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With Medicare, the Best Plan Is to Plan


When their 65th birthday looms, many people focus on gold watches, retirement parties, round-the-world cruises and how they'll spend their days with no boss to please.

Now, here's some unsolicited but valuable advice from the government: About three months before the big 6-5, start thinking about Medicare--while there's still Medicare.

Planning can prevent unpleasant and potentially expensive gaps in health insurance coverage, say government officials.

Who Calls Whom

You can expect to be contacted by the Social Security Administration if you already receive Social Security retirement or disability benefits or railroad retirement benefits. You will be provided the necessary information to sign up for Medicare.

If you are disabled, the automatic notification occurs after you have received Social Security or railroad retirement disability benefits for 24 months.

You should contact the Social Security Administration if you are not getting any of the benefits mentioned above.

You can call the Social Security Administration, (800) 772-1213, and ask operators to set up a phone appointment with your local SSA office. Or, you can visit your local SSA office and take care of the paperwork in person.

Even if you don't plan to retire at 65, it's still advisable to contact Social Security because you can still sign up for Medicare. It may cover costs not covered by the employer health plan.

Decisions, Decisions

Medicare Part A--also called hospital insurance--covers care in a hospital or skilled nursing facility, home health care and hospice care. Part B--also called medical insurance--covers outpatient hospital care, doctor bills and various other medical services not covered under Part A.

Depending on employment history and income, you may or may not pay for Part A premiums, which this year range from $187 to $311 a month. Part B, the voluntary coverage, costs $43.80 per month this year. The seven-month initial enrollment period for Part B (and, for those who pay their own premiums, also for Part A) begins three months before you turn 65.

If you don't enroll during the seven-month period, you must wait to enroll during the next general enrollment period, usually Jan. 1 to March 31 each year, and pay a higher premium, with coverage effective in July of the same year. But in certain cases, you can put off Part B enrollment without paying more.

It is also possible to have Part B without Part A, says a representative for the federal Health Care Financing Administration, which oversees the 30-year-old Medicare program. (The Social Security Administration enrolls consumers in Medicare and collects premiums.)

Your Membership Card, Please

Once enrolled, you are issued a Medicare card imprinted with your name, Medicare claim number, coverage, and the date the coverage went into effect. You show the card whenever you obtain medical services. About 38 million Americans receive Medicare benefits.

The Process

To administer Medicare, the Health Care Financing Administration forms partnerships with health care providers (hospitals, managed care plans, nursing homes, home health care agencies, laboratories, doctors, medical equipment suppliers). Commercial insurance companies are under contract with the HCFA to process and pay Medicare claims. Groups of doctors and other health care providers have contracts to monitor the care delivered under Medicare.

For More Information

* Medicare Hotline, (800) 638-6833, is operated from 5 a.m. to 5 p.m. weekdays by the HCFA. During off-hours, voice prompts help callers order the Medicare Handbook and listen to taped health information.

* Web sites: and

* This column looks at the concerns of older Americans. Reader suggestions are welcome. Send to The Second Half, Health, Los Angeles Times, Times Mirror Square, Los Angeles, CA 90053.

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