000 for a single person or $170,000 for a married couple, you will pay a higher Medicare Part B premium, regardless of when you enroll in the program.

The cost of your Medicare Part B premium will depend upon how long you waited to enroll in Medicare, and your premium will remain higher as long as you have Medicare Part B coverage. Medicare Part B premiums increase by 10% for each full 12-month period that you could have had Medicare Part B but didn’t take it, except in special cases.

After becoming age-eligible for Medicare, some people continue to work full-time and receive health care benefits through their employers. If this circumstance applies to you, you may choose to delay enrollment in Medicare Part B without a premium penalty under certain conditions. For working Medicare-eligible persons who have health care benefits through an employer, a special enrollment period is created. This special enrollment period enables you to enroll in Medicare without incurring premium penalties:

• Anytime you are still covered by the employer or union group health plan through your or your spouse’s current or active employment, or
• During the 8 months following the month the employer or union group health plan coverage ends, or when the employment ends (whichever is first).

If you do not enroll in Medicare before this special enrollment period expires, you may enroll during the next General Enrollment Period, but you will pay a higher monthly Medicare Part B premium as a result and your Medicare coverage will not become effective until July 1 of the year you enroll.

During the General Enrollment Period, you can sign up for Medicare Part B, or Medicare Part A and Part B at your local Social Security office or online. If you get benefits from the Railroad Retirement Board (RRB), call your local RRB office or 1-877-772-5772.

To enroll in Medicare, you must have met the basic eligibility criteria. You must be age 65 or older, a US citizen or qualified non-resident and you must have worked for at least 10 years in a position where Social Security taxes were collected/paid on your behalf. You also qualify for Social Security benefits if your spouse worked for 10 years and accumulated enough work credits to qualify for Social Security benefits, as long as you meet the other program requirements.

You may apply for Medicare benefits in person at your local Social Security office, or you may apply for benefits online, if you have access to a computer and the Internet. The online application form takes approximately 10 minutes to complete. You will need your date of birth and Social Security number; banking information; income and employment information for the most recent tax year; income estimates for the upcoming year; military service dates; the names and birthdates (or ages) of your current and/or former spouse(s); and your most recent Social Security statement.  The Social Security statement is mailed to you annually in the months preceding your birthday.

The Social Security Administration may also ask you to provide documentation, such as your birth certificate; naturalization papers; military service records, and current/recent income tax returns.  After your application for Medicare benefits is processed and approved, you will receive a Medicare card in the mail. You will give the information on this card to your health care providers when they render health care services on your behalf.

For more information about Medicare enrollment and Medicare Advantage plans in Arizona, please call (480) 706-1702.

• worked for at least 10 years and paid Social Security taxes during that time
• worked in a federal government position that provided Medicare coverage as a benefit
• are 65 years or older
• are a citizen or permanent resident of the United States
• get (or are eligible to get) retirement benefits from Social Security or the Railroad Retirement Board

You are also eligible for Social Security if your spouse earned enough work credits to qualify for Social Security benefits

Before age 65, you might also qualify for Medicare Part A coverage without having to pay premiums if you have:

• End-Stage Renal disease and meet certain requirements
• Received Social Security or Railroad Retirement Board disability benefits for 24 months prior to applying for Medicare

Note: You will be eligible for Medicare when you turn 65 even if you are not eligible for Social Security retirement benefits. For more information, please visit our retirement age FAQ.

If you have questions about your eligibility for Medicare Part A or Part B, or if you want more information about Medicare benefits, Medicare Advantage plans or Medicare Part D plans, please call (480) 706-1702.

• People age 65 or older.
• People under age 65 with certain permanent disabilities.
• People diagnosed with End-Stage Renal Disease.

Part A (Hospital Insurance)

Medicare Part A provides partial hospitalization insurance coverage. Most people do not pay for Medicare Part A premiums, because they (or their spouse) paid sufficient Medicare taxes before they retired. If you are already enrolled in Medicare, your red-white-and-blue Medicare card should say HOSPITAL (PART A) on it.

If you do not qualify for Social Security because you or your spouse did not accumulate enough credits for coverage while you were working, or you are partially disabled but have returned to work, you may still be able to buy Medicare Part A insurance.

Part B (Medical Insurance)

Medicare Part B provides routine care coverage. Most people pay a monthly premium for Medicare Part B services. Beneficiaries can also purchase additional services by paying a higher premium. Enrollment in Medicare Part B is optional.

Medicare Part B pays for doctors’ services, outpatient care, and other medical services that Part A doesn’t cover, such as physical and occupational therapy, and some home health care. Part B helps pay for these covered services and medically necessary supplies.

In 2011, Medicare Part B enrollees will pay a monthly premium of $96.40 or $110.50 for coverage. Some high-income beneficiaries may pay higher Medicare Part B premiums. Beneficiaries who enrolled after their initial special enrollment period may also pay higher lifetime premiums for Part B services. Your monthly premium is normally deducted from your Social Security benefit check.  If you do not receive a benefit check, you will receive a quarterly bill for your premiums.

