Medicare

Medicare is a federal health insurance program operated by the Social Security Administration for persons 65 years of age and over or who are disabled. These are the most common parts used. For questions and advice on selecting a plan, call a SHIP counselor. See below for telephone numbers.

Hospital Insurance (Part A) helps pay for care in hospitals with certain follow-up care. Medicare pays benefits directly to the provider. You will get a Medicare benefits notice, which gives the office to contact if you have questions.

Medical Insurance (Part B) pays a portion of doctor bills, certain outpatient services, other medical items, and services not covered under Part A. This is optional, with monthly premiums.

Prescription drug benefit (Part D) pays for prescription drugs. Optional, with monthly premiums, copays, deductibles and restrictions depending on plan selected.

Medicare Advantage plans have lower premiums but manage your care through a network of participating providers, similar to an HMO or PPO.

Statewide toll free number (Social Security & Medicare information)

• 800 772-1213
• Web site: www.medicare.gov
• Web site www.mymedicare.gov – personal account to view your own plan details.
• For a list of Medicare participating physicians, call Medicare at 800-633-4227 or go to http://medicare.gov/find-a-doctor/provider-search.aspx.

MEDICARE SUPPLEMENTAL INSURANCE

Pays costs not covered by Medicare, such as co-pays and co-insurance. For a listing of the individual supplemental policies available for sale, contact:

NJ Dept of Health & Senior Services
Division of Senior Affairs
P O Box 807
Trenton, NJ 08625-0807
800 792-8820

MEDICARE SAVINGS PROGRAMS

These programs help people who do not qualify for Medicaid pay for some of the costs of Medicare. Income and asset levels vary. Income limits (2010) were $14,621 single and $19,670 couple. Asset limits are generally $6600 single and $9910 married. Application: Mercer County Board of Social Services for an appointment to complete an application.

• Mercer County Board of Social Services
• 200 Woolverton St
• P.O. Box 1450
• Trenton, New Jersey 08650-2099
• (609) 989-4664 or 800-564-1595 
• Web site: www.mcboss.org/

QI - 1

Pays for Medicare's Part B premium

QUALIFIED MEDICARE BENEFICIARY (QMB)

Anyone 65 and older or disabled who receives Medicare A and/or Medicare B and whose income and resources are at or below the federal poverty guidelines. Coverage includes portions of Medicare Part B premiums and deductables, assistance with substantial co-payments for doctor bills, outpatient care, hospital stays over 60 days and skilled nursing home care over 21 days.

SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)

SLMB is a program providing payments of Medicare Part B premiums and deductibles for persons not eligible for New Jersey Care because their income is too high. Application made through PAAD (New Jersey's Pharmaceutical Assistance program).

MEDICARE RIGHTS CENTER

The Medicare Rights Center is a national nonprofit that works to ensure access to affordable health care for older adults and people with disabilities through counseling, educational programs and public policy initiatives.

Web site: http://www.medicarerights.org/

STATE HEALTH INSURANCE ASSISTANCE PROGRAM (SHIP)

A statewide program administered by the New Jersey Dept. of Health and Senior Services, Division of Senior Affairs, with major funding from the U.S. Dept. of Human Services, Health Care Financing Administration. SHIP provides trained volunteers to assist Medicare enrollees at no cost in filing claims with Medicare, Medigap, Medicare Advantage, Prescription Plans and long-term care options.

• 800 792-8820
• Mercer County, call Family Guidance Center: (609) 924-2098 for an appointment
• Somerset County: Call RSVP: (908) 704-6319
• Monmouth County: Call RSVP: (732) 531-5511

PRO (PEER REVIEW ORGANIZATION)

• Medicare patient's rights. Investigates and mediates discharges from hospital for Medicare patients—if you feel you were discharged prematurely.
• 557 Cranbury Rd, Ste 21, East Brunswick, NJ 08816
• (732) 238-5570 or 800-624-4557

The Princeton Senior Resource Center does not endorse any of the resources listed on these pages. We collect and provide information from many sources as a service to those seeking services in the Princeton area. No listed provider pays to be in our directory.