Medicare Part C (Medicare Advantage)

Medicare Advantage Plans (also known as Medicare Part C) provide HMO-like insurance coverage for both Part A and Part B services. Most MA plans also include Medicare Part D, prescription drug coverage.

When you enroll in a Medicare Advantage plan, you must be eligible to receive Medicare Part A, and you must pay Medicare Part B premiums.  Medicare Advantage plans may also have their own premiums, which you would pay in addition to your Medicare Part B premium.  Some Medicare Advantage plans also offer extended coverage options, and services that may not be covered by Medicare Part A or Medicare Part B, like health and wellness programs or basic dental services.

Medicare Part D (Prescription Drug Coverage)

Medicare Part D is an optional Prescription Drug plan. Most prescription drugs are not covered by Medicare Part A or Medicare Part B.  If you enroll in a Medicare Part D plan, you will pay an additional monthly premium. Most Part D plans pay for drugs based on a formulary that changes each year.  Not all prescription costs are covered with a Medicare Part D plan.  Many prescription plans could produce high out-of-pocket costs if coverage limits are exceeded during the plan year.

For more information about Medicare and Medicare Advantage plans in Arizona, please call (480) 706-1702.

• The applicant must be an Arizona resident.
• The applicant must be a US citizen or qualified non-resident
• The applicant has a valid Social Security number
• Applies for all available income, such as Social Security benefits, a pension or unemployment benefits
• The applicant has a gross income of $903 or less (individual), or a combined gross monthly income of $1,215 or less (applicant and spouse).

Physical Disabilities

Certain physical disabilities and conditions (such as blindness) may also qualify applicants for health care services that are paid jointly by Medicare and Medicaid. To qualify for coverage in this case, the applicant must meet all of the eligibility tests listed above. In addition, the applicant must:

• Receive Social Security disability or is determined blind or disabled by the Disability Determination Services Administration (DDSA)

Low-Income Premium Assistance

Certain individuals may be eligible to have AHCCCS pay their Medicare premiums, copays and deductibles.  Generally, individuals who meet these criteria are eligible to receive a benefit that pays both the Medicare Part A and Part B premiums, if:

• The applicant is an Arizona resident.
• The applicant must be a US citizen or qualified non-resident
• The applicant has a valid Social Security number
• Applies for all available income, such as Social Security benefits, a pension or unemployment benefits
• The applicant qualifies for Medicare Part A
• The applicant has a gross income of $903 or less (individual), or a combined gross monthly income of $1,215 or less (applicant and spouse).

Certain applicants whose monthly gross income is less than $,1219 (individual) or combined monthly income is less than $1,640 (applicant and spouse), may still qualify to have AHCCCS pay their Medicare Part B premiums only.

For more information about Dual Eligibility through AHCCCS, please call (480) 706-1702.

Health care coverage offered by AHCCCS is delivered through a network of pre-approved health care providers. In many ways, AHCCCS is similar to a Health Maintenance Organization (HMO). You can determine your health plan provider based on your ZIP code. You will choose a primary care doctor, who will coordinate all of your health care services, including routine doctor’s visits, diagnostic tests, routine health care, and non-emergent hospital services.  AHCCCS will also provide coverage for emergency health care services and transportation.

Some health care providers that offer services to AHCCCS-eligible persons require co-pays for some services. The co-pay amounts are listed on the AHCCCS Web site, and services that incur copays are identified.

For more information about health care services available to Medicare-eligible persons, please call (480) 706-1702.

The Department of Insurance became involved when one of the physicians whose identity was stolen contacted them to report that patients he had never treated were calling about charges from his office that showed up on their insurance statements. Further investigation led the Department to the fraudulent claimants.

The Obama administration recently awarded $9 million in grants to help more than 50 organizations combat Medicare fraud. Much of the money will be spent on information and education programs designed to teach Medicare recipients how to spot and report potential Medicare fraud. The grants, which fund the Senior Medicare Patrol (SMP) are targeted to assist in areas where Medicare fraud is among the highest. To date, the program has reached more than 3 million Medicare recipients and has produced more than 3,000 reports of Medicare fraud, waste and abuse.

Medicare fraud is a growing problem. The National Health Care Anti-Fraud Association estimates that about 3% of total expenditures on health care are based on fraudulent claims. If the statistic is accurate, that means about $15 billion is wasted each year on fraudulent Medicare claims.

In October, the FBI launched raids that resulted in the arrests of 73 Armenians with ties to organized crime after finding billing for $163 million from nearly 120 non-existent clinics in 25 states. In this particular fraud ring, the organizers used identity information stolen from nearly 3,000 New York Medicare recipients to generate bills for services. About $36 million was paid since the operation began in 2006. Phony invoices for unreasonable tests performed by specialists tipped investigators to the fraudulent scheme.

The outreach program works with other community organizations to deliver prevention and education programs and Spanish-language advertising materials to the state’s Hispanic media organizations. In addition, SCAN Health Plan Arizona will increase its participation in community health fairs, and will host open houses designed to attract Hispanic senior citizens.

Some Medicare patient advocates believe that new federal health reform legislation will result in reduced care for aging Hispanics. Under current regulations, they charge that a study by the Heritage Foundation shows as many as 41% of Arizona’s Hispanic seniors currently enrolled in a Medicare Advantage plan will lose their coverage by 2017. This is in part due to changes in a beneficiary’s ability to enroll in Medicare Advantage plans when all of the health reform provisions are in effect.

Critics charge that beneficiaries who would have chosen Medicare Advantage plans under the old system will be barred from selecting that option under the new reform rules. The majority of persons affected by the change will be low-income and minority beneficiaries, many of whom are Hispanic. The Heritage Foundation report says that nearly 5 million Americans will either lose Medicare coverage altogether or will have their coverage significantly reduced, while their out-of-pocket expenses significantly increase.

SCAN hopes to reverse this and ensure that Medicare covers all Hispanic seniors in Arizona adequately by providing outreach programs in settings that are culturally sensitive, and in ways that eliminate the language barrier. The organization has already participated in one focus group study with Hispanic seniors and health care providers to better understand the concerns of Hispanic seniors and to make sure these concerns are addressed.

SCAN (Senior Care Action Network) is a non-profit organization dedicated to providing affordable, comprehensive health care and health care advocacy for all seniors. The group is also active in the State of California.

Advocates for physician-owned hospitals say that the loss or restriction of Medicare funding for these institutions could reduce the number of Medicare providers or push certain institutions into bankruptcy. In August, The Arizona Heart Institute and Abrazo Health Care announced that they were in talks to be acquired by Vanguard Health Systems as part of a bankruptcy reorganization plan. The Arizona Heart Hospital, which is affiliated with the Arizona Heart Institute, was also in talks with Vanguard.

Part of the concern driving the restriction on physician-owned health care facilities is that these facilities selectively treat patients. More than twice as many relatively healthy patients admitted to physician-owned hospitals undergo surgeries for uncomplicated problems like blocked coronary arteries compared to patients admitted to hospitals with no physician ownership interests. Patients treated at non-physician-owned facilities tend to have more complications that limit or modify surgical options.

Patient advocates complain that physician-owned facilities get better reimbursement from the treatment of uncomplicated disease because they have fewer longer-term care patients, lower nursing costs and more patients with shorter hospital stays. This amounts to unfair competition and sets up a conflict of interest. When physicians own the hospital, they have a larger interest in accepting only those cases that will preserve profits.

About 30 new physician-owned facilities are scheduled to open their doors by December 31, 2010, ahead of the new restrictions. About 45 new physician-owned hospitals are expected to miss the deadline. Healthcare industry analysts say that for these hospitals, failure to get the doors open could be a financial disaster, since hospitals receive about half of their overall revenue from treating Medicare patients.

PHA and the Texas Spine and Joint Hospital are suing the federal government to stop the new rules from taking effect as planned, saying that the reforms unfairly restrict competition for health care providers at a time when significantly more providers will be needed.

Read more about Arizona Medicare Plans.

The current plan offers Medicare Advantage coverage to about 8,000 beneficiaries and has provided Medicare Advantage coverage in Arizona for three years. SCAN Health Plan Arizona says it has agreements in place with most of the leading hospitals and health care providers, and will focus its MA coverage on “affordable and accessible senior health care.” The SCAN Health Plan Arizona Medicare Advantage plan earned 3.5 out of 5 stars on its Medicare Part D (prescription drug coverage) but the Medicare Advantage plan itself does not yet have star ratings. The company’s California-based Medicare Advantage plan earned 3.5 out of 5 stars for its health care coverage and 4 out of 5 stars for its Medicare Part D coverage.

Eligible beneficiaries are those persons who are eligible for Medicare Part A and Medicare Part B, and who live in either Maricopa or Pima County. Updated plan information will be posted on the SCAN Health Plan Arizona Web site prior to the open enrollment period. Premiums for 2011 have not yet been determined, but in 2010, SCAN Health Plan Arizona did offer $0 premium plan options, exclusive of the Medicare Part B premium, which every enrollee pays. In 2010, the Medicare Part B premium was about $100 per month.

SCAN Health Plan is the nation’s fourth largest Medicare Advantage provider and serves about 130,000 enrollees in California and Arizona. To enroll in the program, eligible Medicare beneficiaries must choose the SCAN Health Arizona plan during the open enrollment period, which runs from November 15, 2010 to December 31, 2010. Coverage will begin January 1, 2011.